Rather than destroy old news items, they will be stored here. It will probably be a record of my changing interests. They are in reverse order, with the most recent weeks at the top.
Week beginning July 19th 2021
July 23rd 2021; 21.30 hrs. European Board exam BSRM success
We have just had the results from the recent European Board rehabilitation examination results. Eleven UK candidates passed, of 12 who entered. Looking at the relative scores on different components, we were around the average for the whole group. We did notably well (more that 15% higher) in ‘cardiovascular and respiratory functions, drug treatment, amputations, and cardiovascular disorders. Out weaker areas were rehabilitation of the frail elderly, of temporo-mandibular disorders, and of pulmonary disorders, in assessment of motor impairment, and in neurophysiology.
These differences may all be chance, as the numbers are small. Overall, UK candidates did as well as average.
July 19th 2021; 17.45 hrs. All curriculum documents published
The three main curriculum documents for doctors training in Rehabilitation Medicine are now on the Joint Royal Colleges of Physicians Training Board (JRCPTB) website (here). They are the curriculum, the Rough Guide, and the syllabus.
The curriculum is in the ‘curriculum’ section, unsurprisingly! The Rough Guide and syllabus are under ‘Forms and Guidance’. The ARCP decision Aid has yet to be uploaded.
July 19th 2021; 14.00 hrs. Physiopedia rehabilitation course
Between September 13th and October 30th 2021 Physiopedia will be running a free online course on “Understanding Rehabilitation as a Health Strategy”. See here for details. This course content seems completely concordant with the philosophy behind this site, taking a holistic view of rehabilitation and its place in society.
July 19th 2021; 12.30 hrs. BSRM/SRR/ACPPLD conference
The dates for the next annual conference of the British Society of Rehabilitation Medicine (BSRM), Society for Research in Rehabilitation (SRR), and Association of Chartered Physiotherapists for People with Learning Disability (ACPPLD) will be on November 9th and 10th. It will again be a virtual conference. Likely cost is £65.00. As far as I can see there is no website giving information on any of the sites: BSRM, SRR, or ACPPLD.
The provisional title is “Rehab 2021 – Living and ageing with long term conditions“. I will give more news when available.
Week beginning July 12th 2021
July 18th 2021; 20:45 hrs. £19.6M for rehabilitation research
The National Institute for Health Research (NIHR) announced today a total of £19.6M would be spent on 15 research projects into Long Covid. Seven of these projects directly concern rehabilitation, accounting for 68% of the total funding; they are all relevant to rehabilitation. Included within the projects is, if what I have found is correct, probably the largest trial in rehabilitation history (4,500 to be recruited).
To read more, go here. This post gives the limited information currently available. It argues that rehabilitation has a once-in-a-lifetime opportunity to change radically so that all patients needing rehabilitation receive a quality service.
July 18th 2021; 13:00hrs. £3.4M rehabilitation research (delayed)
The embargoed new was released today (18th). Dr Manoj Sivan, Associate Clinical Professor and Honorary Consultant in Rehabilitation Medicine in the Faculty of Medicine and Health, University of Leeds and his 27 collaborators and co-investigators from 10 centres across all four nations, have been awarded £3.4M by the UK National Institute for Health Research (NIHR) to investigate and develop better rehabilitation services for patients with Long-Covid. The project summary is here.
Week beginning July 5th 2021
July 7th 2021; 20.00hrs. NICE guidance of shared decisions
The National Institute for Health and Care Excellence (NICE) has produced a new guideline on shared decision making. (here) While this may sound good, it has two drawbacks. Most of its recommendations are platitudinous and generally vague. If carried out a General Practitioner might see 10-15 people a day and all hospital out-patient clinics would grind to a halt. Although there is a comment about proportionality, it is hidden and unexplained.
It made me look at the NICE guidance on Mental Capacity Act and best interests. Another vague and unhelpful document which could never be carried out. (here) It also requires the Care Quality Commission to check that all Trusts comply with the Mental Capacity Act and NICE’s guidance. Not done.
Week beginning 24-May-2021
Week beginning 21st June 2021
June 27th 2021; 22.00hrs. Assessing entrustability
In August 2021 the whole system of training all specialist doctors will change, the biggest change being a move from assessing competence as the ability to undertake a specified activity independently, to assessing whether a doctor can be entrusted to undertake a complex activity over a time. This is going to require both trainers and existing trainees to acquire new educational skills. The Joint Royal Colleges of Physicians Training Board (JRCPTB) have recently made available training resources, especially some short videos. Accessible here.
June 25th 2021; 09.00hrs. Survey on advanced clinical practitioners.
Week beginning 14th June 2021
June 19th 2021; 11.15hrs
The latest Cochrane Rehabilitation newsletter published (here). Links to two recent reviews, three ‘Cochrane corners’ (in journals), and to posters from 2021 ISPRM conference.
Week beginning 7th June 2021
June 8th 2021. 21.30 hrs. Carers’ week
Did you know that June 7th-13th is national carers week? Well, nor did I, but it is. See here.
June 8th 2021. 21.15hrs NHS workforce planning
Published today here: House of Commons Health and Social Care Committee (Chair: one Jeremy Hunt) Workforce burnout and resilience in the NHS and social care. Tells you what we have known for 20-40 years, including when Jeremy Hunt was ‘in charge’:
Paragraph 31, from “Conclusions and Recommendations”, page 58:
“It is clear that workforce planning has been led by the funding envelope available to health and social care rather than by demand and the capacity required to service that demand. Furthermore, there is no accurate, public projection of what health and social care require in the workforce for the next five to ten years in each specialism. Without that level of detail, the shortages in the health and care workforce will endure, to the detriment of both the service provision and the staff who currently work in the sector. Annual, independent workforce projections would provide the NHS, social care and Government with the clarity required for long-term workforce planning.“
Read chapter five and be depressed. Particularly note that the People Plan is high quality rhetoric, but meaningless (like Operation Moonshot and vaccinating the whole world in the next 18 months).
May 27th. 21.30hrs. SSNAP June newsletter out now
The Sentinel Stroke National Audit Programme (SSNAP) is, for anyone who has not come across it, the most fantastic resource on stroke. Your hospital will be there. There are regular newsletters and the latest was published today. It is available for download from this page here.
May 25th. 22.00hrs. Bowel/bladder guideline.
A Clinical Practice Guideline on the Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury has been published by the Consortium for Spinal Cord Medicine. It is, unfortunately, not Open Access as far as I can see. It is available here. It will be of great relevance to all Rehabilitation Medicine trainees, and to many consultants too.
May 24th. 17.00 hrs. RCP reaches 40,000
Doctors in Rehabilitation Members are physicians, and all can join the Royal College of Physicians (RCP) whatever their core training. It offers great resources: CPD diary, library (online), courses, and many others. For example the RCP Research and Innovation hub has a special section on developing research skills which should interest anyone, especially trainees. (here) Visit its home page and explore. (here) Last year membership increased by more than 2000 (+6%) to reach a new record of 40,000 members.
May 24th. 17.30 hrs. RCP: Workforce planning statement
On April 13th (well, this is a ‘new to me‘ page) the Royal College of Physicians published a policy positions statement on Workforce. This should be of great interest to Rehabilitation Medicine where planning has left us unable to respond as we would like to current needs from Covid, trauma, stroke and almost all other conditions. The statement is here, and on May 14th it was welcomed by the Parliamentary health and social care committee. (here) Pressure is needed from all rehabilitation organisations (but I don’t imagine the government will pay any attention).
Week beginning 17-May-2021
May 18th. 09.30hrs. European Forum for Rehabilitation Research.
The 16th Congress of the European Forum for Rehabilitation Research is between 23-25th September in (virtual) Ljubljana. Abstracts need to be submitted by May 25th 2021. The relevant website is http://www.efrr2021.si/index.php/welcome.
May 17th. 15.00hrs. Call for abstracts. UK Stroke Forum
The next UK Stroke Forum meeting has poster sessions on Wednesday 1st and Thursday 2nd December 2021. A call for abstracts has been sent out. The deadline is 17.00 hours on June 29th 2021. To learn more, go here.
Week beginning 10-May-2021
May 11th. 18.15 hrs. Consciousness explained …
Only 11 days ‘old’. A review of what it is to be conscious. I agree, not really rehabilitation news; more news for everyone. Is helpful, though, when considering prolonged disorders of consciousness and also when considering just how people behave. I suggest downloading and printing out, because that will allow more careful attention. Available, free here.
May 12. 14,45hrs. Advanced news (yet to happen!). NICE again
The national Institute of Health and Care Excellence (NICE) will be issuing a call for people (anyone representing him or herself or a voluntary organisation) to register for a guideline entitled “Rehabilitation for chronic neurological disorders including traumatic brain injury“. The call will be issued on June 18th 2021. On that day anyone interested can register by going to this site here and clicking the link ‘get involved’ in the appropriate box.
In the meantime it is exciting news that NICE is taking on this challenge – and it will be a challenge in view of its scope (vast), the difficulty in finding relevant evidence (because it cannot be limited to any disease, impairment, or disability), and the inevitable links with social care.
Week beginning 03-May-2021
May 9th. 13.00hrs. The GetReal Institute
On April 28th 2021 the National Institute for Health and Care Excellence (NICE) signed up to join the GetReal Institute; the NICE statement is here. This is interesting because, up to now, NICE has been reluctant to consider any evidence outside very tightly defined limits, focused on a sub-group of potentially relevant randomised comparative trials. NICE now say: “NICE’s ambition complements the GetReal Institute’s core mission to facilitate the adoption and implementation of real-world evidence in health care decision-making.”
The GetReal Institute was itself launched on April 28th – NICE is a founder member. You can learn more about it here. It is based in the Netherlands (or maybe really in cyberspace). Its history is explained here. Its stated aim is: “We aim to drive standards for quality and innovation in the generation and assessment of RWE, and to facilitate the efficient and appropriate use of RWE in health care decision-making.”
It would be nice to think that this will allow NICE to take a broader view of the evidence relevant to rehabilitation in their five-year strategy – see April 21st news item below.
May 7th. 13.30hrs. SRR AGM call for input.
In a news letter, the President, Fiona Rowe seeks advice from members about timing of the AGM: “In order to improve member attendance at the AGM, we would like to seek your views on when is best to host the AGM. Would you prefer the AGM to be at the end of one of the conference days or is it preferable to you to have the AGM on a separate day? Please email us with your suggestions/preferences for when to host the SRR AGM. “
May 5th. 22.30 hrs. Breaking news! BSRM e-bulletin (April)
About 1hour 40 minutes ago the April e-bulletin from John Burn, President of the British Society of Rehabilitation Medicine was released. Nothing if not up-to-date! You can see it here. I will start a record of all e-bulletins soon. Please read the bulletin to learn what is happening.
May 5th. 10.30hrs. New Resuscitation Guidelines
Although most rehabilitation services will not be seeing acutely ill patients as a routine nevertheless, as a health service, the rehabilitation service will need to have a policy on resuscitation. People in rehabilitation often have cardiovascular disorders and may suddenly fall ill. Resuscitation Council UK have today published an updated (from 2015) 2021 guideline. Available here.
May 5th. 12.40hrs. Veterans (UK) and NHS
Today Maisy Povan and Sarah Barker introduced me to the Veterans Covenant Healthcare Alliance, an organisation I was unaware of. It was set up within the Getting It Right First Time (GIRFT) project to improve rehabilitation for UK veterans (Armed Forces). Of course this will only be possible if all rehabilitation is improved. Details are here. The ready-made solution is here!
Week beginning 26-Apr-2021
May 2nd. 16.30hrs. Empathy v sympathy – a poem
I am just writing a blog about humanities and rehabilitation, and amazingly I can across a poem published seven days ago on empathy, saying much more forcefully than I ever could how empathy differs from sympathy. It is available here.
30th April. 18.00hrs. Leeds Covid scale new versions.
The COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), widely used in the NHS, now has two new self-report versions, one for first assessment and one for follow-up. It is also developing an app with a company within the NHS, ELAROS (here). The details, and the forms can be accessed through the Advances in Clinical Neuroscience & Rehabilitation website here.
28th April. 18.30hrs. Curriculum officially published
The Rehabilitation Medicine 2021 curriculum (for doctors in training) was finally published today. Go to Joint Royal Colleges of Physicians Training Board (JRCPTB) Rehabilitation Medicine website (here) to download it. It is activated in August 2021, but any doctor now training in Rehabilitation Medicine in the UK and due to still be in training in August 2022 should download and read it now, because it will apply to you. The Rough Guide (to the curriculum) should be out within 4-6 weeks.
27th April. 17.15hrs. Equator Network Newsletter
For anyone unaware of the Equator Network, be you a researcher or clinician (there is nothing specific for ‘the public’ but actually it might in interesting) you should become aware. (here) The latest newsletter can out just now, accessed here. It cover five topics: two items on systematic reviews (PRISMA guidance); guidance on reviewing statistics; a new extension to PRISMA on reports on test accuracy; and one on medical students in Palestine.
26th April. 16.15hrs. Severity of damage after Covid
News is what is new to me.
A report published on 31 March 2021 arrived in my paper version of the British Medical Journal 30 minutes ago. A retrospective cohort study of 47,780 patients found 30% were re-admitted and 12% (of all) died in 4-5 months, a much higher rate than matched controls. Multi-organ dysfunction was raised compared with controls. The multi-disciplinary, multi-professional clinics that are set up will need medical input to detect ongoing organ damage, and to guide other team members as to the best rehabilitative approach. See here.
Week beginning 19-Apr-2021
25th April. 17.00hrs: A Covid-19 cohort study
There are many papers reporting follow-up data on Covid-19 patients. This prospective study doe report, accurately, who was not seen to given better context than most studies. The report (here) finds that new symptoms are common, and continuing evidence of lung damage was seen in 19% of those studied. Fatigue is the stand-out symptom (30%) followed by shortness of breath (16%) and sensory disturbance (12%). The need for a multi-professional rehabilitation assessment is obvious, given the span of problems.
23rd April. 11.00hrs; syllabus complete; other documents agreed by GMC
The Rehabilitation Medicine training programme syllabus is now complete, for final review May 13th. Meanwhile the General Medical Council has agreed all other documents. See blog here for details.
22nd April; 08.30hrs: Art images in psychiatry.
A magnificent new resource released yesterday. About 144 essays, each considering a painting and what it reveals about being human. The focus is around mental health. Each is by James Harris, and they explore “the role of the visual arts in representing truths about mental health, coping with illness, trauma and conflict, addressing social stigma, and enriching society’s understanding of mental illness.”
The JAMA (Journal of the American Medical Association) Network has compiled the essays published over 12 years into a website (here) which will provide inspiration, insight and enjoyment to anyone and everyone. Try one on anxiety today? (here)
21st April. 16.00hrs: National ICU Rehabilitation day.
I confess that I had not heard of the National Intensive Care Unit rehabilitation day until I received an email from the Society for Research into Rehabilitation (join here) (@rehabresearchuk) informing me of a petition by a charity, ICUsteps. The Parliamentary Petition can be signed at their website. This has all arisen from the editorial in the British Medical Journal that was mentioned in this News section on April 16th (below).
The landing page of ICUsteps highlights rehabilitation: “To mark national ICU rehabilitation day on 21 April 2021, we’re launching our #RehabIsCritical campaign. We believe all intensive care patients should have access to the community rehabilitation they need to get their lives back after critical illness. Sign our Parliamentary Petition to show your support.” I hope they are members of, or will now be invited to join the Community Rehabilitation Alliance. (see April 19th news item below)
Anyone on Twitter can support them through #RehabIsCritical and anyone can contact the society through firstname.lastname@example.org
21st April; 14.00hrs: NICE new strategy
The UK National Institute for Health and Care Excellence (NICE) has just published a strategy document for 2021 to 2026. Good news, but …
If you search for rehabilitation, disability, disabled, holistic, biopsychosocial, or psychological they are all absent. There is much focus on being scientific, quick etc. One small ray of hope lies in this: “There will be an increased push for integrated guidelines that extend across the health, social care and public health interface.” Unfortunately all past experience, for example the guideline on stroke rehabilitation, suggests they are institutionally unable to handle interfaces between different components of illness, and complex interventions.
Their strategy has a touching faith in technology as the solution – it is one of four pillars – but this reveals a lack of understanding of the human and personal aspects of healthcare – there is no mention of the importance of inter-personal relationships.
They acknowledge that guideline development needs improving, but again foucus on speed and flexibility, rather than taking a holistic approach to the evidence base, as rehabilitation experts have suggested. (here) They will still focus on “the relative effectiveness of new technologies, medicines and interventions.“
In summary, their strategy is based around a reductionist approach within a biomedical model, not an multi-factorial approach based within a holistic biopsychosocial model of illness. It is a 20th century approach to a 21st century set of problems.
19th April. 21.00hrs: Community Rehabilitation Alliance
Although not ‘new’ (first mentioned May 2020, and initiated earlier), the Community Rehabilitation Alliance is a reasonably well-hidden but important initiative. It was initiated by the Chartered Society of Physiotherapy (here), and its purpose and principles are available on the web from the Society for Research in Rehabilitation. (here)
The Alliance is obviously important, and has set up work-streams on:
- Transforming Rehabilitation; with a Reimagining Rehab Task and Finish Group
- Responding to Covid; contributing to Long Covid Task Force
- Improving community rehabilitation data; with a Data and Evidence for Community Rehab Task and Finish Group
- Focusing on social care; with a Social Care and Community Rehab Task and Finish Group
- Influencing decision makers; with a Political Engagement Task and Finish Group
The purpose of this Alliance seems close to the purpose of Rehabilitation Matters, except that I am also interested in hospital-based rehabilitation (which is supported by the Alliance). Several pages and blogs on the site cover bullet points 1, 2 and 4. (here and here and here)
Anyone interested may contact Martha Hannan, the Community rehabilitation alliance lead at the Chartered Society of Physiotherapy. Email: email@example.com
19th April. 09.00hrs: From BSRM webpages
Two items, neither absolutely new.
Part of the site covers documents setting out core standards for rehabilitation services, and guidelines on rehabilitation. A relatively new on (March 2021) has been published, entitled “2021 BSRM Standards for specialist rehabilitation for community dwelling adults – updated 2002 standards“. It can be downloaded by anyone from this webpage (here), where all other similar documents are also listed.
Another part of the BSRM site covers courses. There is advance notice on a Spinal Injury Rehabilitation Course (virtual) to be run in June. No details yet, but it is usually full, and much appreciated. You may “register your interest with Louise Adams in Sheffield – firstname.lastname@example.org“
Week beginning 12-Apr-2021
18th April. Rehabilitation’s roles in Long Covid
The clinics that we (should) run should use the electronic patient record to record and code the presentation symptoms and problems as reported by patients, so that we can build a better understanding of the nature and frequency of problems across the whole spectrum. It will not be epidemiologically perfect, but it will be better than individual reports from individual services.
The second response highlights the role of rehabilitation clinics in the assessment of all patients. Rehabilitation is the speciality which has specific expertise in holstic patient-centred assessment (see here and here). The response emphasises the role of academic Rehabilitation Medicine in campaigning: “We do not believe it is a coincidence that the primary author of this paper is a UK rehabilitation medicine specialist.”
16th April. Rehabilitation after ICU
An editorial in the British Medical Journal (here) highlights that rehabilitation is needed for all people who leave the intensive care unit. While praising the creation of clinics for people recovering from Covid-19 it notes that “a recent study identified no discernible difference between the rehabilitation needs of patients with covid-19 and those admitted to intensive care with other critical illnesses”. It also draws attention to a useful tool developed specifically to identify people who may need rehabilitation after intensive care, the PICUPS (Post Intensive Care Unit Presentation Screen) – see here and here – this was work by a member of the British Society of Rehabilitation Medicine, Professor Lynne Turner-Stokes.
12th April. Time-limited treatment trials
In intensive care it is often difficult to know whether a treatment will make a great difference, perhaps not only saving a life, but also returning the person to good function. The alternative is that a treatment is started which prolongs life but does not alter functional ability. The usual default is to try it, but this may then become difficult to stop. The need for defining a stopping rule before starting has been recognised for many years. This paper here, published in JAMA Internal Medicine, gives a very clear protocol and form of words to use with families. The study found the procedure to benefit patients and families, while reducing wasteful use of intensive care.
Rehabilitation faces a similar dilemma, and often continues rehabilitation in general and/or a specific treatment long after any likelihood of benefit has passed. One reason, better termed excuse, is that “we must not remove hope” – but other people are being denied any access to that hope. We should learn from intensive care practice.