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Physiotherapy is Worth the Investment

 
Physiotherapy can make the difference – that is the Society's loud and clear message for policy makers in Ireland but to achieve this there needs to be significant investment in the physiotherapy workforce and the creation of more physiotherapy posts. 
 
Below are some of the examples demonstrating how physiotherapy is worth this investment.
Irish Examples of the Payback to the State from Investing in Physiotherapists:
There are a multitude of Irish examples of how physiotherapists are creating change and improving patient experiences and outcomes across the Irish Health Service these include:
  • Physiotherapists are key members of the team involved in an Early Supported Discharge service for stroke survivors in Tallaght Hospital.  This model of rehabilitative care reduced average length of hospital stay by 10 days, which if adapted nationally could improve recovery for 54% of stroke survivors and save State up to €7million annually (ESRI and the Irish Heart Foundation Report 2014).
  • A physiotherapy-led pulmonary outreach programme in Beaumont Hospital generates estimated cost savings of over €750,000 per year.  If that model was adapted in the 50 acute hospitals in Ireland the health service could save €38 million.
  • Twenty four physiotherapists developed musculoskeletal triage services in Ireland and within two years had removed over 18,000 people from waiting lists for orthopaedic and rheumatology consultants.
UK Evidence of the Cost Effectiveness of Investing in Physiotherapy
United Kingdom:

Physiotherapy Works” is a series of information papers produced for the Chartered Society of Physiotherapists (UK) in conjunction with health economists that outline the beneficial health economic impact of physiotherapy on a number of conditions.

The cost savings included reductions in admission and readmission rates, length of hospital stays, use of prescription medicines and health staff absenteeism

The following is a summary of a sample of the research based findings that show where physiotherapy has reduced the cost burden (improved clinical outcomes are implicit).

  • Reduction in length of hospital stay through early mobilisation of patients in ICU4
    A Physiotherapy led early mobility protocol showed a decrease in ICU and hospital length of stay   (average 14.5 v 11.2 days) and an average cost savings of 7% on standard patient care costs.
     
  • Reduction in length of hospital stay in people with COPD3
    Intensive multidisciplinary outpatient pulmonary rehabilitation programme including physiotherapy is an effective intervention in the long and short term and resulted in reduced length of hospital stay.
     
  • Reduction in length of hospital stay in patients following pulmonary lobectomy3
    Intensive respiratory physiotherapy following pulmonary lobectomy reduced mean hospital stay from 8.3 to 5.7 days. Further findings included a reduction in rates of mortality, pneumonia and lung collapse.
     
  • Reduced length of hospital stay and admission to institutional care in people with strokes15
    Physiotherapy in the very early stage for people with strokes (mobilising within 24 hours) and at high intensity leads to better outcomes. In the UK, physiotherapy stroke rehabilitation is increasingly based in the community in specialist stroke services. Early supported discharge (within 24 hours) has been shown to be clinically effective in people with mild or moderate disability. It has also been shown to reduce long term dependency, admission to institutional care and length of hospital stay.
     
  • Reduced length of hospital stays and future hospital admissions in people with Dementia5
    An intensive physiotherapy in-patient service and follow up home service for people with dementia showed reductions in length of hospital stays and future hospital admissions. (58% of the people were able to return home).
     
  • Reduced length of stay in patients with cancer12
    Physiotherapy has been shown to reduce length of inpatient stays
  • Reduction in hospital admissions and IV antibiotics through physiotherapy outreach programmes in people with Cystic Fibrosis14 
    The programme resulted in substantial health care savings by significantly reducing the need for IV antibiotic treatment and hospital admissions. Increased participation rates were also found.
     
  • Reduction in readmissions through pulmonary rehabilitation post COPD exacerbation3
    Showed a 26% reduction in readmission rate with cost effectiveness demonstrated
     
  • Reduced admissions with Physiotherapist-led Falls Prevention programme in the community10 
    The programme showed a reduction in admission due to falls in the home (32%), in institutional care (27%) and in the street (nearly 40%) over a 10 year period in Glasgow.
     
  • Reduction in admissions, GP and hospital consultant visits through a Physiotherapy-led MDT service for people with Multiple Sclerosis (MS)9  
    Introduction of the above resulted, over a 6 month period, in decreased GP and hospital consultant visits and hospital bed days in 38 people with MS, thereby reducing the inappropriate use of inpatient beds.
     
  • Cost savings in managing early stage breast cancer related Lymphoedema prospectively11 
    A cost comparison study showed that the cost of managing early stage breast cancer related lymphoedema was 80% less per patient when using a prospective physiotherapy surveillance model compared with reacting to symptomatic presentation.
     
  • Reduction in prescription medicines in self-referral programmes2
    Self-referral pilots in 6 NHS sites in England between 2006 and 2008 reduced the number of associated NHS costs particularly for investigations and prescribing; 75% didn’t require prescription medicines. It also reduced work absence among patients. The average cost benefit to the NHS in Scotland of self referral (2009) was estimated as £2.5million p.a. 1
     
  • Reduced health service staff absenteeism2 
  • Triaging to facilitate easy access to staff for musculoskeletal physiotherapy rehabilitation (consistently the most common reported type of work related illness since records began in UK and half of sick absence in the NHS is caused by musculoskeletal disorders (MSD) and 30% of primary care referrals) meant 53.3 % could stay at work, 21.7% returned to work within 8 days and the remainder within 30 days resulting in substantial savings on agency staff.  Two government departments in Northern Ireland offered this service to staff and 80% indicated that physiotherapy prevented their absence from work
Physiotherapy as the more cost effective option:
  • Cheaper and more clinically effective than drug treatment for urinary incontinence6
  • Health Technology Assessment showed that intensive pelvic floor training and lifestyle changes were the most clinically and cost effective first line strategy6
  • Recent NICE review found 5 studies on cardiac rehab were cost effective when compared with traditional care. Physiotherapy exercise focused cardiac rehab programmes are more effective than other cardiac interventions7

 

Extracts from Physiotherapy Works have been summarised by the ISCP (January 2014) with kind permission of CSP (UK).

  1. Chartered Society of Physiotherapy, UK “Physiotherapy Works.... and we have the evidence” Annual Report 2009 CSP, UK
  2. Chartered Society of Physiotherapy, UK “Physiotherapy Works – Occupational health, June 2011
  3. Chartered Society of Physiotherapy, UK “Physiotherapy Works –Chronic Obstructive Pulmonary disease, June 2011
  4. Chartered Society of Physiotherapy, UK “Physiotherapy Works –Critical care, October 2011
  5. Chartered Society of Physiotherapy, UK “Physiotherapy Works – Dementia Care, January 2012
  6. Chartered Society of Physiotherapy, UK “Physiotherapy Works – Urinary incontinence, January 2012
  7. Chartered Society of Physiotherapy, UK “Physiotherapy Works – Cardiac rehab, January 2012
  8. Chartered Society of Physiotherapy, UK “Physiotherapy Works – Musculoskeletal disorders, January 2012
  9. Chartered Society of Physiotherapy, UK “Physiotherapy Works – Multiple Sclerosis, January 2012
  10. Chartered Society of Physiotherapy, UK “Physiotherapy Works – Fragility, fractures and falls, January 2012
  11. Chartered Society of Physiotherapy, UK “Physiotherapy Works – Lymphoedema,  October 2012
  12. Chartered Society of Physiotherapy, UK “Physiotherapy Works – Cancer survivorship,  November 2012
  13. Chartered Society of Physiotherapy, UK “Physiotherapy Works – Rehabilitation, June 2013
  14. Chartered Society of Physiotherapy, UK “Physiotherapy Works – Cystic fibrosis, October 2013
  15. Chartered Society of Physiotherapy, UK “Physiotherapy Works – Stroke, October 2013

 

For more information and to download the Physiotherapy Works leaflets please click on the following link: http://www.csp.org.uk/professional-union/practice/your-business/evidence-base/physiotherapy-works

 

Canada:

The Canadian Physiotherapy Association (CPA) contracted two health economists to provide an evidence-based and relevant valuation of physiotherapy for 12 conditions. 

 

Information from their report has been condensed to a series of information sheets that support the value of physiotherapy:

 

These information sheets can be downloaded via the following link:

http://www.physiotherapy.ca/Advocacy/Legislation/The-Value-of-Physiotherapy

 

The Outcome

Investment in physiotherapy will significantly increase health service effectiveness and save the State millions.

 

Canadian Evidence of the Cost Effectiveness of Investing in Physiotherapy
 

The Canadian Physiotherapy Association (CPA) contracted two health economists to provide an evidence-based and relevant valuation of physiotherapy for 12 conditions. 

 

Information from their report has been condensed to a series of information sheets that support the value of physiotherapy:

 

These information sheets can be downloaded via the following link:

http://www.physiotherapy.ca/Advocacy/Legislation/The-Value-of-Physiotherapy

 

The Outcome

Investment in physiotherapy will significantly increase health service effectiveness and save the State millions.

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