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Case Study Presentation Physiotherapy Association

This database is a resource that can inform, inspire and influence, and which demonstrates the value of physiotherapy:

Submit your own case study

Quality assured case studies of successful physiotherapy initiatives are very important.  They demonstrate our expertise and our ability to innovate, adapt and deliver for patients. This is crucial in shaping and securing our future success. 

Sharing examples of our work enables us to not only show what we can do, but helps us learn from one another's experience. For the CSP, these case studies are also invaluable for our efforts to influence policy and promote the profession.

We aim, with your help, to build a valuable resource for members and the Society, that demonstrates the value of Physiotherapy. We're looking for contributions to our database. Submitting your initiative raises the profile of your work, providing you with the opportunity to share and promote your successes with other physiotherapists across the UK.

Case Studies of individual patients

If you are interested in case studies on individual patients, episode of practice or intervention visit the Big Physio Survey.

The Big Physio Survey seeks to capture contemporary physiotherapy practice in the UK and globally, through online case studies on individual practice which are open to all: clinicians, students, managers, educators and researchers. Find out more: www.bigphysiosurvey.com

Adding a case study

You can send your case studies to us online. They will then go through a quality assurance process. As part of this process, we will contact you to clarify points or to get more information if needed.

Our aim is for all published case studies to be of a similar standard, and meet a set of minimum criteria. This is essential, if they are to be a valuable resource to the wider profession.

How we can support you

While submitting a case study is not a quick task, it is a supported process.  We're here to help you showcase your work and what you have achieved in the best possible light. You can contact us on 0207 314 7852 or casestudies@csp.org.uk if you’d like to discuss or have questions about case studies. 

We also have a five minute option to ‘Get a steer’, where you can submit a simple online form with an outline of your project.  We will then come back to you to advise you whether or not to proceed with a full submission. To submit your case study or ‘Get a steer’ visit the Physiotherapy Case Studies website.

Introduction

Physiotherapy should ‘promote, maintain and restore physical, psychological and social well-being’ (Chartered Society of Physiotherapy 2002a).

‘Mental health problems affect one in four of us at some time in our lives. They can also be the result of drug or alcohol dependency, illness or long-term physical disability’ (Chartered Society of Physiotherapy 2005).

From these descriptors given by our professional body, The Chartered Society of Physiotherapy (CSP), it is clear that the influence over wellbeing of both psychological and physical health is recognised. However, the history of physiotherapy within mental health is a recent one compared to the work done in physical specialties. Still many people both outside and within the profession wonder what physiotherapists' role in mental health might involve.

Physiotherapists working in mental health may be working as part of a Community Mental Health Team (CMHT) or as a member of a larger physiotherapy team. Some will be employed directly by a mental healthcare trust and some by a Primary Care Trust (PCT) or may work in the private or charity setting.

Provision of, and access to, a specialist, physiotherapy, mental health service varies dramatically dependent upon geographical location. Some services focus on older adults while others have input into all age groups. ‘Care-group’-specific services may occur for eating disorders, personality disorder, primary care anxiety disorders or addictive behaviours. There are specific facilities for forensic mental health, which deal with people who are detained in a special hospital or secure unit following a court judgement that their offence was wholly or partially due to their mental ill health.

Patients/clients may be in hospital voluntarily or may have been admitted under a section of the Mental Health Act in order to safeguard themselves or others. The majority of people with a mental health diagnosis, e.g. bipolar disease, depression, anxiety are treated by their GPs. If more specialised treatment is required then the CMHT may be involved. Initiatives to enable people to stay in the community include: Intensive Home Support Teams; Crisis Intervention Teams and Assertive Outreach Teams whose remit is to engage those clients whom have long-term enduring mental illness and may have difficulty maintaining concordance with treatment.

Clinical specialist physiotherapists in mental health have developed roles in orthopaedic and rheumatology clinics and may act as liaison specialists for physical health services in both primary and secondary care settings.

Wherever the physiotherapist works effective input occurs when the wider team together with the client and carers are involved, as stated in ‘New Ways of Working for Psychiatrists, Enhancing Person Centred Care by…True Multidisciplinary Working’ (DoH 2005).

Skills transfer between other specialties and mental health can range from musculoskeletal to continence, from neurological to respiratory but specific skills of anxiety management, massage, communication in challenging situations may best be learnt in the mental health environment. Our work correlates with the government drivers of the wellbeing agenda which include the National Service Framework (NSF) for Mental Health (DoH 1999) and the NSF for Older Adults (DoH 2001) along with Our Health, Our Care, Our Say (DoH 2006).

Evidence for physical interventions and effects are most prolific in terms of the positive outcomes of exercise in depression and anxiety. Other studies which have, by nature of their size, given evidence but have acknowledged flaws include studies of massage, acupuncture and falls prevention with general mobility for older adults.

Examples include:

Exercise for people with dementia improves cognitive functioning (Fox 2000, Laurin et al 2001)

Exercise reduces falls risk (Skelton 1999) and in depression (Liu et al 1998)

Regular activity reduces incidence of depression (Mutrie 2000)

Exercise may alleviate secondary symptoms of schizophrenia (Faulkner & Biddle 2002)

Exercise has a positive effect on self esteem (Fox 2000)

Exercise is an effective treatment for depression (Lawler & Hopker 2001)

Exercise has a low-to-moderate anxiety reducing effect (Taylor 2000)

Exercise brings benefits to problem drinkers (Donaghy & Mutrie 1999).

The outcomes of a student placement or junior post should be to develop a clear knowledge of three key facts: (i) the interaction of physical and mental health, (ii) the effects of our core skills on mental disorder and (iii) the need to provide equitable access and quality of physical care to clients who also have a mental health diagnosis. Alongside those gems of knowledge an inspired physiotherapist who wants to use skills learnt to help bridge the gap, which still exists, between physical and psychological health provision would be deemed a great and successful outcome.

The following case studies give a glimpse of the variety of client group, clinical settings, and skills required and the professional opportunity offered in physiotherapy in mental health. They include cases from primary, secondary and tertiary care and range from somatisation to anorexia.