“Physiotherapy is about regaining function, reversing the problems that arise after injury or disease,” explains Professor Karen Middleton, Chief Executive at the CSP.

“It’s used for people of all backgrounds after events like stroke, head injury or heart attack, as well as in supporting children with learning disabilities or ongoing conditions like cerebral palsy."

"There’s no area of medicine where physiotherapy isn’t involved.”

While acute rehab within hospitals is recognised and “pretty good”, the CSP is concerned about what happens when the patient goes home. “TV presenter, Andrew Marr told us that the inpatient treatment for his stroke was fantastic but that life after discharge was like falling off a cliff – and he’s one of the fortunate ones who can pay for ongoing treatment.”


Hidden at home


Part of the danger, Professor Middleton explains, is that patients can become ‘invisible’ to the system after discharge: “Some people go home after life-altering injury or disease with nothing in the way of support. In one survey, 45 per cent of stroke patients said they felt ‘abandoned’ after discharge. One young cancer patient said everybody told her how positive it was that she was going home, but inside she was frightened and feeling she was on her own.

"The problems happen at home, they’re hidden. Invisibility is the enemy of rehab.”

As an example of how good services look, she cites the case of her very independent mother-in-law, who had a devastating stroke recently at the age of 92. “She had brilliant inpatient rehab and went home with a full programme of multi-disciplinary support which helped her regain her confidence and get back to being independent.”

For many patients, return to paid work is a critical but often overlooked goal, says Professor Middleton. “Physiotherapists are enablers who start with the patient’s real goals and what they can do, then work on reversing any limiting symptoms to reaching that goal.”


Changing commissioners’ decisions


Professor Middleton believes recognition of this asset-based approach is crucial to improving services – which are very variable across the country – and saving costs. “The CSP is preparing a fresh lobbying campaign to push for improved and more widely available services because we know the difference they make. Physiotherapy is very inclusive: physios will engage with family and friends to get them involved in helping the patient practice their daily exercises, for example.

“We need to convince the health commissioners of that value, so that they recognise that recovery can carry on and that quality of life can continue to improve, and take decisions accordingly.”

It is highly cost-effective to provide ongoing support services, says Professor Middleton. “If people have home rehab, they are less likely to turn up at A&E or at the GP’s. There are long-term savings to the system as well as maximized potential for the individual – it’s a win-win policy.”