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Bevan Exemplar Cohort 8 Projects

Unloader Knee Brace Service in CMATS East

Sian Crinson

Betsi Cadwaladr University Health Board

This service development proposal aims to address the inequity across Betsi Cadwaladr University Health Board in the provision and management of patients diagnosed with unicompartmental knee osteoarthritis. It aims to streamline current management practices to make better use of resources. To date, there is no defined pathway in place to manage this group of patients in BCUHB. It is important to use resources appropriately and only refer those patients who are a surgical target onto Orthopaedic care. Current practice results in a number of patients enduring a lengthy wait to be reviewed by an Orthopaedic Consultant to determine whether they are a surgical target, or would be better managed with an unloading knee brace. For those patients who would be better managed in a brace, this decision could be made much earlier in the pathway of management and avoid the associated costs of being reviewed unnecessarily in Orthopaedics when they could be more efficiently managed in the Clinical Musculoskeletal Assessment and Treatment Service (CMATS).

This project will create a pathway of management for patients presenting with radiologically confirmed, uni-compartmental knee osteoarthritis, that includes earlier clinical decision making regarding the appropriate and timely referral for both Orthopaedic intervention and the use of an unloader knee brace.

Over the following 12 months, the project will delivered in stages as follows:

Quarter 1
Data collection of current pathway.
Provide training for fitting of unloader braces to CMATS clinicians.

Quarter 2
Establish monthly multi-disciplinary team meeting with Orthopaedic Consultants specialising in knee joint pathologies and CMATS clinicians.
Initiate pilot – transfer fitting of braces to CMATS clinicians (within Orthopaedics).

Quarter 3
Data collection from pilot and preparing business case.

Quarter 4
Present business case to Management team and transfer delivery of service to CMATS.

The anticipated benefits of the project include:

  • Improved timelier access to specialist advice and application of unloader brace.
  • Reduction of inappropriate referrals and time waiting to see Orthopaedic team.
  • Improved patient outcomes and satisfaction.
  • Upskilling of Physiotherapists.