The Allied Health Professionals in the Therapies department and Sarcoma Unit at the Royal National Orthopaedic Hospital NHS Trust have together developed projects to evaluate the quality of rehabilitation services and patient experiences after major surgeries for musculoskeletal tumours. Utilising novel approaches and ideas with a view to improve services, the team have developed high quality evidence-based service evaluation projects. 

This was a prospective cross-sectional service evaluation project in a single centre to assess the burden of falls, prevalence and risk-factors of falls in the sarcoma population.

  • MSc Student: Miss Samantha Foo
  • Project Supervisors: Dr Sherron Furtado (Senior Supervisor/Author), Dr Steve Taylor and Mr Craig Gerrand
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  • Achievements: 50 patients recruited and dissemination in process. Presented at BSG 2020 and selected to present at EMSOS 2021, Manuscript submitted to Disability and Rehabilitation Journal – Prize-winning project @UCL, Won the Prestigious Scales Prize in UCL in 2019/2020

Isobel Maccallum, Sherron Furtardo, Abigail McCarthy

Post-operative protocol following sacrectomy with plastic surgery limit’s hip flexion and avoids pressure on the wound. This leads to extended bed rest affecting function, strength, range of movement, blood pressure and mood.

This service evaluation reviewed the early use of tilt table following surgery to establish whether patients stand and mobilise independently sooner.

Results support the use of tilt table following sacrectomy in hastening the achievement of physical milestones.

The small sample size is a limitation of this project and therefore results are prone to sampling errors. A further investigation with a larger sample size is required.

A, Kowalska, A. McCarthy, C. Gerrand, S. Furtado

Test the feasibility of using the Patient Specific Functional Score (PSFS) as a clinical outcome measure to monitor and inform inpatient rehabilitation post-operatively in patients treated for musculoskeletal tumours.

Although an ongoing study, early results shows the PSFS is feasible to use, easy to administer, useful in setting goals and priorities jointly with patients treated for musculoskeletal tumours.  It promotes an individualised approach to developing goals with patients and demonstrates early efficacy in improving patients’ ability to perform activities.

L. Mitham, Sherron Furtado, A McCarthy

Anecdotally patients following surgery for bone and complex soft tissue tumours reported a feeling of isolation and reduced motivation to mobilise. A new hospital building with single rooms provides further challenges for social integration on the ward. A daily walking group introduced “Stanmore Steppers” may enable extra mobility and opportunities to meet other people. This concept fed into the national initiative of #PJparalysis which is a campaign aiming to get patients up and moving.

Stanmore Steppers significantly improved physical activity and performance outcomes after major surgery for musculoskeletal tumours, yet some improvements maybe due to natural recovery. These interventions are valuable additions to inpatient rehabilitation.

Abby McCarthy, Roisin Delany, Prof Deborah Eastwood, Dr Sherron Furtardo

Massive pelvic tumour excision with/without reconstruction requires prolonged rehabilitation for optimal outcomes.  Recent literature describes a lack of objective outcome measures.  The aim of the study is to review the effect of instrumented gait analysis in targeting rehabilitation and improving outcome in patients who underwent tumour excision/reconstruction.

Preliminary results support the use of instrumented gait analysis, TESS and QOL-CS in reflecting outcomes following complex hip reconstruction and encouraging a tailored physical and psychological programme.

Kate Scanlan

The aim of the project was to reduce patient length of stay, reduce occupational therapy time spent on ward involved in discharge planning, with aim to increase time spend on functional re-training on ward post-surgery to improve patients functional outcomes, explore patient views on pre-assessment, explore if pre-assessment anticipated functional levels are accurate.

In conclusion, therapy led pre-assessment service was well received by patients and positive patient experience. Pre-assessment is now embedded within orthopaedic oncology team.

Laura Mitham, Abby McCarthy, Dr Sherron Furtardo

The aim of this project is to potentially improve patient’s access to the information we provide to them during and following their inpatient stay by using a Quick Response (QR) code to access advice and information booklets. Consequently the information will be more up to date and patients will be able to access a bespoke exercise program along with the opportunity to view video demonstrations. We are hoping also that through the reduction of more paper booklets being given out, there would also be reduced printing costs and a decrease in wastage.

Author: Clare David, Macmillan Specialist Sarcoma Radiographer

Published:  UCLH Connect Magazine, Issue 10, August 2021, Pages 16-19

The aim of this project was to assess the impact of the newly implemented Macmillan specialist sarcoma radiographer role on sarcoma patient pathways within the radiotherapy department.

An anonymous questionnaire survey was sent by post to 32 sarcoma patients who were treated with radical radiotherapy prescriptions in the six months preceding the commencement of the Macmillan specialist sarcoma radiographer role. Identical surveys were then posted to 28 sarcoma patients who were treated with radical radiotherapy prescriptions in the first six months after the role commenced.

The results survey demonstrate the merit of the Macmillan sarcoma specialist radiographer role. The patient pathway has been enhanced and patient satisfaction has improved since the role commenced. This patient cohort has clearly benefited from having a keyworker present throughout their entire treatment journey. The telephone follow-up clinics have been very successful, not only in improving the patient experience, but also by flagging and resolving issues that occur between the final radiotherapy treatment and the initial follow-up appointment.