MRHT Department Focus- Renal Physiotherapy Service

Triona Cusack Senior Physiotherapist in Chronic Disease Management
Midland Regional Hospital Tullamore

MRHT Renal Physiotherapy Service 350 x 250
Triona Cusack Senior Physiotherapist in Chronic Disease Management

Renal Physiotherapy is patient-centred care. This therapy is given to the patient while they are on dialysis or else prior to dialysis Renal rehabilitation. It allows the patient to have Physiotherapy at their convenience without interrupting an already busy life which is restricted by medical appointments. Renal Physiotherapy is well established in the United Kingdom and is now forming around Ireland.

In existence in Midland Regional Hospital Tullamore (MRHT) for over 6 years now, it was the first renal unit to offer Physiotherapy in Ireland.  Triona Cusack Senior Physiotherapist in Chronic Disease Management who has been in post for the last 4 years has experienced first-hand the benefits to renal patients such as, for example, improved mobility, receiving prosthetics fitting and rehab within MRHT working coherently with the NRH outreach team with no inpatient stay, weight-loss and an overall improved mood and quality of life.

Triona states ‘The services provided by the department vary depending on the needs of the patient and the needs of the patient are the centre of the rehab goals to increase functional wellbeing at their convenience. The lives of a patient on dialysis revolve around a strict medical schedule making it very hard to go to different appointments but also difficult to become active and manage their condition and well-being or recover from an illness that caused deconditioning.

Dialysis patients benefit from the use of the Letto bike while on dialysis. The morning exercise programme in the gym is offered to the patient early before they start dialysis to both build strength, mobility and balance often due to discontinuing from a recent hospital admission. Pre- dialysis patients with high BMI benefit from the gym service while awaiting transplant.

Amputee dialysis patients who are awaiting prosthesis get the essential rehab needed in a way that is convenient for them. The localisation of this service means that Triona works alongside the NRH outreach team who provides the service here in MRHT. The prosthesis at the NRH facilitates rehab by having a joint session in Tullamore Hospital avoiding the patient travelling to appointments.

Triona states ‘They measure the legs in MRHT, make test sockets and come back with the new prosthetic leg on rehab mornings.  I continue to rehab the patient twice a week while linked with the NRH. The patient is already getting a taxi to dialysis and awaiting treatment. This only delays their day by one hour but yet facilitates rehab at their doorstep avoiding NRH admission, Physiotherapy, Community and many other services required.

As a result of this admission to hospital for rehabilitation may not be required, but in fact it can be carried out in the morning prior to dialysis.’

This 1:1 relationship built with the team over the 8-week programme in MRHT ensures constant feedback and communication with relevant services regarding prosthetic fittings and waiting lists. Patients that are recognised as possible candidates for the programme are identified by any member of the dialysis team in MRHT or from the community team asking to facilitate patients' requirements while in for dialysis. Following medical clearance they are invited to an information session where they will learn about the services available. Following this, the patients give consent to a 1:1 or group exercise plan. Initial assessments then take place, followed by the rollout of the 8-week plan with Triona. Each class is progressive with continuous monitoring of oxygen, Borg and heart rate.

Triona continues ‘There is also the social side to this programme which is fantastic, weekly education sessions with a cup of tea after group exercise classes give patients a chance to check-in others with similar diagnosis to them but also physiotherapists, occupational therapists, dietitians and pharmacy staff.’

Patient feedback such as below shows the incredible impact Renal Physiotherapy can make on the lives of patients in the Midlands region ‘I learned how to walk again here in Tullamore and this meant I didn’t have to leave my family for rehabilitation for 6 weeks. I brought the prosthetic leg here and learned how to walk. Now I am a fully independent bilateral amputee and I have no walking aids. My rehab took no time out of my day as I came in before dialysis and I am forever grateful.’

After the 8-week programme there is an assessment with feedback to both General Practitioners and consultants regarding progress made and personalised exercise programme provided by the Physiotherapist for home use.

Noreen Galvin, Dialysis Manager in MRHT states: 'The Renal Service welcomed the introduction of the Physiotherapy service to the Midlands Regional Hospital Tullamore Renal Unit in 2017. This service is an excellent example of direct patient-centred care, delivered directly to the patient at his bedside.

The weight reduction programme enables and motivates patients to continue on their weight loss journey. The exercise programme promotes and encourages a healthier lifestyle and enables patients to think positively in terms of having accountability and responsibility for their well-being and health. Being on dialysis should not be self-limiting.

The physio programme for patients post-amputation allowed for the patient to have his dialysis treatment during this period at his home base. This meant patients did not have the added stress of having to relocate to another dialysis site, a stressful move in a difficult and challenging time. The patients and staff welcome this service and welcome additional supports to further develop same’