Re-thinking rehab

It is estimated that around 110,000 people are living with multiple sclerosis (MS) in the UK. It is just one of many long-term conditions that require ongoing rehabilitation to improve quality of life and avoid preventable deterioration in a person’s condition.

Limited rehabilitation provision in many areas, coupled with an increase in life expectancy and therefore people living with multiple long-term conditions, means the need for rehabilitation is greater than ever.

Charities, such as the Samson Centre in Surrey, are a vital resource that complement NHS services and offer specialist rehabilitation services alongside practical and emotional support.

The effect of the Covid-19 pandemic on rehabilitation services meant many people with MS were at risk of deterioration and developing potentially life threatening complications. During these unprecedented circumstances, Sara McGowan and her team demonstrated innovation and a commitment to keeping the MS population in their region living well, despite the strains and challenges of the last year.

Some of the changes they made have proven highly successful and have improved accessibility to the services that the charity offers. The work of the Samson Centre is testament to how we can all build back better.

Sara McGowan, lead physiotherapist at the Samson Centre for MS 

Based in Guildford, Surrey, the Samson Centre is a charity that provides practical and emotional support for people living with MS. It offers a wide range of support, including physiotherapy, exercise and gym classes and oxygen therapy.

How large is your team and what professions are involved? 

We have three physiotherapists and six other staff who have a mixed background of massage therapy, fitness, sports science and personal training. They have a great mix of skills and we try to match our member’s needs with our staff’s skills. All of our staff are part-time.

What does your work involve?

We see the full spectrum of MS. From newly diagnosed, who need support and advice in managing their symptoms, all the way to those with advanced MS and have been living with it for 30 to 40 years.  

For many of our members, we are their route to self-managing their symptoms, keeping fit, keeping strong and staying active. We offer individual physiotherapy for those whom need some specific intervention.

We are seeing increasing problems associated with ageing, such as arthritic changes, dementia and falls as people are living longer and their needs are changing. 

Most importantly of all, the centre is an oasis of support for our members, their family and their carers.  

Do you link in with the NHS to help manage MS in the community? 

Yes. We work with our local NHS community and inpatient teams and see ourselves as providing a place for people to manage their MS in the long-term. By working with our members on a regular basis, we like to think that we are ‘nipping problems in the bud’…such as spotting pressure areas, offering postural advice and managing falls.  We also run ‘Living with MS’ talks, on topics such as fatigue management and brain health.

What sort of challenges do you face?

We are a small, independent charity and this has its limitations…for instance we have no human resources, IT or facilities departments, so we often have to just muck in with jobs around the centre.  

Fortunately, we have good working relationships with our local MS practitioners and they can often support us with particular clinical issues. Equally, the MS Trust is incredibly supportive especially with learning and development of staff. 

During the first lockdown, I set up a Zoom support group of other lead physiotherapists working in the MS therapy centres and this was an invaluable support during this time.  

How have you adapted your service in response to the pandemic?

We are currently offering a combination of in-person and virtual sessions. All of our classes are online at present and it has been fun developing these skills but it’s also been challenging to ensure that our IT and tech is all running smoothly.
We would never have dreamed that virtual classes would work for our members - how wrong could we be! 

They have been fantastic at giving it a go.

It’s also given us the opportunity to reach people with MS who find it difficult to get to the centre due to geography, travel, work commitments and care arrangements. So we plan to keep some of our classes online and offer a ‘mix and match’ approach in the future.

Any other benefits for your members?

We know our members so well and they know us, so we can signpost people to the most appropriate class to suit their needs. They find that when they log on, they see a familiar face, someone who may have been working with them for a few years, knows their problems and can adjust an exercise for them. They also see their Samson friends who offer advice and have a joke with them. 

In normal times, we have a large number of missed appointments due to the complexity of living with MS, such as fatigue or pain. But having virtual appointments has reduced our non-attendance rate, and having a regular timetable means that they have to make a commitment to attend and are much more likely to turn up.

Has the situation inspired you to try any other new approaches? 

Yes. During lockdown, I set up a 30-minute relaxation and mindfulness session on Zoom and it has worked a treat. We’ve had good attendance and people can log on in the comfort of their own home, no matter what their level of ability is.
It’s been difficult in the past arranging appointments to train care staff or family members to complete stretches. But I now run a weekly group on Zoom called ‘Stretch with a carer’. This has worked really well - training care staff, improving carryover to the home setting and a created a lovely support group.  You can access more information here from the Samson Centre for MS

Community rehab resources

The CSP has developed a variety of resources to support members across the UK to improve community rehabilitation services.

• Identify the specific strengths of your services and find areas for improvement by using this physiotherapy service checklist.
• Learn how to champion community rehab with local healthcare decision makers, with our community rehab influencing toolkit.
• And see all of our community resources and information on the work the CSP is doing.