Specialist Physiotherapist PREP : Taking innovative rehabilitation into the community for people with a life limiting illness Nicola MacKinnon Specialist Physiotherapist June 2019 Nicola.mackinnon@willen-hospice.org.uk

PREP : The start of an exciting opportunity

Proactively engage patients in interventions to improve and maintain their physical activity Partnership with the community to provide patients with activities that are accessible and familiar, promoting community engagement Promote a wider understanding of rehabilitation within the hospice setting and reduce barriers to accessing services PREP : 3 Key Drivers

PREP : The Vision The aims of the service are to empower palliative patients to maximise their physical activity in order to promote an active lifestyle and develop resilience in managing the impact of their conditions

PREP : Paced Rehabilitation and Enablement Programme

PREP : Engagement Delivery Sustainability Patients Organization (Finance, HR, clinical teams) Setting Clinical Team Funding Delivery Hospice Senior Management Team Commissioners Referrers Partnerships (Local Council, Hospital) Sustainability

PREP : Delivery and Development Phase One Initial Assessment with Physiotherapist Mondays at 2pm, 2 hours per week for 8 weeks at Leisure Centre One to one sessions with Occupational Therapist at Week 2 or 3 First Hour Exercise – Led by Level 4 Gym Instructor or off site gym Second Hour – Formal Education and discussion Opportunity to use café afterwards Ongoing review and final review week 8 Phase Two Moved from the Leisure Centre to the Hospice Reduced times from 2 hours to 1.5 hours per week Reduced from 8 weeks to 6 weeks Exercise session Led by Physiotherapist or Rehab Nurse

PREP : Challenges “As rehabilitation in Palliative Care is advocated and the evidence base for it’s provision is growing, inappropriate beliefs about referrals need to be explored and challenged” Nelson, Hasson and Kernohan (2012)

Volunteer Rehabilitation Assistant PREP : Successes Clinically: Average increase in performance status of 10% within AKPS, all achieved their goals & all patients were maintaining their physical activity based on personal aspirations at 3 and 6 months. Therapeutically: Transition between health and non-health in promoting long term activity and resilience is key to the clinical successes ; the setting, the staff and the contents. Organisationally: PREP has enabled Willen Hospice to establish and promote a rehabilitation ethos focusing on the benefits of therapy-led intervention. PREP was specifically commended in our CHKS Accreditation Inspection. Locally: Very supportive collaboration of local services including local council. Involved with council in promoting activity across the city and walking groups. Anna Volunteer Rehabilitation Assistant

PREP: A Real Privilege Rehabilitation in Palliative Care is “Never Easy, often challenging but always rewarding” Doyle (1997)

References Tiberini R and Richardson H (2015). Rehabilitative Palliative Care: enabling people to live fully until they die – A challenge for the 21st century. Hospice UK. Nelson LA, Hasson F, Kernohan WG (2012). Exploring district nurses’ reluctance to refer palliative care patients for physiotherapy. International Journal of Palliative Nursing Vol 18, No 4 p163-170