Background and aims It has long been suspected that the rehabilitation available to patients with primary malignant bone sarcoma (PMBS) is not always adequate and appropriate to their needs. The National Specialised Commissioning Group (NSCG) commissioned the 2012–2013 Quality Improvement Development and Innovation Scheme (QIDIS) project (rehabilitation programme) to review the current rehabilitation services available to the PMBS patient groups at all five bone sarcoma specialist centres in England. Methods The 220 participating PMBS patients were provided with questionnaires, and clinicians at the participating centres were interviewed face-to-face. Patients were analysed in groups: upper limb and lower limb, and in the subgroups major and minor surgery. The groups were compared according to their preferences for rehabilitation interventions, the additional rehabilitation post-surgery that they felt was or would have been beneficial, and by their Toronto Extremity Salvage Scores (TESS). Results Out of the 220 questionnaires provided, 136 questionnaires were returned (a 62% response rate). This study identified the lack of the following factors to be associated with PMBS patients' rehabilitation and functional outcomes: equitable access to rehabilitation treatments; suitable rehabilitation admission; allied health professional (AHP) clinical progress reviews; a reliable and equitable referral system with robust referral criteria; a rehabilitation case coordinator; a nationally accepted functional outcome measure; and patients' involvement in the management of their rehabilitation to achieve the best possible outcome. Conclusions This study identified gaps in the current rehabilitation services for PMBS patients and makes several recommendations. The authors designed a postoperative model of rehabilitation, which identifies a number of target areas that may improve current rehabilitation services and enable rehabilitation professionals to assess a PMBS patient's needs to identify the most suitable rehabilitation programme for them.

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These data shows that small service developments can make a big impact on palliative patients and the opportunity to exercise can and should be made available to all patients.

BackgroundCollection of outcome measures within hospice services is challenging due to the varied conditions and diverse trajectories patients follow. Within The Spring Centre there was no standardised outcome measure in place and therefore no consistent validated evaluation of the impact of services on the health and wellbeing of patients.AimTo assess if the Wellbeing Star is a viable outcome measure tool to evaluate the impact of out-patient services within The Spring Centre on patients’ health and wellbeing.MethodFollowing recommendation from West Hertfordshire Macmillan Wellbeing and Rehabilitation Project and extensive review of literature and similar services, the Wellbeing Star, a validated and well researched measure, was deemed to be the best potential tool for our patients. After funding by Macmillan, formal training was undertaken and Star licences obtained. Wellbeing Stars are completed at first assessment with further reviews at three months and nine months (or as near to these dates as possible). This is an ongoing evaluation.Results27 patients’ data was analysed.An increase in all points of the Star was noted.The greatest improvements were in ‘Feeling positive’, ‘Managing your symptoms’, ‘Your lifestyle’ (59%, 56%, 56%).The smallest improvements were in ‘Money’, ‘Where you live’ (22%, 26%).ConclusionsUsing the Wellbeing Star has been beneficial in embedding a measure within our practice, showing a positive impact of services on patients. Some limitations are evident and timing of reviews is challenging with the demographics of patients using services. We remain undecided on its appropriateness as deterioration due to disease rather than the services not meeting needs is not illustrated. We will continue to collect data for a further nine months and then assess if it adequately meets the needs of hospice out-patient services. The cost of using the Wellbeing Star will also need to be considered.