• Teaching medical students rehabilitation medicine.

      Gibson, Jeremy; Lin, Xia; Clarke, Karen; Fish, Helen (2010)
      PURPOSE: The principles of rehabilitation medicine will become ever more important across many medical and surgical specialties in view of the rising prevalence of chronic and disabling conditions. Yet rehabilitation medicine has traditionally been unpopular with medical students. This article aims to review the existing evidence of problems in teaching medical undergraduates in rehabilitation medicine and provide published recommendations and practical approaches from our own experience. METHOD: A literature review was carried out to search for publications relating to teaching rehabilitation medicine to undergraduates in order to identify problems that potentially affect undergraduate education in rehabilitation medicine and its future as a medical speciality. CONCLUSION: The lack of consistent undergraduate curriculum, knowledge of rehabilitation medicine and academic opportunities contribute to the inadequate perception of the speciality to the undergraduates. The attitude of medical students towards rehabilitation medicine is important for its future development as a specialty. Further standardisation of teaching rehabilitation medicine at a national level, promoting research activity in this area and increasing the profile of rehabilitation medicine are warranted.
    • Accuracy of clinical diagnosis in tremulous parkinsonian patients: A blinded video study

      Bajaj, Nin; Gontu, Vamsi; Birchall, James (2010-11)
      Background: This study examines the clinical accuracy of movement disorder specialists in distinguishing tremor dominant Parkinson's disease (TDPD) from other tremulous movement disorders by the use of standardised patient videos. Patients and methods: Two movement disorder specialists were asked to distinguish TDPD from patients with atypical tremor and dystonic tremor, who had no evidence of presynaptic dopaminergic deficit (subjects without evidence of dopaminergic deficit (SWEDDs)) according to ¹²³I-N-ω-fluoro-propyl- 2β-carbomethoxy-3β-(4-iodophenyl) nortropane ([¹²³I] FP-CIT) single photon emission computed tomography (SPECT), by ‘blinded’ video analysis in 38 patients. A diagnosis of parkinsonism was made if the step 1 criteria of the Queen Square Brain Bank criteria for Parkinson's disease were fulfilled. The reviewer diagnosis was compared with the working clinical diagnosis drawn from the medical history, SPECT scan result, long term follow-up and in some cases the known response to dopaminergic medications. This comparison allowed a calculation for false positive and false negative rate of diagnosis of PD. Results: High false positive (17.4-26.1%) and negative (6.7-20%) rates were found for the diagnosis of PD. The diagnostic distinction of TDPD from dystonic tremor was reduced by the presence of dystonic features in treated and untreated PD patients. Conclusion: Clinical distinction of TDPD from atypical tremor, monosymptomatic rest tremor and dystonic tremor can be difficult due to the presence of parkinsonian features in tremulous SWEDD patients. The diagnosis of bradykinesia was particularly challenging. This study highlights the difficulty of differentiation of some cases of SWEDD from PD.
    • Learning about research: How can trainees in rehabilitation medicine become competent in appraising and conducting research?

      Phillips, Margaret (2010-12)
      This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is ‘The trainee is able to critically appraise scientific, clinical and sociological research literature’ and ‘The trainee is able to complete a clinical audit study from the planning to final report stage’.
    • Using systemic approaches, methods and techniques in rehabilitation medicine

      Ward, Christopher; Smith, Alison; Bruder, Mel (2011-01)
      This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is 'The trainee demonstrates a knowledge of benefits and limitations of counselling approaches, specifically in this article systemic family therapy.'
    • Bone health in multiple sclerosis.

      Gibson, Jeremy; Summers, Greg (2011-12)
      People who are disabled with multiple sclerosis (MS) may be at increased risk of osteoporosis. This review discusses issues relevant to bone health in MS and makes practical recommendations regarding prevention and screening for osteoporosis and fracture risk in MS. A search of the literature up until 5 April 2011 was performed using key search terms, and articles pertinent to bone health in MS were analysed. Bone mineral density (BMD) is reduced at the lumbar spine, hip and total body in MS, with the degree of reduction being greatest at the hip. A strong relationship exists between the disability level, measured by the Expanded Disability Status Score, and BMD at the lumbar spine and femoral neck, particularly the latter. The rate of loss of BMD also correlates with the level of disability. Pulsed corticosteroids for acute episodes of MS, even with a high cumulative steroid dose, do not significantly affect BMD, but an effect on fracture risk is yet to be elucidated. There appears to be no correlation between vitamin D levels and BMD, and the relationship between disability and vitamin D levels remains unclear. Falls and fractures are more common than in healthy controls, and the risk rises with increasing levels of disability. The principal factor resulting in low BMD and increased fracture risk in MS is immobility. Antiresorptive therapy with bisphosphonates and optimising vitamin D levels are likely to be effective interventions although there are no randomised studies of this therapy.
    • Is patient-centred care a good thing?

      Ward, Christopher (2012-01)
      The problem: Rehabilitation professionals recognize the need to adopt a social as well as a medical model of disability, but the full implications of a social orientation towards disability are less easily accepted. If the physical environment can both produce and alleviate disability, so also can the social environment. If disablement is not to be seen as the problem of one individual then problems in rehabilitation must be ‘owned’ not solely by a single patient but also by other people implicated in a situation. It follows that ‘patient-centred care’, where a professional directs assessments and interventions towards one person, has shortcomings in rehabilitation. Theoretical considerations: A human systems model, shifting the focus of rehabilitation towards relationships, enables rehabilitation problems to be seen as provisional and context-dependent; the relational context of problems is clarified, and the positive and negative effects of professional power are more apparent. Clinical implications: Rehabilitation practitioners using a systemic approach would no longer view ‘carers’ and other significant individuals as mere bystanders but would integrate them within rehabilitation’s ethical and therapeutic system. Professionals would more readily recognize their roles within such a system, and would be better positioned to manage their negative as well as their positive effects. (
    • A multidisciplinary approach to Parkinson's disease.

      Lindop, Fiona (2012-04)
      Overview of the Parkinson's Disease Service model developed by the multidisciplinary team (MDT) at Derby Hospitals NHS Foundation Trust. The importance of understanding basal ganglia function and subsequent dysfunction in Parkinson disease, cues and strategies in MDT management of basal ganglia dysfunction and the roles of different members of the Derby MDT are discussed
    • A pilot study of a crossover trial with randomized use of ankle-foot orthoses for people with Charcot–Marie–Tooth disease

      Phillips, Margaret (2012-06)
      Objectives: This was a pilot and feasibility study of a crossover trial with randomized use of ankle-foot orthoses by people with Charcot–Marie–Tooth (CMT) disease, investigating the effects of these on gait parameters, practical aspects of use and achievement of goals. Design: A randomized crossover trial. Setting: The community and ambulatory care. Participants: Eight adults with CMT disease type 1 or 2. Interventions: Ligaflex™, custom-made polypropylene and silicone ankle-foot orthoses worn in randomized order for three weeks each, with a washout week in-between; the orthoses of each participant’s choice were then worn until 28 weeks. Main outcome measures: The primary outcome measure was gait velocity; other outcome measures included Goal Attainment Scaling; Likert scores, concerning aspects of orthosis use and gait analysis parameters. Results: Gait velocity was greatest wearing polypropylene orthoses, median 0.96 (interquartile range (IQR) 0.75–1.18) ms −1, compared with silicone orthoses, median 0.88 (0.71–1.12) ms −1, and no orthosis, median 0.79 (0.56–0.84) ms −1, P = 0.006. The silicone orthoses met goals more successfully and scored more favourably for comfort, 5.0 (5.0–6.0), P = 0.003 and pain, 5.5 (4.0–7.0), P = 0.015. Future modifications to study methodology were identified, such as a longer period of wear and measurement of walking in different situations. Conclusions: This study confirmed the feasibility of a larger trial. It indicated differences in walking velocity and parameters concerning wear of the orthoses that could be explored further. A further crossover trial would require 27 participants in order to show a clinically meaningful difference in velocity of 0.13 ms −1 with 90% power and alpha of 5%.
    • DrivAbility: teaching medical aspects of driving.

      Gibson, Jeremy; Whiteman, Leo (2012-06)
      CONTEXT: Teaching medical aspects of fitness to drive (FTD) is currently inconsistent across UK medical schools, with almost one-third of UK medical schools offering no tuition on medical aspects of FTD. It is, therefore, not surprising to find that medical students and doctors tend to lack confidence regarding the medical aspects of FTD and Driver and Vehicle Licensing Agency (DVLA) medical standards. INNOVATION: In response to this inconsistency we developed an innovative new learning module to teach our medical students the importance of giving appropriate advice to patients about driving, the role of the DVLA regarding medical aspects of FTD, how to recognise when patients should be referred to a driving assessment centre and what adaptations are available to allow patients with physical disabilities to drive safely. As far as we are aware Derby is the first centre in the world to incorporate the practical experience of driving adapted vehicles (at a driving assessment centre) into the undergraduate medical curriculum as an aid to teaching medical aspects of FTD. This practical learning module has proven popular with the students. IMPLICATIONS: Driving these adapted vehicles has allowed our students to appreciate some of the practical difficulties disabled drivers experience when learning new driving techniques. However, as only 18 driving assessment centres exist within the UK, an exact replication of this learning module will be limited elsewhere. Nevertheless, we would encourage other medical schools to evaluate the local resources that could enhance the delivery of their undergraduate curricula.
    • A randomised controlled feasibility study investigating the use of eccentric and concentric strengthening exercises in the treatment of rotator cuff tendinopathy.

      Bateman, Marcus (2014-01)
      OBJECTIVES: To conduct a feasibility study to compare concentric and eccentric rotator cuff strengthening exercises for rotator cuff tendinopathy. METHODS: A total of 11 patients with rotator cuff tendinopathy who were on the waiting list for arthroscopic subacromial decompression surgery were randomised to perform eccentric rotator cuff strengthening exercises, concentric strengthening exercises or no exercises. Patients were evaluated in terms of levels of pain and function using the Oxford Shoulder Score and a Visual Analogue Scale initially, at 4 weeks and at 8 weeks. RESULTS: The study design was found to be acceptable to patients and achieved a high level of 86% compliance. The drop-out rate was 0%. Two patients performing eccentric strengthening exercises improved sufficiently to cancel their planned surgery. CONCLUSION: Further research in this area is recommended. The study design was feasible and power calculations have been conducted to aid future research planning.
    • The effectiveness and cost of corticosteroid injection and physiotherapy in the treatment of frozen shoulder-a single-centre service evaluation.

      Bateman, Marcus (2014-07)
      Frozen shoulder is a common condition resulting in pain, stiffness and functional impairment. Symptoms can persist for months or even years if left untreated. Various treatments are available, but a standard care package does not exist and the most cost-effective treatment has not been established. The objective of this study was to conduct a service evaluation of current practice to establish the effectiveness of corticosteroid injection and physiotherapy intervention and the costs associated. A review of all patients with a diagnosis of frozen shoulder who had received a corticosteroid injection and physiotherapy was undertaken for a 12-month period at a single NHS hospital in the UK. Patient-reported outcome measures were analysed and the costs for treatment calculated. Out of the 55 patients, 43 were happy to be discharged following treatment. Ten were referred for a surgical opinion and two were lost to follow-up. The median pain rating significantly reduced from 8 (interquartile range (IQR) 7, 9) to 2 (IQR 0, 3.75) (p < 0.001). Of the patients, 62 % reported a greater than 60 % improvement. On average, patients attended for an initial consultation and four follow-up sessions at a total cost to the NHS of £135. Based on this small service evaluation study, corticosteroid injection administered by an experienced physiotherapist with follow-up physiotherapy appears to be an effective treatment for frozen shoulder.
    • Who should have a pre-discharge home assessment visit after a stroke? A qualitative study of occupational therapists’ views

      Fellows, Karen (2014-08)
      Introduction: The number of patients who have a pre-discharge home assessment visit following a stroke has been reported to vary nationally. The purpose of this research was to explore the factors influencing occupational therapists’ decisions to complete such visits. Method: Semi-structured interviews were completed with 20 senior occupational therapists working with stroke in-patients, from a range of urban and rural locations in the United Kingdom. The interviews explored their views about those patients for whom a pre-discharge home assessment visit would and would not be required. The interviews were analysed using thematic analysis. Findings: Three themes were identified: the patient’s level of physical, cognitive, or perceptual impairment and its impact on performance in activities of daily living; factors relating to the patient’s home environment, including the availability of support within the home environment; and other influences on occupational therapists. The presence of a cognitive impairment was a particularly important factor. Conclusions: Occupational therapists balanced aspects from each of these themes in order to determine whether a visit was needed or not. Although the level of impairment was important, the most dependent patients were not necessarily those believed to be the most likely to need a visit.
    • Does a specialist unit improve outcomes for hospitalized patients with Parkinson's disease?

      Skelly, Robert; Brown, Lisa; Fakis, Apostolos; Kimber, Lindsey; Downes, Charlotte; Lindop, Fiona; Johnson, Clare; Bartliff, Caroline; Bajaj, Nin (2014-11)
      OBJECTIVE: Suboptimal management of Parkinson's disease (PD) medication in hospital may lead to avoidable complications. We introduced an in-patient PD unit for those admitted urgently with general medical problems. We explored the effect of the unit on medication management, length of stay and patient experience. METHODS: We conducted a single-center prospective feasibility study. The unit's core features were defined following consultation with patients and professionals: specially trained staff, ready availability of PD drugs, guidelines, and care led by a geriatrician with specialty PD training. Mandatory staff training comprised four 1 h sessions: PD symptoms; medications; therapy; communication and swallowing. Most medication was prescribed using an electronic Prescribing and Administration system (iSOFT) which provided accurate data on time of administration. We compared patient outcomes before and after introduction of the unit. RESULTS: The general ward care (n = 20) and the Specialist Parkinson's Unit care (n = 24) groups had similar baseline characteristics. On the specialist unit: less Parkinson's medication was omitted (13% vs 20%, p < 0.001); of the medication that was given, more was given on time (64% vs 50%, p < 0.001); median length of stay was shorter (9 days vs 13 days, p = 0.043) and patients' experience of care was better (p = 0.01). DISCUSSION: If replicated and generalizable to other hospitals, reductions in length of stay would lead to significant cost savings. The apparent improved outcomes with Parkinson's unit care merit further investigation. We hope to test the hypothesis that specialized units are cost-effective and improve patient care using a randomized controlled trial design.
    • An update of stabilisation exercises for low back pain: a systematic review with meta-analysis.

      Smith, Benjamin (2014-12)
      BACKGROUND: Non-specific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long term sickness amongst the workforce and is associated with high levels of fear avoidance and kinesiophobia. Stabilisation (or 'core stability') exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment within the UK there is a lack of positive evidence to support its use. The aims of this systematic review update is to investigate the effectiveness of stabilisation exercises for the treatment of NSLBP, and compare any effectiveness to other forms of exercise. METHODS: A systematic review published in 2008 was updated with a search of PubMed, CINAHL, AMED, Pedro and The Cochrane Library, October 2006 to October 2013. Two authors independently selected studies, and two authors independently extracted the data. Methodological quality was evaluated using the PEDro scale. Meta-analysis was carried out when appropriate. RESULTS: 29 studies were included: 22 studies (n = 2,258) provided post treatment effect on pain and 24 studies (n = 2,359) provided post treatment effect on disability. Pain and disability scores were transformed to a 0 to 100 scale. Meta-analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain and disability with mean difference of -6.39 (95% CI -10.14 to -2.65) and -3.92 (95% CI -7.25 to -0.59) respectively. The difference between groups was clinically insignificant. When compared with alternative forms of exercise, there was no statistical or clinically significant difference. Mean difference for pain was -3.06 (95% CI -6.74 to 0.63) and disability -1.89 (95% CI -5.10 to 1.33). CONCLUSION: There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion.
    • A questionnaire survey comparing the educational priorities of patients and medical students in the management of multiple sclerosis.

      Gibson, Jeremy; Fakis, Apostolos (2014-12)
      OBJECTIVE: To compare the educational priorities patients and students raise concerning the management of multiple sclerosis (MS). DESIGN/SETTING: A single-centre comparative questionnaire survey conducted in a foundation trust hospital which provides teaching for one UK medical school. PARTICIPANTS: A total of 255 people with multiple sclerosis (pwMS) and 125 final year medical students attending a mandatory module were invited to participate. MAIN OUTCOME MEASUREMENTS: Questionnaires were developed and piloted for thisstudy and analysed on the basis of the International Classification of Functioning, Disability and Health terminology. RESULTS: Questionnaires were returned by 125 (50%) pwMS (age range 36-86 years; median 58) and 96 (77%) medical students (age range 22-37 years; median 23). The most commonly reported priority listed by people with MS and students concerned 'environmental contextual factors' (95.5% and 99%, respectively). PwMS focused primarily on the 'social and attitudinal aspects' of the environment (53.6%), while students expressed greater interest in the use of medications (91.7%) and investigations (14.6%) (p < 0.001). People with greater psychological or physical impact of the condition were more likely to prioritise 'health condition' topics. CONCLUSIONS: PwMS and medical students identify different topics when asked to list aspects of management of MS which they deem to be important for medical student teaching. These differences in educational priorities should be taken into consideration when teaching students about MS. The findings may also apply to other long-term neurological conditions and warrant further investigation.
    • Hospitalization in Parkinson's disease: a survey of UK neurologists, geriatricians and Parkinson's disease nurse specialists.

      Skelly, Robert; Brown, Lisa; Fakis, Apostolos (2015-03)
      INTRODUCTION: Care for people with Parkinson's admitted to hospital is often suboptimal and services for these patients vary. We conducted a national survey to document current service provision in the UK and to explore clinicians' views on standards of care and potential service improvements. METHOD: We used the mailing lists of British Geriatric Society Movement Disorder Section (BGS-MDS), British and Irish Neurologists' Movement Disorders Group (BRING-MD), and Parkinson's Disease Nurse Specialists Association (PDNSA) and invited participation by email with a link to an online survey (www.surveymonkey.com). The survey was posted in spring 2014 for six weeks. RESULTS: There were 93 respondents from at least 65 different hospitals. The estimated response rate was 19%. Respondents were: 35 consultant geriatricians; 21 consultant neurologists, 29 Parkinson's Disease Nurse Specialists (PDNS), 8 others. 81% respondents report their hospital has a PDNS. 79% have a geriatrician with an interest in Parkinson's. 54% have a Parkinson's clinical guideline, 16% a cohort/specialist ward for Parkinson's and 11% an electronic system for flagging Parkinson's admissions. 21% rated overall standard of care as poor. 61% were not confident that medications were given on time. Having a PDNS see all Parkinson's in-patients, flagging of Parkinson's admissions and having a Parkinson's outreach service were ranked most likely of 16 potential service developments to improve care. CONCLUSION: Care for Parkinson's in-patients is not highly rated by UK Parkinson's clinicians. Interventions to improve care need to be studied but wide variations in current service provision pose a challenge for future study design.
    • A randomised controlled trial on the effectiveness of a lateral glide cervical spine mobilisation on cervicobrachial (neck and arm) pain

      Salt, Emma (2015-05)
      Cervicobrachial (neck and arm) pain is a painful condition which, when chronic, leads to high levels of disability. Small-scale, short-term (<2 months follow-up) studies have identified that lateral glide mobilisation reduces cervicobrachial pain. However, long-term (>6 months) effectiveness of this intervention on cervicobrachial pain is unknown. Purpose: The main objective was to identify whether the lateral glide cervical mobilisation was effective in reducing pain levels in the long-term for patients with chronic cervicobrachial pain. Secondary objectives included evaluating effects of the lateral glide mobilisation on; patient perceived recovery, function and disability, cost, and harm. Methods: Ninety-nine participants with chronic cervicobrachial pain were recruited to the trial from an acute Hospital Trust in the United Kingdom. A randomised controlled trial was undertaken. Participants were randomised to receive lateral glide with selfmanagement (n = 49); or self-management alone (n = 50). Assessments were made on four occasions (at weeks 0 (baseline), 6, 26 and 52 post intervention). The primary outcome measure was the Visual Analogue Scale (VAS) for pain. Secondary outcomes measures included; the Global Rating of Change score (GROC), the Neck and Upper Limb Index score (NULI), the Short-from 36 (SF36) and cervical active range of motion (AROM). In addition to these outcomes the costs (quantity of physiotherapy appointments) and reported number of harmful effects in response to intervention were evaluated. An intention to treat approach was used. Analysis of Covariance evaluated between-group differences on VAS (pain) at the primary end point (52 weeks). Multi-level modelling was the main method used for longitudinal analysis of other continuous outcomes. Mann-Whitney tests were used to evaluate ordinal data. Results: Primary outcome: No statistically significant between-group differences were identified for pain (using VAS) at six weeks (p = 0.52; CI -14.72 to 7.44) and one year (p = 0.37; CI -17.76 to 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p < 0.001). Secondary outcomes: There was a statistically significant difference in NULI scores favouring self-management alone (p = 0.03), but no between-group differences for SF36 (p = 0.07). Cervical AROM indicated no statistically significant findings for most movements measured (p < 0.05). The cost of providing the lateral glide and self-management were twice that of providing self-management alone. Minor harm was reported in both groups, with 11% more harm being associated with the lateral glide. Conclusion(s): According to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE), there is low strength of evidence to support recommendation for the use of the lateral glide for chronic cervicobrachial pain in clinical practice. Future research in the form of a well-designed longitudinal observational study might identify clinically important differences among therapeutic options for specific sub-groups of patients with cervicobrachial pain. Implications: The results of this study indicate that in the long-term 'less is more' with a minimal intervention approach based on self-management strategies being a more cost-effective way to manage chronic cervicobrachial pain than hands-on manual therapy in the form of the lateral glide mobilisation.
    • The Influence of High-Impact Exercise on Cortical and Trabecular Bone Mineral Content and 3D Distribution Across the Proximal Femur in Older Men: A Randomized Controlled Unilateral Intervention.

      Summers, Greg (2015-09)
      Regular exercisers have lower fracture risk, despite modest effects of exercise on bone mineral content (BMC). Exercise may produce localized cortical and trabecular bone changes that affect bone strength independently of BMC. We previously demonstrated that brief, daily unilateral hopping exercises increased femoral neck BMC in the exercise leg versus the control leg of older men. This study evaluated the effects of these exercises on cortical and trabecular bone and its 3D distribution across the proximal femur, using clinical CT. Fifty healthy men had pelvic CT scans before and after the exercise intervention. We used hip QCT analysis to quantify BMC in traditional regions of interest and estimate biomechanical variables. Cortical bone mapping localized cortical mass surface density and endocortical trabecular density changes across each proximal femur, which involved registration to a canonical proximal femur model. Following statistical parametric mapping, we visualized and quantified statistically significant changes of variables over time in both legs, and significant differences between legs. Thirty-four men aged mean (SD) 70 (4) years exercised for 12-months, attending 92% of prescribed sessions. In traditional regions of interest, cortical and trabecular BMC increased over time in both legs. Cortical BMC at the trochanter increased more in the exercise than control leg, whereas femoral neck buckling ratio declined more in the exercise than control leg. Across the entire proximal femur, cortical mass surface density increased significantly with exercise (2.7%; p < 0.001), with larger changes (> 6%) at anterior and posterior aspects of the femoral neck and anterior shaft. Endocortical trabecular density also increased (6.4%; p < 0.001), with localized changes of > 12% at the anterior femoral neck, trochanter, and inferior femoral head. Odd impact exercise increased cortical mass surface density and endocortical trabecular density, at regions that may be important to structural integrity. These exercise-induced changes were localized rather than being evenly distributed across the proximal femur.
    • Physiotherapy treatment for atraumatic recurrent shoulder instability: early results of a specific exercise protocol using pathology-specific outcome measures

      Bateman, Marcus; Smith, Benjamin; Osborne, Sally (2015-10)
      BACKGROUND: Recurrent shoulder instability is usually caused by a traumatic event resulting in structural pathology, although a small subgroup of patients experience symptomatic recurrent shoulder instability without trauma. These patients are usually treated non-operatively but limited evidence exists regarding effective conservative management. In particular, there is a lack of reproducible exercise regimes and none that have been tested with condition-specific outcome measures. METHODS: A service evaluation was conducted over a 15-month period to assess our current treatment protocol used in the management of patients with atraumatic recurrent shoulder instability. The regime is reproducible with target-led progression milestones. Oxford Instability Shoulder Scores (OISS) and Western Ontario Shoulder Index (WOSI) scores were compared between baseline and final follow-up. RESULTS: Eighteen consecutive patients were included with mean follow-up of 4.5 months (range 1.35 months to 11.77 months). A statistically significant improvement was seen in both outcome measures. Mean OISS improved by 16.67 points (confidence interval: 12.34 to 20.99; p < 0.001). Mean WOSI improved by 36.76% (confidence interval: 28.46 to 45.06; p < 0.001). CONCLUSIONS: For this small group of patients with recurrent atraumatic shoulder instability, the Derby Shoulder Instability Programme produced significant improvements over the short term, with a high level of patient compliance. This is the first study to include pathology-specific patient-reported outcome measures to assess outcomes from a specific and reproducible exercise regime in this group of patients. The findings support further research to evaluate the exercise protocol in a larger group of patients over the longer term.