A descriptive analysis of the contents of Care Response, an international data set of patient-reported outcomes for chiropractic patients (original) (raw)
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Collecting and predicting patient reported outcomes in chiropractic practice
2016
2 reports a study looking at the impact of this missing information on the generalisability of the overall data collected. Non respondents to an emailed assessment 30 days after starting care were less likely to have had >30 days pain in the last year but were not otherwise significantly different from those returning electronic assessments. In a telephone survey comparing respondents and non respondents, patients global impression of change (PGIC) scores were identical and there was no statistical difference in pain scores. Paper 3 sought to ascertain if patient less likely to do well with chiropractic care could be identified from data routinely collected at baseline in chiropractic practice. Longer duration of symptoms at presentation, females with higher social disability scores and males with more adverse scores for depression were found less likely to describe themselves as much improved a month after starting care. In investigating for a relationship between outcome and co...
Objective: The purpose of this study was to test the feasibility of collecting valid and widely used health outcomes, including information concerning cost of care, using a Web-based patient-driven patient-reported outcome measure (PROM) collection process within a cohort of UK chiropractic practices. Methods: A Web-based PROM system (Care Response) was used. Patients with low back and neck pain were recruited from a group of chiropractic practices located in the United Kingdom. Information collected included demographic data, generic and condition-specific PROMs at the initial consultation and 90 days later, patient-reported experience measures, and additional health seeking to estimate costs of care. Results: A group of 33 clinics provided information from a total of 1895 patients who completed baseline questionnaires with 844 (45%) completing the measures at 90-day follow-up. Subsequent outcomes suggest that more than 70% of patients improved over the course of treatment regardless of the outcome used. Using the baseline as a virtual counterfactual with respect to follow-up, we calculated quality-adjusted life years and the cost thereof resulting in a mean quality-adjusted life years gained of 0.8 with an average cost of £895 per quality-adjusted life year. Conclusion: Routine collection of PROMs, including information about cost, is feasible and can be achieved using an online system within a clinical practice environment. We describe a Web-based collection system and discuss the choice of measures leading to a comprehensive understanding of outcomes and costs in routine practice. (J Manipulative Physiol Ther 2016;39:31-41)
Who will get better? Predicting clinical outcomes in a chiropractic practice
Objective: To determine if any characteristics exist in baseline data collected from chiropractic patients attending a private chiropractic practice that might predict success with chiropractic treatment. Design: Prospective cohort study. Subjects: Seven hundred and eighty-eight patients with low back pain (LBP) eligible for chiropractic treatment attending a private chiropractic clinic. Methods: Baseline Bournemouth Questionnaire (BQ) scores were collected together with patient gender and duration of symptoms. Outcomes were BQ scores and Patient Global Impression of Change (PGIC) scores at 4 and 12 weeks. Patients were categorised as 'better' if they chose the top two items of the scale. Odds ratios (OR) were calculated to detect potential predictors of outcome. Results: Baseline BQ scores were higher in acute patients with females tending to score higher particularly in depression. Around 74% of patients get better at 4 weeks with a statistically and clinically significant drop of 27 points on the BQ. Further improvement was minimal up to 12 weeks. Having low back pain for less than 4 weeks reduced the risk of poor recovery at 4 and 12 weeks [OR 0.56 (95% CI 0.36-0.88) and 0.41 (95% CI 0.26-0.67)]. In this group low depression scores were also associated with better outcomes in male patients [OR 0.1 (95% CI 0.01-0.55)] while low social disability scores were associated with better outcomes in females [OR 0.1 (95% CI 0.01-0.94)]. Conclusion: Different subgroups of LBP patients that are likely to succeed with chiropractic intervention can be identified using routinely collected data in a chiropractic practice. Duration of symptoms, found here as a predictor, is in agreement with other larger studies although some predictors are unique to this practice population. Further research is needed exploring the possible differences between patients with different duration of other conditions and the potential influence of gender.
Journal of manipulative and physiological therapeutics, 2016
The purpose of this study was to test the feasibility of collecting valid and widely used health outcomes, including information concerning cost of care, using a Web-based patient-driven patient-reported outcome measure (PROM) collection process within a cohort of UK chiropractic practices. A Web-based PROM system (Care Response) was used. Patients with low back and neck pain were recruited from a group of chiropractic practices located in the United Kingdom. Information collected included demographic data, generic and condition-specific PROMs at the initial consultation and 90 days later, patient-reported experience measures, and additional health seeking to estimate costs of care. A group of 33 clinics provided information from a total of 1895 patients who completed baseline questionnaires with 844 (45%) completing the measures at 90-day follow-up. Subsequent outcomes suggest that more than 70% of patients improved over the course of treatment regardless of the outcome used. Using...
Journal of Chiropractic Medicine, 2014
The purpose of this study was to test the utility of Patient-Reported Outcomes Measurement Information System (PROMIS) as a resource for collecting data on patientreported outcomes (PRO) within academic health centers at a chiropractic college; and, to describe changes in PRO following pragmatic chiropractic care incorporating instrumentassisted soft tissue mobilization (IASTM) on pain symptoms. Methods: This was a pre-post intervention design without a control group (case series) involving 25 patients (14 females and 11 males; 40.5 ± 16.39 years, range 20-70 years) who completed their chiropractic care and their baseline and post-treatment pain assessments. The pragmatic chiropractic care intervention included both spinal manipulation and IASTM to treat pain symptoms. PRO's were collected using PROMIS to measure pain behavior, pain interference and pain intensity. Results: The average pre-post assessment interval was 33 ± 22.5 days (95% CI, 23-42 days). The durations of treatments ranged from one week to 10 weeks. The median number of IASTM treatments was six. Pre-post decreases in T-scores for pain behavior and pain interference were 55.5 to 48.4 and 57.7 to 48.4, respectively (P b .05). Only 12 patients had a baseline T-score for pain intensity greater than 50. The pre-post decrease in pain intensity T-scores for these 12 patients was from 53.4 to 40.9. Conclusion: Within the limitations of a case series design, these data provide initial evidence on the utility of PROMIS instruments for clinical and research outcomes in chiropractic patients.
Journal of Manipulative and Physiological Therapeutics, 2005
Objective: To investigate the Bournemouth Questionnaire (BQ) as a baseline, monitoring of progress, and prognostic instrument in chiropractic patients with persistent low back pain (LBP). Study Design: Predictive and concurrent validation study. Study Participants and Setting: One hundred fifteen Norwegian chiropractors collected prospective data on 875 patients with persistent LBP, defined as LBP for at least 2 weeks at baseline and a minimum of 30 days totaling within the preceding year. Methods: Data collection took place at first consultation, fourth visit, and 3 months using the BQ, the revised Oswestry questionnaire, and a 10-point pain box scale. Follow-up at 12 months included the BQ, Oswestry questionnaire, and additional questions on the number of days with LBP and the number of days off work in the past year. Data Analysis: Frequency of reporting of each 7 items in the BQ at baseline was identified as median value with 10th and 90th percentiles. Concurrent analyses of the 2 questionnaires were made at the 4 points in time with calculation of mean differences with limits of agreement together with Bland-Altman plots. Logistic regression was used to identify and compare the predictive values of the questionnaires and to test the relevance of each individual item in the BQ. Results: The median baseline values of the 7 items in the BQ ranged from 2 to 5. The 2 questionnaires did not agree on patients' status, and mean differences between the Oswestry questionnaire and the BQ were largest when patients reported higher scores. The predictive values for the 2 questionnaires were low, with no significant difference between the 2. The predictive value of the BQ could be improved by removing most of the 7 items. Certain items can predict specific outcomes. Conclusions: The BQ is not a useful instrument to identify baseline status, monitor progress, or predict the 1-year progress in chiropractic patients having persistent LBP. However, certain individual items are useful to predict specific outcomes. (J Manipulative Physiol Ther 2005;28:219-227)
Outcome measures and their everyday use in chiropractic practice
2010
OBJECTIVES To describe the extent to which chiropractors utilize standardized outcome and various clinical measures to systematically document patients' baseline health status and responses to treatment, with particular consideration being given towards quantifiable outcome instruments. STUDY DESIGN Cross-sectional mailed survey. PARTICIPANTS Registered chiropractors in the province of Saskatchewan. METHODS A survey was mailed to all registrants of the Chiropractors' Association of Saskatchewan. Respondents graded their frequency of using various standardized pencil-and-paper instruments and functional chiropractic, orthopaedic and neurological tests in the contexts of both the initial intake assessment ('always,' 'commonly,' 'occasionally,' or 'never') and the course of subsequent treatment (after 'each visit,' after '9-12 visits,' 'annually,' when patient 'not responding,' on 'dismissal/discharge,' ...
Chiropractic & manual therapies, 2014
The use of patient-reported questionnaires to collect information on costs associated with routine healthcare services, such as chiropractic, represents a less labour intensive alternative to retrieving these data from patient files. The aim of this paper was to compare patient-report versus patient files for the collection of data describing healthcare usage in chiropractic clinics. As part of a prospective single cohort multi-centre study, data on the number of visits made to chiropractic clinics determined using patient-reported questionnaires or as recorded in patient files were compared three months following the start of treatment. These data were analysed for agreement using the Intraclass Correlation Coefficient (ICC) and the 95% Limits of Agreement. Eighty-nine patients that had undergone chiropractic care were included in the present study. The two methods yielded an ICC of 0.83 (95% CI = 0.75 to 0.88). However, there was a significant difference between the data collectio...