Primary contact physiotherapy in emergency departments can reduce length of stay for patients with peripheral musculoskeletal injuries compared with secondary contact physiotherapy: a prospective non-randomised controlled trial

Objective

To evaluate if direct physiotherapy assessment and management of patients presenting to emergency departments with musculoskeletal injuries (primary contact physiotherapy) results in reduced length of stay without any increase in adverse effects compared with secondary contact physiotherapy, where patients are seen by a physiotherapist after initial assessment by a doctor.

Design

Prospective non-randomised controlled trial.

Setting

Three metropolitan emergency departments.

Participants

Adults (n = 315) presenting to emergency departments with peripheral musculoskeletal injuries were allocated to primary or secondary contact physiotherapy; 306 participants completed the study. Patients with serious pathology, open fractures and spinal pain were excluded.

Intervention

A single episode of physiotherapy.

Main outcome measures

Primary outcome measures were patient length of stay, waiting time and treatment time. Secondary outcome measures were re-presentations to the emergency department, imaging referrals, patient satisfaction and emergency department staff acceptance.

Results

Primary contact physiotherapy resulted in a reduction in length of stay of 59.5 minutes [95% confidence interval (CI) 38.4 to 80.6] compared with secondary contact physiotherapy, with a reduced waiting time of 25.0 minutes (95%CI 12.1 to 38.0) and a reduced treatment time of 34.9 minutes (95%CI 16.2 to 53.6). There were no differences between the groups in imaging referrals or re-presentations. Patients strongly agreed (≥82%) that they were satisfied with their management, and 96% of emergency department staff agreed that primary contact physiotherapists had appropriate skills and knowledge to provide emergency care.

Conclusion

Experienced musculoskeletal physiotherapists working in emergency departments can be the first point of contact for patients with simple, semi-urgent and non-urgent peripheral musculoskeletal injuries, resulting in decreased waiting times and length of stay for patients without any adverse effects.     

The Sport Injury Rehabilitation Adherence Scale: a reliable scale for use in clinical physiotherapy

Objective

To evaluate, through two studies, the factor structure, inter-rater agreement, and test-retest and inter-rater reliability of the Sport Injury Rehabilitation Adherence Scale (SIRAS).

Design

Repeated measures design in both Study 1 (video evaluation) and Study 2 (clinical evaluation).

Setting

University department (Study 1) and outpatient physiotherapy department (Study 2).

Participants

Sixty physiotherapists and physiotherapy students in Study 1 and 45 patients undergoing physiotherapy treatment for a musculoskeletal injury in Study 2.

Intervention

In Study 1, participants rated the adherence of a simulated videotaped patient demonstrating high, moderate and low adherence during rehabilitation. In Study 2, two physiotherapists rated the adherence of patients at two consecutive rehabilitation sessions.

Main outcome measure

The SIRAS.

Results

In Study 1, principal components analysis confirmed a single factor for the SIRAS, and inter-rater agreement values ranged from 0.87 to 0.93. In Study 2, inter-rater and test-retest reliability coefficients ranged from 0.76 [95% confidence interval (CI) 0.54 to 0.83] to 0.89 (95% CI 0.79 to 0.95), and from 0.63 (95% CI 0.36-0.82) to 0.76 (95% CI 0.55-0.88), respectively.

Conclusion

The SIRAS is a reliable measure with high inter-rater agreement when used to evaluate clinic-based adherence to physiotherapy rehabilitation for musculoskeletal injury.     

Physiotherapists’ and general practitioners’ views of self-referral and physiotherapy scope of practice: results from a national trial

Aim

To establish the views of physiotherapists and general practitioners (GPs) on self-referral and physiotherapy scope of practice.

Design

Survey questionnaire design utilising both qualitative and quantitative questioning.

Setting

Twenty-six general practices throughout Scotland.

Participants

Sixty-four physiotherapists and 97 GPs with direct experience of implementing systems of self-referral to physiotherapy in primary care in Scotland.

Method

Questionnaires containing a mix of open and closed questions were distributed at the end of a year-long data collection period of a national trial (2003-2005). Responses were analysed by clinician group: GPs and physiotherapists.

Results

An overall response rate of 73% (117/161) was achieved. High levels of comfort with, and confidence in, physiotherapists acting as first point of contact practitioners were reported by 96% (67/70) of GPs, and just 6% (3/47) of physiotherapists reported not being comfortable. More than 78% (91/117) of all clinicians indicated that there could be possible and definite benefits for musculoskeletal patients if physiotherapists were involved in monitoring and prescribing non-steroidal anti-inflammatory drugs, issuing sickness certificates and requesting X-rays, although this was more strongly supported by physiotherapists (>88% vs >63%; P < 0.001). Seventy-eight percent (35/47) of physiotherapist respondents felt that physiotherapists could accept self-referrals very ably, 47% (21/47) felt that not all physiotherapists were sufficiently experienced, and 16% (7/47) reported the need for additional training before physiotherapists could undertake this role. Only 34% (16/47) of physiotherapists felt that the public understood what physiotherapy is and what it can offer.

Conclusion

The concept of physiotherapists working as first point of contact practitioners is strongly supported by the majority of GPs and physiotherapists. Potential benefits for patients were identified if physiotherapists undertook extended roles with regard to other aspects of musculoskeletal management. There is a need to address both professional and public awareness of physiotherapy and self-referral specifically.     

Use of ultrasound imaging by physiotherapists: a pilot study to survey use, skills and training

Objective

This study aimed to design and pilot a questionnaire to survey the use of ultrasound imaging (USI) by physiotherapists in the United Kingdom (UK), the type and content of ultrasound training physiotherapists using USI had undertaken and their perceived future training needs.

Background

The use of USI by physiotherapists is becoming increasingly common but is highly operator dependent and there are safety and professional issues regarding use in physiotherapy practice. Currently there are no specific training guidelines relating to physiotherapists using USI.

Methods

A questionnaire was developed, based on research literature and guidelines. Twelve experts in USI commented on the content and design. The electronic on-line questionnaire was piloted on groups that were likely to be users of USI.

Results

Forty-six respondents completed the questionnaire. Results indicated that USI is used predominantly for biofeedback and there are many unmet training needs. Respondents reported a mismatch between techniques for which they had received training and those that they used in practice and indicated a more structured training framework is required.

Conclusions

The development and piloting of the questionnaire provides a starting point for a more extensive evaluation of how USI is being used, the training needs of physiotherapists and benefits as a biofeedback tool. Refinement is needed and replication in a larger sample. Results could assist the development of a structured formal training framework encompassing key skills.     

An investigation into the alignment of a South African physiotherapy curriculum and the expectations of the healthcare system

Until 1994, physiotherapy education and training were aligned with the expectations of the South African healthcare system. Subsequent to policy shifts since 1994, the professional role of physiotherapists has expanded. In the absence of guiding strategies to support this change, physiotherapy curricula have remained relatively static.

Objective

The paper examines the discrepancies between physiotherapy education and training at a South African university post apartheid and the expectations of the healthcare system.

Design

Located within critical feminist research framings and employing narrative inquiry as the selected methodology, data were produced through multiple methods to obtain multiple perspectives and orientations.

Participants

This multisectorial data production approach involving student physiotherapists, physiotherapy academics and practising physiotherapists included in-depth focus group interviews, individual interviews, life-history biographies and open-ended questionnaires. The data were analysed separately for each group of research participants (physiotherapy students, practitioners and academics), followed by a cross-sector analysis.

Results

The analysis illustrated current disciplinary trends and shortcomings of the physiotherapy undergraduate curriculum, whilst highlighting that which is considered valuable and progressive in physiotherapy and health care. The dominant themes that emerged included issues relating to physiotherapy theory and practice, and issues that influenced the construction of relationships in the curriculum.

Conclusion

The significance of this study lies in the value of student and practitioner feedback to inform curriculum and professional development in the light of sociopolitical changes and healthcare expectations.     

Who wants expert patient programmes for chronic mechanical spinal pain?: An investigation into the value of, and recruitment to, an expert patient programme as part of the physiotherapy management of chronic spinal pain

Objective

To investigate the recruitment to, and value of, an expert patient programme as part of the physiotherapy management of patients with chronic spinal pain.

Design

A qualitative design incorporating semi-structured audiotaped interviews subsequently transcribed and coded. Interviews were held with patients as individuals and a group of nine physiotherapists participating in a single focus group.

Setting

Interviews were held in a physiotherapy department within a small community hospital.

Method

Initially an expert patient programme was organised and 20 patients were recruited. Interviews were held with five patients who had declined to participate and five patients who agreed. Those who agreed were interviewed before and after participation in the programme. Nine physiotherapists involved in recruiting patients to the programme were interviewed collectively in a one-off focus group.

Results

Patients and physiotherapists were not well-informed about the expert patient programme and were uncertain as to its value. There was resistance amongst patients to join the programme for logistical, perceptual and personal reasons. Recruitment was time-consuming for the physiotherapists involved and required persistence, commitment and persuasiveness. Some physiotherapists felt that they had inadequate time to recruit patients and were uncertain as to who would be suitable. Attendance on the single programme studied was poor, with two out of a potential 12 patients attending all six of the sessions. Participants who attended the programme found it a positive and useful experience.

Conclusions

This study confirms previous work that found a low uptake of places on programmes and difficulties in recruiting. Physiotherapists managing patients with chronic spinal pain are unsure as to the efficacy of expert patient programmes but feel that they could be useful for a small number of patients who are psychologically ready and sufficiently motivated to join. Patients who are successfully recruited to a programme can gain benefits including empathy and support. Further work needs to be carried out to demonstrate the value of the programme to both patients and physiotherapists.     

Motivating patients with shoulder and back pain to self-care: can a videotape of exercise support physiotherapy?

Objectives

The National Health Service is developing an ethos of self-care. Patients are being encouraged to become proficient in helping themselves. This has long been a philosophy of the physiotherapy profession, where self-care between consultations has been an integral part of the treatment process through encouraging the uptake of self-care skills training. This study explored how patients with shoulder and back pain perceived videotaped exercises and instructions to support their routine physiotherapy, and how the videotape was used.

Design

A videotape, developed by physiotherapists for patients with musculoskeletal problems, of exercises to view at home was given to patients by their physiotherapists to support their routine physiotherapy consultations. A qualitative methodology was used to examine how patients responded to being given a videotape of exercises and instructions between consultations. Data were collected through semi-structured interviews.

Setting

The study was based in 26 general practices that had access to practice-based physiotherapists in two primary care trusts in the north-west of England.

Participants

Thirty-three patients with shoulder and back pain who received a videotape of exercises and advice were interviewed.

Results

Three themes emerged from the data: finding space for exercise; remembering and doing exercises; and supporting the physiotherapy-patient relationship. Patients discussed aspects of motivation, and described how a videotape of exercises might support or inhibit the performance of exercises prescribed by physiotherapists. Patients identified a range of different ways in which they derived support from the videotape.

Conclusions

The videotape supported patients with a variety of different needs as it enhanced their ability to complete exercises correctly. Videotapes (or DVDs) are useful for patients and could be adopted as a tool to support treatment.     

An evaluation of equipment to assist patient sit-to-stand activities in physiotherapy

Objectives

Facilitating patient sit-to-stand activities has been identified as a major cause of back pain. Whilst some aspects of equipment use have been addressed in health care, few studies have considered physiotherapy activities. This study aimed to establish whether equipment could be used to replace the manually assisted rising component of patient sit-to-stand treatment activities.

Design

Four types of equipment were evaluated: a chair lifter, a stand-and-turn aid, a stand-and-walk aid and a walking harness. The equipment was evaluated according to a randomized, balanced presentation order.

Setting

Two hospitals specializing in patient rehabilitation.

Participants

A convenience sample of 10 physiotherapists and 10 patients who needed assistance to stand.

Main outcome measures

Perceived rate of exertion, stability, ease of use, effectiveness, posture and duration of task. Qualitative data were collected via a focus group discussion with the physiotherapists.

Results

The task duration varied significantly between equipment types, with the walking harness taking nearly 4 minutes (95% confidence interval 3-6 minutes) to use and the chair lifter taking 1 minute (95% confidence interval 0.5-1 minute). There were no significant differences between conditions for other variables, although the chair lifter and the walking harness were found to result in a high risk of musculoskeletal injury. The physiotherapists suggested that equipment could complement treatment activities, and recommended a variable-speed option to meet individual patient's needs. The multi-functional design of the stand-and-walk aid and the walking harness was preferred for early treatment activities, whereas treatment carryover could be enhanced with the chair lifter and the stand-and-turn aid in functional situations.

Conclusions

Equipment can be used to complement manual assistance during treatment activities and is preferable to poorly performed techniques. Further studies are indicated for more specific guidance on patient selection, treatment progression and effect on physiotherapists’ posture.     

First impressions: an information leaflet for patients attending a musculoskeletal outpatient department

Objective

The purpose of this work was to design and evaluate an information leaflet for new patients attending a physiotherapy outpatient department. This formed part of a wider agenda of improving the patients’ experience and increasing adherence to the Chartered Society of Physiotherapy's core standards.

Design

A needs analysis was undertaken with existing patients to determine the content of the new leaflet. This was then tested for readability, reviewed by physiotherapy staff and evaluated by patients via a questionnaire.

Setting

The musculoskeletal outpatient physiotherapy department at Southampton General Hospital.

Participants

Patients referred to the outpatient physiotherapy service, plus all clinical and support staff employed in the musculoskeletal outpatient team.

Main outcome measures

Numerical Rating Scale and Gunning's Fog Index.

Results

Thirty-seven of 50 patients completed the needs analysis (74%), generating 42 ideas for the leaflet content. The definitive leaflet addressed one core standard and 16 specific criteria, and had a readability of grade 8.3, which is below the recommended maximum limit of grade 9 for health education leaflets. Using an 11-point Numerical Rating Scale, where 0 = of no benefit and 10 = extremely helpful, the mean rating for the leaflet from 29 of 100 patients was 8.6.

Conclusions

This work has produced a patient information leaflet for physiotherapy outpatients, a copy of which is freely available (electronically) from the author. The leaflet forms part of an ongoing commitment to improving the patients’ experience.     

Patient-centredness in physiotherapy from the perspective of the chronic low back pain patient

Objective

To define patient-centredness from the patient's perspective in the context of physiotherapy for chronic low back pain (CLBP).

Design

Qualitative study using semi-structured interviews to explore perceptions of various aspects of physiotherapy management of CLBP.

Setting

Physiotherapy departments in one geographical area of the UK National Health Service.

Participants

Twenty-five individuals who had received physiotherapy for CLBP within the previous 6 months.

Results

Six key themes emerged as the dimensions that the participants perceived to be important for patient-centred physiotherapy: communication; individual care; decision-making; information; the physiotherapist; and organisation of care. Communication was the most important dimension, underpinning the five other dimensions as well as being a distinct dimension of patient-centred physiotherapy.

Conclusions

Physiotherapists should have an understanding of the six dimensions of patient-centred physiotherapy for CLBP. Improving physiotherapists’ communication skills may better facilitate patient-centred physiotherapy, and therefore enhance the experience of physiotherapy for this client group.     

Mechanisms-based clinical reasoning of pain by experienced musculoskeletal physiotherapists

Objective

In light of recent advances in understanding of the neurophysiological basis of pain, the use of mechanisms-based clinical reasoning strategies for pain has been advocated within physiotherapy. The purpose of this qualitative study was to investigate the nature and extent of mechanisms-based clinical reasoning of pain by experienced musculoskeletal physiotherapists, in relation to three different clinical pain presentations.

Design/participants

Guided by an interpretative approach, a qualitative multiple-case studies design was used. Three videotaped patient-therapist clinical interviews were produced, each describing a different pain presentation. During and after the viewing of each of the three pain presentations, an audiotaped semi-structured interview was carried out with a purposive sample of seven experienced physiotherapists. The therapists were encouraged to verbalise their thoughts on aspects of each patient's pain presentation. All interviews were subsequently transcribed, coded and analysed.

Results

Four main categories of mechanisms-based clinical reasoning were identified. These were: (1) nociceptive; (2) peripheral neurogenic; (3) central; and (4) autonomic/sympathetic. There was some evidence to suggest that reasoning within these categories variously influenced therapists’ prognostic decision making as well as the planning of physical assessments and treatment. There was minimal evidence of reasoning according to the cognitive-affective mechanisms of pain, and no evidence of reasoning associated with motor, neuroendocrine and immune mechanisms and influences on nociception.

Conclusion

The mechanisms-based clinical reasoning of pain by the participants in this study appeared to reflect the integration of a limited understanding of the neurophysiological basis of pain into clinical decision making associated with patients with musculoskeletal disorders. Physiotherapists may benefit from continuing education in order to broaden and update their knowledge of applied pain neurophysiology.     

Conceptions of physiotherapy knowledge among Swedish physiotherapists: a phenomenographic study

Objectives and design

Knowledge in physiotherapy is based on both scientific evidence and clinical practice. Different perspectives of knowledge generate different implications for theory development. The aim of this qualitative, phenomenographic study was to describe physiotherapists’ conceptions of physiotherapy knowledge.

Intervention and participants

Open, semi-structured interviews were conducted with 10 physiotherapists working in different sectors of physiotherapy. The transcribed material was analysed according to phenomenographic analysis.

Results

The physiotherapists’ conceptions of various aspects of physiotherapy knowledge are described by four qualitatively different categories: (a) interaction, i.e. the ability to create opportunities for patients and develop patients’ competencies, equally influenced by both theoretical and practical knowledge, with a patient-oriented perspective conceiving the physiotherapist as a coach; (b) personal competencies, i.e. the ability to provide good therapy influenced more by practical knowledge oriented towards the physiotherapist; (c) professional demands, i.e. the ability to be professional according to rules and scientifically proven interventions, influenced more by theoretical knowledge oriented towards the physiotherapist; and (d) scientific areas, i.e. the ability to use different knowledge, as an expert, in the interaction with the patient, strongly influenced by theoretical knowledge and oriented towards the patient.

Conclusions

The results can contribute to physiotherapy students’ understanding of the multi-dimensional nature of physiotherapy. The paradigm of physiotherapy must be studied further in order to understand and explain its complexity.     

An investigation of the use of passive movements in intensive care by UK physiotherapists

Objectives

To investigate the current use of passive movements (PMs) by National Health Service (NHS) physiotherapists working with sedated and ventilated patients in critical care settings.

Design

Postal questionnaire.

Setting

All open NHS critical/intensive care units in England, Northern Ireland, Scotland and Wales.

Participants

Physiotherapists working in UK NHS critical/intensive care units.

Results

Questionnaires were posted to 246 physiotherapists working in intensive care units; 165 (67%) were returned. One hundred and fifty-two respondents routinely treated ventilated and sedated patients, of which 151 (99%) reported utilising PMs. They were used most commonly (>70%) in patients admitted to critical care with medical, neurological or surgical problems. Respondents reported using a median of five repetitions of PMs once daily, and the majority of respondents took joints to the end of range (>78%). Joints most commonly treated included the shoulder, hip, knee, elbow and ankle. Heart rate and blood pressure were monitored by over 84% of respondents during treatment.

Conclusions

Whilst there is little empirical evidence to underpin the use of PMs, this study found that PMs were used regularly by 99% of respondents working in NHS critical care settings. Further work is now needed to evaluate the immediate and long-term effects of PMs in critically ill patients to inform and develop future practice.     

Physiotherapists’ perceptions of equity and career progression in the NHS

Objective

To evaluate physiotherapists’ personal perceptions of equality and diversity both in the NHS and within their profession. In order for policy to make a difference and change to occur in actual practice, personal beliefs of frontline staff must be evaluated and incorrect beliefs challenged.

Design

National Survey.

Setting

The UK.

Respondents

Four hundred and twenty physiotherapists.

Results

The findings were assessed in relation to respondents’ own beliefs in relation to equality and diversity. Key findings included that 88% of respondents agree that diversity is important in the NHS and that equality and diversity policies make a difference. However, 24% think the NHS is not working hard enough to promote equality and diversity. Fifty-five percent of respondents agreed that women experience barriers to career progression. Sixty-three percent of respondents think that black and minority ethnic (BME) groups are not well represented at senior levels in the NHS, 65% of respondents think that BME groups are not well represented at senior levels in physiotherapy. Overall, 19% of all respondents reported being treated differently in the workplace, yet 36% of non-white respondents reported being treated differently in the workplace.

Conclusions

Policy and procedures are making a difference in the NHS. However, as advocated, the CARE framework (http://www.liverpool.ac.uk.clinpsy.breakingbarriers) would be beneficial in facilitating change. Further efforts are required by NHS and physiotherapy leaders to promote equality in the workplace and diversity within the workforce.     

A comparison of the perceptions and aspirations of third-year physiotherapy students trained in three educational settings in Poland

Objectives

In Poland, physiotherapy is offered at three types of school: medical universities, universities of physical education, and schools that do not specialise in either the medical sciences or physical education. This study explored the knowledge of students who were completing their physiotherapy studies about working in Poland and other countries of the European Union (EU), and about their vocational plans. Students were asked, through self-assessment, about aspects of the professional skills they had gained.

Design

Quantitative questionnaire-based study of students in three university settings.

Setting

Eleven university-level schools in Poland offering studies in physiotherapy and representing three orientations: medical sciences (MS), physical education (PE) and other universities (OU).

Participants

The study sample comprised of 954 third-year Bachelor programme students.

Results

The differences in university profiles did not influence the vocational plans of the students, with more than 70% (668/954) declaring that they would look for work outside Poland: 76% (725/954) in the UK and 69% (658/954) in Germany. Most students stated that finding work as a physiotherapist is difficult in Poland (686/954,72%) and easy in other EU countries (763/954, 80%). Differences in university profiles had an effect on the students’ assessments of their professional skills, as students from universities without a long-standing tradition of training in physiotherapy declared that they were less well prepared to work as physiotherapists; the difference was statistically significant for 12 of the 16 domains examined (P < 0.05).

Conclusions

In the light of these results, an increased influx of Polish physiotherapists, trained according to European standards, into EU countries, especially the UK and Germany, is to be expected in the near future. The physiotherapists will predominantly be graduates of medical and sports-oriented state universities. It appears advisable to launch, under the auspices of an EU programme, an integrated employment information system for physiotherapists that would offer updated information on current demand in individual EU countries.     

Self-referral, access and physiotherapy: patients’ knowledge and attitudes—results of a national trial

Objectives

To identify service users’ views and attitudes to access, physiotherapy and patient-autonomous health-seeking behaviours.

Study design

Mixed qualitative and quantitative questionnaire.

Setting

Twenty-six locations representing a range of socio-economic and geographical settings throughout Scotland.

Participants

Three thousand and ten patients over 16 years of age.

Methods

Postal questionnaires containing a mix of open and closed questions, attitude statements and free text for comments were sent to all consenting patients 4 weeks after discharge from physiotherapy. Responses were analysed by referral group: self-referred patients; patients referred by their general practitioner (GP); and patients referred at the suggestion of their GP.

Results

A response rate of 72% (2177/3010) was achieved. Males, females and all age groups were represented. Strong support for the effectiveness of physiotherapy was reported by all groups (>90%). Despite more than 80% of respondents claiming that they were able to confidently predict when they needed physiotherapy, less than 23% reported being knowledgeable or very knowledgeable about physiotherapy, with no significant association between level of knowledge and referral group (P = 0.129). Self-referred patients were more satisfied (P < 0.001), more supportive of being able to self-refer (83% vs 69% of GP-referred patients and 71% of patients referred at the suggestion of their GP), and more supportive of physiotherapists making decisions about their fitness for work or activities (59% vs 53% of GP-referred patients and 53% of patients referred at the suggestion of their GP).

Conclusions

Physiotherapy was regarded positively by all referral groups, particularly by self-referred patients, despite there being a distinct lack of knowledge about the profession. There is a clear need to raise awareness and knowledge of physiotherapy if autonomous health-seeking behaviours are to be encouraged and self-referral schemes progressed appropriately.     

A survey of physiotherapists involved in paediatric lower limb amputee rehabilitation in the British Isles

Objectives

Children require extensive rehabilitation following lower limb amputation and there are few reports describing this rehabilitation process. A survey to assess opinions, practice and caseloads amongst physiotherapists involved with paediatric amputee rehabilitation in the British Isles was therefore undertaken.

Design

A 17-item structured telephone survey was developed to include the main aspects of physiotherapy rehabilitation of children following lower limb amputation. Physiotherapists working in paediatrics and/or amputee rehabilitation in a range of acute, outpatient and community settings were surveyed.

Results

Data were collected between November 2001 and October 2002. Physiotherapists from 70 centres were contacted, and 52 treated paediatric lower limb amputees. A variety of causes of amputation were managed. All physiotherapists commented that they saw very few paediatric patients. No centre had protocols in place for any stage of management. In all geographical areas, rehabilitation was available throughout recovery for all causes of lower limb amputation. Core elements of rehabilitation were similar; however, additional elements differed between centres.

Conclusions

This survey indicates that the small population of children with lower limb amputation has access to rehabilitation throughout their recovery. However, there is variation in the provision of physiotherapy rehabilitation services throughout the British Isles. Redesigning physiotherapy rehabilitation services for paediatric lower limb amputees, and formalisation of cross-speciality links between paediatric and amputee physiotherapists may help to address these issues and better equip these children for future function.