The use of a standardised outcome measure within the Musculoskeletal Physiotherapy Services across a Trust in Staffordshire

Purpose

Musculoskeletal (MSK) physiotherapy teams within Midlands Partnership NHS Foundation Trust (MPFT) historically used a variety of outcome measures including the EuroQol (EQ-5D-5L) alongside condition specific PROMS and a patient experience-reported experience measure, in line with Chartered Society of Physiotherapy (CSP) recommendations. However, teams used different outcome measures and data collection, inputting and analysis methods varied considerably.

In 2017, the MSK Health Questionnaire (MSK-HQ) was introduced and a data inputting and analysis calculator was developed following a consensus group exercise with the clinical and operational leads of MSK physiotherapy teams to facilitate the implementation of the MSK-HQ.

Over 6,000 complete data sets
(6,044 in February 2019) have been recorded since the introduction of the MSK-HQ.
Patients with duration of symptoms up to 2 weeks (N=109)
had the greatest improvement in MSK-HQ score (19.4)...
Data is consistent across all teams and demonstrates that over 80% of patients
achieve a significant clinical improvement following physiotherapy treatment.
Overall completion rates across MPFT are 10.2%;
these vary considerably between teams that have administrative support (19.1%) and teams that do not have administrative support (3.7%).

Approach

The MSK-HQ and the calculator were introduced gradually to all MSK physiotherapy teams within MPFT: teams with administrative support were the first implementers. The calculator was made available to the teams within the Trust's intranet system: designated administrative staff and the clinical and operational leads for each team were granted access. A standard operating procedure, in relation to using the calculator, and a data collection sheet, which was made available via the Electronic Patient Record, were produced to facilitate the implementation process.

Outcomes

Over 6,000 complete data sets (6,044 in February 2019) have been recorded since the introduction of the MSK-HQ. Overall completion rates across MPFT are 10.2%; these vary considerably between teams that have administrative support (19.1%) and teams that do not have administrative support (3.7%).

Data is consistent across all teams and demonstrates that over 80% of patients achieve a significant clinical improvement following physiotherapy treatment. Specifically, 5114 patients (84.6%) achieved an improvement equal to or greater than the minimal clinically important difference (MCID) for the MSK-HQ; whereas 866 patients (14.3%) had no clinically significant change and 64 patients (1.1%) had a clinically important deterioration. Patients with duration of symptoms up to 2 weeks (N=109) had the greatest improvement in MSK-HQ score (19.4), followed by those who had duration of symptoms 2-6 weeks (N=648) with average positive improvement of 17.6 whereas patients with duration of symptoms of over 1 year (N=1909) had the smallest improvement (13.1). Patients who achieved a significant clinical improvement had an average initial MSK-HQ score of 30 or lower whereas patients who did not had an initial score of 34 or greater.

The use of the calculator enhanced the implementation of a standardised outcome measure (MSK-HQ) and routine data collection on demographics, socioeconomic and health condition specifics. Therefore, it has provided a large dataset on outcomes of physiotherapy care, which allowed comparisons of different services across a large Trust.

Implications

The calculator enhanced the implementation and clinical use of a standardised outcome measure by providing clear guidance on data collection and interpretation of results. The tool became freely available to other NHS Trusts in November 2018 (Physiotherapy Frontline). It has been shared with over 45 Trusts (including Trusts in England, Scotland, Wales and Northern Ireland). Researchers, outcome measures developers and operational leads should consider providing such tools when new outcome measures are released together with the provision of appropriate administrative support to increase clinical uptake and implementation.

Additional notes

This work was presented at Health Services Research UK Conference 2019 and at Physiotherapy UK 2019