I am a physiotherapist working with patients with complex neuro-disability, many of whom require provision of specialist equipment as a part of muscle tone and 24-hour postural management. As such, I work closely with a variety of wheelchair services to provide seating systems.
This was my first PMG conference and I found it to be a very valuable, educational event, which provided an excellent occasion for networking with others in the field. The conference is an opportunity for researchers and clinicians to share their experience and the most recent developments in the field of postural management and mobility. At the same time, displays of innovative technological advancements of mobility and postural aids, as well as new trends and designs, provided opportunities to explore the latest developments, and enabled brainstorming to generate ideas and solutions for a range of problems.
I would like to highlight some of the seminars which appealed to me since I see myself incorporating this information in my practice.
The presentation by NHS England’s Steven Pruner, Personalising wheelchair services, your chance to influence the process, showcased funding possibilities to meet individual needs. He discussed various options in the decision-making process for patients presenting with clinical needs, but not meeting the equipment provision criteria. As stated by Steven, based on a national survey, 70% of patients who were able to contribute towards the decision-making process reported an improvement in their independence, which had a significant impact on their quality of life. But, is it realistic?
On the other hand, Sue Nowak, also from NHS England, showed figures and estimated changes related to funding for NHS wheelchairs (NHS England, 2016). The debate provided the opportunity to share examples of difficulties and problem solving possibilities. Since I work in the private sector, it was all very intriguing to me from the perspective of involving patients and incorporating realistic measures in relation to costs. These sessions were both inspiring and reflective.
One other presentation entitled Making a difference delivered by Ray Hodgkinson, Director of Public Affairs, British Healthcare Trades Association (BHTA), put further emphasis on patient participation in the decision-making process as the way forward for equipment provision. Given that patients judge changes or improvements individually (National Health Service England, 2016), it is important to implement adequate outcomes to provide evidence for cost effective healthcare and efficient interventions.
The presentation entitled A quantitative positional outcome measure for seated posture interventions by Susan Hillman demonstrated the technique of measuring and comparing patients’ presented posture from an engineering perspective, which allowed for provision of an optimal seating system. However, further outcome measures are required to identify patients’ participation and functional effectiveness of tools associated with postural support (Rice, Wong, Salentine, & Rice, 2013). Taken together, this will be beneficial in meeting patients’ expectations. Photograph above of Susan Hillman presenting on Outcome Measures at PMG Conference 2016. Photo courtesy of Suzie Hunt.
Professor Derick Wade’s presentation entitled What outcome data should I collect? highlighted the importance of finding sensible and answerable questions, particularly to measure the result of complex interventions which go a long way in the monitoring of successful therapeutic implementation. It was helpful to explore the questions “what and how?” to measure. This led me to reflect on assessment and evaluation of several outcomes used in my current practice.
Following my attendance at this conference, I have been considering the wider use of evaluation tools to measure effectiveness of assistive technology and postural management, such as the Wheelchair Seating Discomfort Assessment Tool (WcS-DAT) and Individually Prioritised Problem Assessment (IPPA). This has, as a short-term evaluation, provided benefits for patients and other colleagues as it led to an in-depth analysis of our existing strategies, and prompted the implementation of new ones.
Exploring the exhibition and seeing the variety of wheelchairs and their accessories increased my awareness of the current trends in the field. I familiarised myself with different types of options to address specific issues, such as considering increased pressure points. Many of the accessories related to pressure care products could be used in my practice to maintain patient sitting tolerance, particularly while awaiting wheelchair reviews. I believe that a significant percentage of my patients could benefit from using gel padding and other pressure care products, the benefits of which I became convinced of at the conference.
I gained a phenomenal amount of knowledge regarding the wide range of headrests and wheelchair adaptations on the market today. This has improved my ability to propose more patient-specific and cost-effective alternatives. My patients will definitely benefit from ongoing assessments and my implementation of suggestions taken on board at the conference. This will allow further improvements such as using dynamic wheelchairs for patients with extensor spasticity.
My attendance at the conference has had a significant impact on my practice, as I am able to use the knowledge acquired to make better patient-centred, as well as cost-effective, decisions during implementation of postural equipment. The seminars have widened my perspective and inspired me to pursue further learning.
I found this to be a remarkable and memorable experience, one of which I will continue to use to aid my personal development in the future. In addition, the conference enabled me to think differently about how I could further incorporate the knowledge on recent developments in posture and mobility, as well as advancements in equipment, to support my patients.
Making cost effective decisions whilst retaining the patient-centred focus of intervention was the key take home message from the conference for implementation in my practice.
Developing a Wheelchair Tariff Pilot Programme July 2016. (2016), (July), 1–46.
Doyle, C., Lennox, L., & Bell, D. (2013). A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. http://doi.org/10.1136/bmjopen-2012-001570
National Health Service England. (2016). Commissioning Guidance for Rehabiliation, (4919).
Rice, I. M., Wong, A. W. K., Salentine, B. a, & Rice, L. a. (2013). Differences in participation based on self-esteem in power and manual wheelchair users on a university campus: a pilot study. Disability and Rehabilitation: Assistive Technology. http://doi.org/10.3109/17483107.2013.840864