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The Stakeholders

Amputee Rehabilitation - A Rural Perspective Dianne Whitten Senior Physiotherapist Upper Hunter Community Health. The Stakeholders. Surgeon/ General Practitioners Nursing Staff Physiotherapy Team The Patient. Surgeon/ General Practitioners. Obstacles encountered:

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The Stakeholders

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  1. Amputee Rehabilitation - A Rural PerspectiveDianne Whitten Senior Physiotherapist Upper Hunter Community Health

  2. The Stakeholders • Surgeon/ General Practitioners • Nursing Staff • Physiotherapy Team • The Patient

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

  4. Nursing Staff Hospital Nurses – • 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 Community Nurses – experts in wound Mx

  5. Physiotherapy Team • Recruitment and retention issues – fluctuating staffing levels –> outreach services compromised first • Diversity of caseload • Lack of experience in treating amputees • 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

  6. The Rural 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 - lack of knowledge of available services

  7. The Rural 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

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

  9. Strategies to enhance treatment effectiveness • Establish a NETWORK of support with physios at rehab centres • 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 • join professional groups

  10. Strategies –cont. • Familiarise yourself with the patient’s requirements eg. job, home situation • 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

  11. Education Strategies • 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

  12. 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

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