Objective: The use of the prone position to treat patients with COVID-19 pneumonia who are critically ill and mechanically ventilated is well documented. This case series reports the location, severity, and prevalence of focal peripheral nerve injuries involving the upper limb identified in an acute COVID-19 rehabilitation setting. The purpose of this study was to report observations and to explore the challenges in assessing these patients. Methods: Participants were patients with suspected peripheral nerve injuries following discharge from COVID-19 critical care who were referred to the peripheral nerve injury multidisciplinary team. Data were collected retrospectively on what peripheral neuropathies were observed, with reference to relevant investigation findings and proning history. Results: During the first wave of the COVID-19 pandemic in the United Kingdom, 256 patients were admitted to COVID-19 critical care of Queen Elizabeth Hospital, Birmingham, United Kingdom. From March to June 2020, a total of 114 patients required prone ventilation. In this subgroup, a total of 15 patients were identified with clinical findings of peripheral nerve injuries within the upper limb. In total, 30 anatomical nerve injuries were recorded. The most commonly affected nerve was the ulnar nerve (12/30) followed by the cords of the brachial plexus (10/30). Neuropathic pain and muscle wasting were identified, signifying a high-grade nerve injury. Conclusion: Peripheral nerve injuries can be associated with prone positioning on intensive care units, although other mechanisms, such as those of a neuroinflammatory nature, cannot be excluded. Impact: Proning-related upper limb peripheral nerve injuries are not discussed widely in the literature and could be an area of further consideration when critical care units review their proning protocols. Physical therapists treating these patients play a key part in the management of this group of patients by optimizing the positioning of patients during proning, making early identification of peripheral nerve injuries, providing rehabilitation interventions, and referring to specialist services if necessary. Lay summary: During the COVID-19 pandemic, patients who are very ill can be placed for long periods of time on their stomach to improve their chances of survival. The potential consequences of prolonged time in this position are weakness and pain in the arms due to potential nerve damage. There are some recommended treatments to take care of these problems.

Purpose: Vertebral fragility fractures (VFFs) are the most common type of osteoporotic fracture and a powerful predictor of further future vertebral and/or hip fracture without treatment. These fractures cause significant morbidity and risk of mortality. Therefore, identification of a recent VFF is an indication to consider specialist osteoporosis anabolic drug treatment. However, recognition of the signs and symptoms of VFF remains a challenge, with up to 70% going undiagnosed. The evolving role of First Contact Physiotherapists (FCPs) in primary care presents an opportunity for physiotherapists to help reduce the Osteoporosis Care Gap, but little is known about their scope of practice for osteoporosis. Methods: A case report was written to demonstrate an example of the scope of practice of an Advanced Level FCP. A lady in her 70s presented to her GP surgery with lower back pain following a fall from a chair. Her medical history included hypothyroidism and hypercholesterolaemia. She had six consultations with various clinicians at the surgery and was prescribed analgesia, before being assessed by the FCP three months after onset. Despite having no tenderness to percussion over the thoracic or lumbar spinous processes, a diagnosis of VFF was suspected because of ongoing pain following low energy trauma, pain when sitting and lying supine, and an increased thoracic kyphosis. Results: The FCP referred the patient for urgent thoracic and lumbar x-rays, which confirmed VFF of T10 and L1. The patient was initially prescribed alendronic acid, calcium, and vitamin D. Blood tests were ordered to exclude secondary causes of osteoporosis. An urgent bone density scan was requested, alongside a referral to rheumatology for consideration of more potent anabolic drug treatment due to the high risk of future fracture. The patient was also referred to the falls service for exercise advice and home equipment. The patient was prescribed specialist osteoporosis drug treatment (romosozumab) under the care of rheumatology. One year later, she was not needing analgesia, and she had not had any further falls or fractures. Conclusion(s): This case report highlights the difficulty in diagnosing VFF, with several missed opportunities to refer for x-ray initially. A delayed diagnosis of VFF can result in suboptimal symptom management and subsequent increased healthcare utilisation, as well as missed opportunities to enact prompt secondary prevention and particularly specialist treatment, to reduce the risk of further fragility fractures. The FCP in this case report demonstrated advanced clinical reasoning, as well competency in radiology and bloods requesting and interpretation, non-medical independent prescribing, and timely appropriate onward referral. This highlights the valuable role FCPs can have in improving osteoporosis care. Impact: It is recognised that this case report cannot be used to demonstrate scope of practice and competency of all FCPs nationally. FCPs are required to complete a Roadmap to Practice demonstrating advanced level musculoskeletal knowledge and critical thinking, but there are no osteoporosis-specific competencies. Further research to ascertain osteoporosis knowledge and scope of practice amongst FCPs across the United Kingdom would be beneficial to highlight any training needs and establish best practice. 1st Keyword: “First Contact Physiotherapist” 2nd Keyword: “Vertebral fragility fracture” 3rd Keyword: Osteoporosis Ethics approval: The HRA decision-making tool was used, which confirmed that no ethical approval was required. Funding acknowledgements: This work was completed as part of the Birmingham Health Partners West Midlands Pre-Doctoral Bridging Programme but received no direct funding.

Background: Knowledge of patient lived experiences of functioning and disability is limited. This study aims to address the gap in the literature by exploring patient lived experiences of functioning and disability following lumbar discectomy. Method: A secondary analysis, reported in line with the Standards for Reporting Qualitative Research, was conducted of qualitative data exploring patient journeys following lumbar discectomy surgery (DiscJourn). Adult patients (≥ 16 years) undergoing elective or emergency primary lumbar discectomy were recruited from one National Health Service secondary care centre in the UK. Semi-structured interviews were conducted at 1-3 weeks and 1-year post surgery. Participants who completed both semi-structured interviews were eligible for the secondary analysis. Transcripts from the semi-structured interviews were analysed using interpretative phenomenological analysis (IPA). IPA involved two independent reviewers identifying themes for individual data sets followed by an iterative process involving the wider research team to identify overarching themes that represented the whole date set. Subthemes generated from the IPA were mapped against the International Classification of Functioning, Disability and Health (ICF) framework at the level of chapters, in order to ascertain the ICF's utility in capturing experiences of functioning and disability. Strategies to enhance trustworthiness of data analysis included blind coding, peer examination and debrief, declaration of pre-conceived beliefs and active reflexivity throughout the study. Results: Nine participants met the eligibility criteria and their interview transcripts were analysed. Patient lived experiences of functioning and disability were captured by three overarching themes: Immediate impact following surgery, Multiple roads to recovery over 1 year, and Functioning influenced by personal loci of control. Each theme consisted of three subthemes which were subsequently mapped onto the ICF. Three subthemes mapped to the ICF's body component, 1 to activity and participation and 3 to environment. Two subthemes themes did not map onto the ICF. Conclusion: Findings provide valuable insights into patient experiences of functioning and disability following lumbar discectomy. Convergence in experiences of functioning and disability were identified immediately following surgery. Divergence in such experiences were identified with regards to the roads to recovery over 1 year and the individuals' locus of control. Findings build on the body of literature exploring patients functioning and disability following discectomy and make recommendations for future research and clinical practice.

Objective: To evaluate the feasibility of implementing a self-management intervention to improve mobility in the community for stroke survivors. Methods: A two-phase sequential mixed methods design was used (a pilot randomised controlled trial and focus groups). Participants were adult stroke survivors within six months post discharge from hospital with functional and cognitive capacity for self-management. The intervention included education sessions, goal setting and action planning, group sessions, self-monitoring and follow up. The control group received usual care and both groups enrolled for 3 months in the study. Feasibility outcomes (recruitment and retention rates, randomisation and blinding, adherence to the intervention, collection of outcome measures, and the fidelity and acceptability of the intervention). Participants assessed at baseline, 3 months and 6 months for functional mobility and walking, self-efficacy, goal attainment, cognitive ability, and general health. A descriptive analysis was done for quantitative data and content analysis for the qualitative data. Findings of quantitative and qualitative data were integrated to present the final results of the study. Results: Twenty-four participants were recruited and randomised into two groups (12 each). It was feasible to recruit from hospital and community and to deliver the intervention remotely. Randomisation and blinding were successful. Participants were retained (83%) at 3 months and (79.2%) at 6 months assessments. Adherence to the intervention varied due to multiple factors. Focus groups discussed participants' motivations for joining the programme, their perspectives on the intervention (fidelity and acceptability) and methodology, perceived improvements in mobility, facilitators and challenges for self-management, and suggestions for improvement. Conclusion: The self-management intervention seems feasible for implementation for stroke survivors in the community. Participants appreciated the support provided and perceived improvement in their mobility. The study was not powered enough to draw a conclusion about the efficacy of the program and a future full-scale study is warranted.

No abstract available

Every year there are 1.3 million hip fractures globally; this is expected to rise to 6 million by 2050. Estimates of global cost is 1.75 million disability adjusted life years, and in established market economies, costs associated with hip fracture represent 1.4% of the total healthcare burden. New models of care will be required to meet this demand. Advance physiotherapy roles in elective arthroplasty across global settings have demonstrated benefit in safely reducing time burden on surgical teams and healthcare costs. The utility of similar roles in the care of hip fracture is unclear. This quality initiative (2020-2023) aimed to implement and evaluate a new model of care substituting a surgical registrar with an advanced physiotherapist in a post-discharge hip fracture clinic. Across many nonlinear, action/reflection cycles, a multi-disciplinary team engaged to operationalize key implementation strategies, mapped to the Expert Recommendations for Implementing Change (ERIC) project. Across the reporting period, 346 patients were seen by an advanced physiotherapist. Eighty-one patients seen by an advanced physiotherapist required informal discussion with the consultant surgeon. Fifteen patients required a formal consultant review. There were no patient complaints, critical incidents or other unintended consequences. The net surgical time realized over the three years was 110 hours.