Beyond physiotherapy: exploring access to neurological occupational therapy for people with multiple sclerosis in Rugby, South Warwickshire

Following the discussions with many different delegates of differing professions at the masterclass, I decided to explore how the service delivery for patients with multiple sclerosis (MS) differed locally in our service. The service I work in is uni-disciplined; however, we do share office and treatment spaces with neurological occupational therapy (OT). The neurological OT service do not share a treatment space in Rugby and will only see patients with MS, if a neurologist refers them into their service, and they can attend outpatient appointments at Leamington Spa Rehabilitation hospital- 22 miles away. Immediately, this highlighted health inequalities for this patient group. With the current prevalence of the neurology transformation program, government 10-year health plan and the getting it right first-time neurology project, there is clear evidence to support this criticism. I formalised an audit plan with the clinician that works in the Rugby clinic to track the following: If they would have referred to neurological OT if it was available to refer into; what treatments they would have referred for; if they were managing those OT needs instead and how confident from a scale of 0-10 they were managing these OT needs. The clinician tracked this for all the active MS patients that she has treated during her time within the rotation until September.

The results as highlighted in the poster were as follows:

There were a total of 11 patients that were included into this audit that were active patients within the service throughout April 2026 to September 2026. Patients that were seen by other clinicians in previous years were not included. At the time of the audit there were 11 active patients, 10 from this financial year and 1 from the previous year's cohort of referrals. The total number of patients that had been accepted into the service from this financial year was 10, and the year prior was 28.

Of the 11 patients included in this audit, 5 would have been referred into neurological OT if the service was available. 100% of these patients were receiving treatment from physiotherapy that would have been more appropriate to be treated by neurological OT. These treatments included: fatigue management, activities of daily living practice, upper limb rehabilitation and management.

The clinician's confidence at completing these treatments with each patient was measured from 0 equating to no confidence and 10 equating to highest confident with treatment. The range of scores were between 6 and 7 and the mean average was 6.6.

On analysing this data, I felt it was clear that although the relative number of patients the service see's is fairly low, that these patients have unmet needs. This unwarranted variation is evidently against the neurology transformation and 10-year health plan. After analysing this data, I began to think more broadly at these patients, not just from a physiotherapy and occupational therapy perspective, but from a wider discipline. I liaised with the south Warwickshire MS rehabilitation team that is comprised of physiotherapy, OT, therapy assistants, speech and language therapists and neuropsychologists to discuss data further. Unfortunately, they did not have data easily accessible to review how many patients see what discipline, how frequently and their impact on these patients' quality of life. This did inspire the further steps that could take place following this audit that would be a much greater piece of work. With regards to the current service delivery from a neurological physiotherapy perspective, needs that would be addressed by a neurological OT are being met within physiotherapy sessions to the best of the clinician's ability. The clinician's confidence levels were at a moderate level, this may not always be consistent within the service, as this role is rotational every year. This may affect the quality of the delivery of these treatments and may lead to clinicians not completing this rehabilitation. Clinicians may refer to community OT who may have minimal experience treating patients with MS. This can affect quality of patient care and have a detrimental effect on community therapy wait times. This further opposes the pillars of the modern framework for neurological care of patients receiving the right care, by the right person at the right time, in the right place.

This project has shown that there is an unmet need from a neurological OT perspective for patients with MS in Rugby. It has also opened the door to further research into the disparity of the management of these patients holistically, from a wider multidisciplinary team. Going forward, I would look to continue to collate a year's worth of data around the main project- focusing on neurological OT to then present the data and proposal to the integrated care board for funding for a part-time OT to close this gap. Beyond this I would look to expand this project with data support from the south Warwickshire community MS rehabilitation team to further establish what the discrepancy of service is between the patients they see, and the lack of input patients within Rugby receive from a wider multidisciplinary team. Looking at the current service directly, I would also consider auditing the time spent completing treatments for these patients that the clinician would have referred to neurological OT if available, to better understand the demands this has on the service.