Just Go With The Quo?

Rhona BurchWorking as a physiotherapist in acute medicine I hear the phrases ‘revolving door’ and ‘frequent flyer’ used regularly. It is often applied to our increasing elderly population, at times struggling to maintain their independence at home, or to those struggling with addictions and lifestyles that see them admitted back into hospital with increasing frequency.

I feel these phrases, accepted as the status quo, exude complacency: because the hamster continues to run on the wheel doesn’t mean we shouldn’t offer it anything more stimulating or innovative to do!

What if we could shake things up?

What if we could really look at what our practice with a patient group associated with this ‘revolving door’ and see if we can stop it from spinning…or at least slow it down.

This concept is the motivation behind my current AHP Career Fellowship project with regard to physiotherapy interventions and alcoholic liver disease/alcohol misuse patients in an acute setting.

With 24,060 Scottish residents admitted to hospital with an alcohol related condition and on average, higher-risk drinking causing around 697 hospital admissions and 22 deaths a week I found it difficult to comprehend the results of my library assisted literature search showed no recent, relevant evidence for physiotherapy interventions with alcoholic liver disease/alcohol misuse patients in an acute hospital setting…none at all!

It is in not an exaggeration to say that in my current practice it would be rare to have a day without a patient from this client group in my caseload. So how can it be that we don’t have an established evidence base for our daily interventions with such a prevalent patient group occurring such huge cost implications on the NHS- estimated to cost Scotland over £3.6 billion?

What evidence I did find was generally positive but set in dedicated inpatient detoxification units/settings as opposed to an acute hospital ward. These relatively small scale studies repeatedly highlighted that physiotherapy led interventions with regards to physical activity as an adjunct or method of improving abstinence from alcohol were beneficial and effective. Other studies also discussed the beneficial effects of physiotherapy input with liver transplant patients, ‘pre-habilitating’ these patients prior to transplant to improve physical fitness and post-operative recovery. There are also no existing SIGN guidelines or working/best practice groups specifically relating to physiotherapy and alcohol misuse/alcoholic liver disease patients (if excluding transplant-related evidence) to allow for the sharing of existing innovative practice or creation and dissemination of new evidence and advancements within the field.

So during my application to the AHP Career Fellowship Project I raised the proposition that we as physiotherapists could potentially use our acute front line position and specific skill set in mobilisation, motivation and health promotion to offer something better, more effective and efficient for this patient group.

I wanted to reach out to my colleagues across NHS Scotland as part of my project and see if we could create this network which is currently absent. From here we could work as a cohesive group to evaluate our practice; use the wealth of knowledge this group would have to innovate and develop service provision for this hugely prevalent patient group; and work towards positive changes and the future creation of an evidence base so lacking at present.

Through a tedium of enquiring phone calls I have managed to get over 30 contacts for physiotherapists in NHS acute wards who deal with alcohol misuse/alcoholic liver disease patients and have created a survey that I am using to evaluate current practice and seek out any gems of current practice that may be going unnoticed.

I now hope to use this blog and the magic of social media to shine a light on my AHP Career Fellowship Project and cast a wider net for anyone who feels they want to get involved with my project. So, if you’re not on this list and think that you should be I want to hear from you!

Let’s not just assume that the status quo is as good as it can be.

Let’s look to better our practice for the benefit of our patients and our NHS.

Let’s be the catalyst for change.

Let’s not just ‘Go with the Quo’ any longer.

Get in touch with me via Twitter @BurchRhona or via my email at Rhona.Burch@ggc.scot.nhs.uk

Statistics used and more interesting, if alarming, reading can be found via the links below:

Health harm – ScotPHO

Alcohol and drugs – gov.scot



  1. completely on board with your cause! You and the team will hopefully get support from nursing staff!

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