Even if providing additional out-of-hours physiotherapy services is effective, the issue of who pays remains.19 Are additional physiotherapy services worth the cost? Several studies have investigated the cost-effectiveness of

providing additional physiotherapy at weekends. A review of the health economics of providing rehabilitation concluded that it was cost-effective to provide additional rehabilitation therapy for people with Forskolin supplier stroke or orthopaedic diagnoses.20 Recently, a health economic analysis alongside a randomised controlled trial found that there were likely cost savings in providing additional Saturday rehabilitation to a mixed cohort of inpatients.21 Primarily through a reduction in

length of stay, costs to the health service were reduced, even though there was the added expense of employing physiotherapists and occupational therapists at the weekends. One of the challenges is that the part of the health system that accrues the savings may not be the same part that provides the immediate budget for staffing the additional services. A barrier to providing a 7-day physiotherapy service may be the attitudes of physiotherapists and the perceived stress of working out of regular hours. Physiotherapists who are used to working Monday to Friday may be less willing FG-4592 nmr to work at weekends or in the evenings. However, it was found in our trial that there was no difficulty in staffing a Saturday rehabilitation service.7 and 20 Part of the issue may be in expectations established during training. Including out-of-hours clinical placements during training, similar to nurses and doctors, may lead to positive attitudes and acceptance of working in a 7-day service. It may also help to structure work schedules to include a day off at the weekend, which can be important in helping health professionals to recover from work stress.22 In conclusion, a

7-day physiotherapy service in some form and in some areas has long been a part of practice. There is now emerging evidence that providing additional out-of-hours physiotherapy services (including Ergoloid at the weekends) can help to improve patient outcomes and be cost-effective. As health professionals providing an important service in the health system, it seems that physiotherapists should be working when other members of the healthcare team are working and at a time that provides care when patients need it. The challenge is to provide evidence in areas of practice where evidence remains scant, and to change the culture and embed the notion that providing additional physiotherapy through a 7-day service can be a routine, beneficial and desirable part of practice.