Shared learning database

PhysioFunction Ltd
Published date:
February 2011

Functional Electrical Stimulation can dramatically improve the quality of life for a patient with foot drop, enabling them to walk further and with confidence. Many Healthcare professionals don't have knowledge of this technology, so following the NICE guidance Jan 09 - we decided to find a way of running en Education event to address this gap in knowledge and ultimately improve patient care for those with dropped foot.

Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

To increase awareness amongst healthcare professionals that in Jan 2009, NICE declared Functional Electrical Stimulation a safe treatment for dropped foot and therefore improve patient care. Patients who have been discharged prior to this date need to be advised that this treatment may be suitable for them and until all healthcare professionals have knowledge of FES, this guidance cannot be put into practice. The Main objective of the initiative was to offer GPs, Physiotherapists, Occupational Therapists and Case Managers the opportunity to see the technology in action in an educational environment, so that they can consider FES as a treatment option for any of their patients who have dropped foot. Many patients are living with dropped foot and currently using an ankle-foot splint or avoid walking due to pain, discomfort or fear of trips and falls. This all has a negative impact on their quality of life. These patients will be unaware that this technology may be suitable for them unless their healthcare team have the appropriate knowledge.

Reasons for implementing your project

It is estimated that 20% of stroke survivors have a persistent foot drop (Wade et al 1987), which also occurs in a high percentage of people with acquired brain injuries, is seen in patients with spinal cord injury and is a common condition for sufferers of multiple sclerosis, cerebral palsy, Parkinson's disease and hereditary spastic paraparesis. The most common orthotic solution for this is the use of a thermoplastic ankle foot orthosis (AFO), which is worn in the shoe or a metal calliper which is fitted externally to the shoe. FES can be used to apply small electrical pulses to the common peroneal nerve producing dorsiflexion and eversion, lifting the foot in swing and stabilising the ankle when it is returned to the ground. Not only does FES reduce trips and falls, it can also make walking faster and less effortful, restoring confidence. Overtime the muscles can even relearn how to lift the foot without the stimulator. Once NICE published its Guidance in January 2009 we expected to see an increase in FES referrals of patients that may have lived many years with AFOs. It became apparent following our attendance at the Primary Care conference, that many healthcare professionals have never heard of the technology or seen it in action. Therefore they would not be able to discuss this treatment option with their current patients who have dropped foot. We fed back to the main FES product manufacturers that this was an educational need and set up an Independent project to offer 250 Healthcare professionals the opportunity to learn about the technology, meet current FES users and watch the improvement in gait with patient demonstrations.

How did you implement the project

Methods: We wanted to reach a cross section of healthcare professionals who are all in regular contact with patients who have dropped foot, to ensure the message reached those patients who had their stroke, head Injury or illness diagnosed years ago. We offered educational places to five healthcare categories - General Practitioners, Occupational Therapists, Neurological Physiotherapists, Case managers and support workers. We put together a morning of lectures covering an Overview of FES, Research effectiveness, Clinical Videos and economic considerations and a description of the main four systems in the UK. In the afternoon healthcare professionals watched patient demonstrations and the improvement in gait. The education event was communicated via occupational membership associations and supporting charities i.e. MS Society, Different Strokes, Headway and Parkinson's Disease Association. External independent CPD accreditation was obtained. The costs of the project was funded on an even split between the main 4 suppliers of the equipment in the UK. It was run as an educational not for profit event.

Key findings

Results and evaluation: 211 healthcare professionals attended the education event in November 2010. All feedback forms state that the information was of high relevance to them in their daily roles and they will now consider FES as a treatment option. Several Hospitals are now arranging in service training events.

Key learning points

Key learning points: Good preparation time is essential to apply for CPD accreditation and to communicate the event to all the healthcare professional groups Having patient assessments and demonstrations ensured all attendees saw the gait improvement versus an AFO Involvement of the charities and support associations proved invaluable resource. The Education event was poorly attended by GPs, upon reflection if we could have obtained the budget - we would have sought CPD accreditation from the GMC as GPs are likely to see most patients with dropped foot, and therefore well placed to inform them of the NICE guidance for FES treatment options.

Contact details

Julia La Garde
Independent Project Manager
PhysioFunction Ltd

Tertiary care
Is the example industry-sponsored in any way?

The event was sponsored, but non profit, to give Healthcare professionals the opportunity to see FES in action, free of charge so there were no barriers to attendance. This submission is voluntary and not sponsored.