Measuring Outcomes in MSK: Analysis of Practice and Recommendations for Development

Purpose

Clinical outcomes are a vital part of understanding quality in healthcare. As part of this, a large Musculoskeletal (MSK) physiotherapy department in Hampshire has measured the clinical outcomes for all of the patients referred into the service. The outcome tool employed was the MSK-HQ (Musculoskeletal Health Questionnaire), a 14 point outcome measure developed to identify and measure the multi-dimensional aspects of musculoskeletal pain. A multi-dimensional tool was chosen to reflect the complexities and co-morbidities that patients with musculoskeletal conditions commonly present with. The MSK-HQ is a tool that can identify the impact that physiotherapy has had on patient health and well-being as opposed to their musculoskeletal complaint in isolation. The aim was to use the data to improve working practices within the service.

Approach

Pre and post scores were recorded. These results were then presented graphically according to whether they had made a clinically significant improvement or not. An increase of six points or more has been taken as a clinically significant change following correspondence with the MSK-HQ authors. This is presented for the service as a whole but can also be broken down by team, body part and/ or clinician. The clinic notes of patients not showing a clinically significant improvement were scrutinised to establish what lessons could be learnt to inform further practice.

Outcomes

Data recorded from June 2017 to January 2018 across all sites demonstrated consistency in results with a range of 73-81% of patients recording a clinically significant improvement, the modal score being 78%, the mean score 77.75%. There was no significant difference between body parts. Differences in outcomes between sites were noted. 67% of patients demonstrated a clinically significant outcome in the lowest scoring centre and 90% in the highest.

From reviewing the notes of patients not achieving a clinically significant improvement, the following points were noted:

  • Many patients received optimum management despite failure to achieve clinically significant improvement.
  • Initial improvements in patient pain and function were not always followed up with progression of rehabilitation.
  • Treatment plans needed further adaptation when progress was not made.

Further emphasis of early agreed goal setting was required

Implications

These observations demonstrate that the MSK HQ pre and post scores can be employed to observe patterns of performance. This has been used to promote service development by identifying areas requiring closer attention or aspects of good practice that can be disseminated to other teams.

The outcome scores have been used in supervision for staff to identify particular development needs and in appraisals for objective setting. A greater emphasis has now been placed on later stage rehabilitation after identification that this area needed improvement for certain patients. Clinical leads are also now working more closely with sites showing lower improvement scores to support their patient management.

Consistent performance measurement promotes transparency, allows benchmarking of practice and provides a clear performance indicator for stake holders. Further audits will cross reference clinical outcomes with prognostic stratification tools to ascertain if specific groups of patients require closer attention.

Fund acknowledgements

This work was not funded.

Additional notes

This work was presented at Physiotherapy UK 2018.