Patient-reported outcome measures (PROM's) following Secondary Care NHS Musculoskeletal Physiotherapy

Purpose

The aims of this report were:

  • to provide a large, transparent dataset from which other organisations can benchmark clinical outcomes
  • to provide the first documented large-scale musculoskeletal (MSK) physiotherapy outcomes evaluation using the MSK Health Questionnaire (MSK-HQ)
  • to compare clinical outcomes of MSK physiotherapy with NHS England average clinical outcomes associated with surgical procedures.

Approach

The project was based at a large NHS Teaching Hospital. As a service evaluation, according to the HRA decision-making tool and confirmed by our audit department, Ethical Committee approval was not required.

The following three paper-based health-related PROMs were collected pre and post MSK physiotherapy; EQ-5D-5L index, EQ-VAS; scored between -0.594 to 1, and 0 to 100, worst to best respectively and MSK-HQ. The changes in EQ-5D-5L and EQ-VAS scores were compared to the finalised 2016-2017 NHS England PROMs data for surgery accessed via the NHS Digital website. While there was no comparable database to which MSK-HQ comparisons could be made, the threshold for a minimum clinically important difference has been set at 6 points.

Outcomes

Data from 3042 patients (1904 female: 1138 male) with a mean age of 50.93± years were collected between January 2016 and January 2018. Referral sources included Trauma and Orthopaedics, Pain and Occupational Health services.

The EQ-5D-5L index improved in 90.04%, worsened in 2.98% and remained unchanged in 6.98% of patients (n=2149) with a change of 0.224 points (SD:0.0785). The EQ-VAS improved in 88.73%, worsened in 3.83% and was unchanged in 7.44%. Mean improvement was 26.11% with a wide variation (77.78) from n=886. The MSK-HQ improved in 96%, worsened in 2.89% and was unchanged in 1.04% of patients with a mean increase of 15.88 points (SD:8.96) representing a 28.36% improvement change from n=884.

Improvements were noted across patients recovering from knee replacement, shoulder, ankle, wrist fracture, back pain and knee osteoarthritis. Knee replacement patients scored the highest improvement in scores across all questionnaires (EQ-5D-5L Index=0.303(SD:0.186) (n=74), EQ-VAS=26.36%(SD:3.53%) (n=58), MSKHQ=21.28(SD:2.12) (n=64)).

Physiotherapy intervention for non-surgical and atraumatic conditions also showed improvements, e.g. back pain intervention (EQ-5D-5L Index=0.218(SD:0.086) (n=218), EQ-VAS=21.73%(SD:35.36%) (n=108), MSKHQ=11.00(SD:6.36) (n=118) and shoulder pain intervention (EQ-5D-5L Index=0.212(SD:0.110) (n=129), EQ-VAS=19.57% (SD:35.36%) (n=54), MSKHQ=15.83(SD:14.68) (n=55)). In comparison, the finalised PROMS average health changes were lower for groin hernia repair (EQ-5D-3L Index=0.081, EQ-VAS -0.4) and varicose vein surgery (EQ-5D-3L Index =0.093, EQ-VAS -0.1).

Implications

Results suggest that physiotherapy has a positive and clinically significant impact on general and MSK health. Improvement levels compare well with other commissioned interventions, notably groin hernia repair and varicose vein surgery; although comparison may be influenced by variable data collection processes and questionnaire responsiveness. A collaborative approach to the development of a national database which evaluates MSK Physiotherapy care is recommended. This may provide powerful evidence of physiotherapy's effectiveness and support the profession during healthcare commissioning in a time of financial austerity.

Fund acknowledgements

No external funding was received to conduct this report. Support was provided by Nottingham University Hospitals NHS Trust Therapies Department in terms of staff time and ICT resources.

Additional notes

This work was presented at Physiotherapy UK 2018.