Practical considerations in running a clinical service
Authors: Swain, I., Taylor, P., Singleton, C., Bersch-Porada, I. and Brown, L.
Pages: 311-345
DOI: 10.1049/PBHE062E_ch11
Abstract:The aim of this chapter is to highlight the issues that need to be considered and the facilities that need to be put in place to run a clinical electrical stimulation (ES) service. It is not a definitive, prescriptive list, as it will vary depending upon the country's healthcare system, funding mechanisms, resources available and the patient groups being treated. Rather, it provides guidelines and suggestions and poses a series of questions that need to be addressed to set up a clinical service and ensure its continued success. A checklist of the various factors that need to be considered is provided in Appendix A. The chapter is based on the authors' experience of establishing clinical services and we seek to show what we learnt and the approaches we used in the research setting, and how we applied research to service provision. Currently, there is an increasing interest in using ES and functional electrical stimulation (FES) (where the stimulation is applied to facilitate function) in particular, to address the perceived deficit in rehabilitation, as, particularly in the UK, the clinical workforce struggles to implement the recommendations for more rehabilitation post stroke [1,2]. While the new guidelines are specific to adult stroke rehabilitation, it is clear that the principles are equally applicable to the rehabilitation of people with other neurological and musculoskeletal conditions. There is increasing recognition that ES can play an important role in allowing the therapy team to do more with its resources, enabling their patients to achieve better outcomes, greater independence and quality of life. While the wider use of ES and FES is to be welcomed, the need to maintain high standards of clinical practice is a concern. To address this, ACPIN (Association of Charted Physiotherapists In Neurology) in the UK has published a set of Clinical Practice Guidelines (CPG) that make recommendations for each stage of the patients journey and how the clinical service should operate [3]. CPGs for the use of AFO and FES post stroke were also developed and endorsed by the American Physical Therapy Association (APTA) and the Academy of Neurologic Physical Therapy (ANPT) to further support clinical decision making and the evidenced-based application of FES across outcomes spanning participation, activity and body structure and function [4].
Source: Scopus