Amputee Rehabilitation - A Rural Perspective Dianne Whitten Senior Physiotherapist Upper Hunter Community Health

The Stakeholders Surgeon/ General Practitioners Surgeon/ General Practitioners Nursing Staff Nursing Staff Physiotherapy Team Physiotherapy Team The Patient The Patient

Surgeon/ General Practitioners Obstacles encountered: Conservative approach to patient management, wound care, rehab, etc Conservative approach to patient management, wound care, rehab, etc Resistance to new techniques Resistance to new techniques Lack of awareness of current best practice Lack of awareness of current best practice Remedy this by establishing liaising regularly to achieve a good rapport -> able to educate in CBP

Nursing Staff Hospital Nurses – Acute care orientated, not rehab focussed– unintentionally tend to disable rather than enable patient because of general caseload, Acute care orientated, not rehab focussed– unintentionally tend to disable rather than enable patient because of general caseload, Limited number of staff rostered on each shift – increased demand on staff in times of emergencies Limited number of staff rostered on each shift – increased demand on staff in times of emergencies Community Nurses – experts in wound Mx

Physiotherapy Team Recruitment and retention issues – fluctuating staffing levels –> outreach services compromised first Recruitment and retention issues – fluctuating staffing levels –> outreach services compromised first Diversity of caseload Diversity of caseload Lack of experience in treating amputees Lack of experience in treating amputees Distance from PD opportunities, clinical support Distance from PD opportunities, clinical support Budget issues –unable to keep a ready supply of stump socks, shrinkers, etc.? Which is the best source of supply Budget issues –unable to keep a ready supply of stump socks, shrinkers, etc.? Which is the best source of supply

The Rural Patient Stoicism of patient Stoicism of patient - will often tolerate condition for longer period before seeking help - have to keep working at all costs as there may be no one else to do the work - distance from doctor and other health services can be a deterrent to seeking advice, help - distance from doctor and other health services can be a deterrent to seeking advice, help - lack of knowledge of available services

The Rural Patient Transport inaccessibility: especially impacts on elderly patient Transport inaccessibility: especially impacts on elderly patient - long distances to/from services - no public transport in smaller towns -elderly may have to depend on family, friends for transport – even more difficult if living out of town - access to NEMT, Neighbour Aid, and other volunteer services, Aged Day Care bus

The Patient Compliance upon discharge from hospital/rehab – assuming responsibility for self care Compliance upon discharge from hospital/rehab – assuming responsibility for self care If elderly, the impact on spouse or other household members If elderly, the impact on spouse or other household members Attitude towards making lifestyle changes Attitude towards making lifestyle changes Ability to follow HEP instructions Ability to follow HEP instructions

Strategies to enhance treatment effectiveness Establish a NETWORK of support with physios at rehab centres Establish a NETWORK of support with physios at rehab centres Frequently liaise with other members of the multidisciplinary team Frequently liaise with other members of the multidisciplinary team Increase awareness of resources – internet, CIAP, journals,videoconferencing (eg. APA telehealth service for rural and remote PTs)NSW PAR meetings Increase awareness of resources – internet, CIAP, journals,videoconferencing (eg. APA telehealth service for rural and remote PTs)NSW PAR meetings join professional groups join professional groups

Strategies –cont. Familiarise yourself with the patient’s requirements eg. job, home situation Familiarise yourself with the patient’s requirements eg. job, home situation Home visits Home visits – especially if transport access is a problem, _ enables you to be aware of home safety issues - enables you to educate patient to use resources available within the home - benefits of doing h/v with OT

Education Strategies These serve to improve patient’s compliance These serve to improve patient’s compliance - be aware of information overload and use of medical jargon when giving HEP - use illustrations, as well as written instructions - discuss Tx plan, set goals and give patient responsibility for carrying out plan - explain relevance of each exercise and exactly how you want this performed

HEP Strategies (cont) - prioritise exercises so that patient can vary exercises to avoid boredom, and can progress HEP as need arises ensure that patient can execute exercises correctly and is aware of trick movts that can render HEP ineffective instruct patient about what he should/should not feel, any adverse reactions - KISS, SMART goals, exercise diary - educate carer, support person where possible