Patient reported outcomes in a large cohort of patients receiving osteopathic care in the United Kingdom (original) (raw)
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2010
Notwithstanding the limitations outlined above, piloting the SDC in practice produced a set of pilot data that could represent a useful first step to developing a profile of UK osteopathic practice. Key findings about the SDC tool included: The SDC tool developed with and by the profession performed extremely well. The tool was clear and easy to complete and generated meaningful data. Practitioner compliance was high with 86% of those volunteering actually collecting data, and data collection forms were completed thoroughly and validly. Practical issues for completion were cited including that some patients were in considerable pain and, understandably, did not want the added burden of having to complete a form prior to their consultation. Other reports included that patients were simply short of time either attending in their lunch time or on the way to other appointments. The data collection form has been amended to reduce the burden on patients. A few questions were reported to have ambiguous wording and these have been reworded to make the meaning clearer. Key findings from the SDC pilot data included: Patient demographics 56% of patients were female and 43% were male 93.9% of patients were white The age range of patients was from 5 days old to 93 years old Occupational data showed that 47.9% were in full time employment, and 10.9% selfemployed full time; 19% were retired, and 14.2% worked part time as either employed or selfemployed, and 6.3% were not currently employed GP referral was reported by 6.3% of patients A total of 48.1% of patients reported between 1 and 4 visits to their GP concerning their current symptoms, and 29% had undergone previous NHS treatment or investigation Access to treatment was rapid. A total of 16.8% of patients were offered an appointment on the same day; a further 54.2% were offered appointments within the next 72 hours. Symptom profiles Space was provided to record up to three symptom areas. Lumbar symptoms were the most common (36%), followed by cervical spine (15%), sacroiliac/pelvic/groin (7.9%), head/facial area (7%), shoulder (6.8%), and thoracic spine (6%) Additional symptoms were recorded in 2.9% of patients Symptom duration for the current episode was categorised and included acute (<6 weeks) in 51%; subacute (7-12 weeks) in 15%, and chronic (13 weeks or more) in 32%. A total of 2% of patients did not respond A total of 797 patients reported the presence of comorbidities, as diagnosed by their medical practitioner. The most common of these was hypertension (11.7%), followed by asthma (6.6%), and arthritis (5.7%) Osteopathic patient management Practitioners recorded that 97% of patients were suitable for osteopathic treatment Treatments given to patients were varied and complex. Soft tissue treatment was the most common (78%), followed by articulation (72.7%), and HVLA thrust/manipulation techniques (37.7%). These were followed in frequency by cranial osteopathy (25.8%), muscle energy (18.3%), and functional technique (13.7%) Additional interventions in patient management included education (35.8%), and exercise (22.6%). A variety of self-management strategies were discussed with 88% of patients Outcomes of treatment Simple patient-reported outcomes were recorded on the data collection sheet. These were drawn from the literature but are not validated measures and their findings should be treated with caution. After the first appointment, the majority of patients (59.4%) reported no complications of treatment. The most common complications within the first 24-48 hours after treatment were increased stiffness (18%), increased pain (14%), and fatigue (6.6%). After the second and subsequent appointments, 77.3% of patients reported no complications of treatment. Only a small number of patients (10.4%) were off work at first presentation; of these 5.3% were able to return to work after one treatment, and 3.1% after two treatments. In cases where patients underwent onward referral, 88% were to their GP for further investigation, and 13% were to a hospital consultant.
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)
Patient-Reported Outcomes in Orthopaedics
Journal of Bone and Joint Surgery, 2018
Patient reported outcome measures (PROMs) are key tools when performing clinical research and PROM data are increasingly used to inform clinical decision-making, patient-centered care, health policy and more recently, reimbursement decisions. PROMs must possess particular properties before they are used. Thus purpose of this paper is to give an overview of PROMs, their definition, how their evidence can be assessed, how they should be reported in clinical research, how to choose PROMs, the types of PROMs available in orthopaedics, where these measures can be found, PROMs in orthopaedic clinical practice and what are some key next steps in this field. If PROMs are used in accordance with the guidance in this article, I believe we will gain considerable insight into PROMs in orthopaedics and will advance this field in a way that can contribute to science, improve patient care and save considerable resources. Why Patient Reported Outcome Measures? The development, testing and implementation of tools to aid in the measurement of phenomena in medicine are central to clinical practice and clinical research. Measurements in clinical practice form the basis of diagnosis, prognosis, evaluation and follow-up. Measurements in clinical research allow for the collection of data that afford us the information needed to test specific hypotheses [1]. The field of measurement in medicine includes both psychometrics and clinimetrics [2-4]. But, it has been argued that there is little distinction between these two areas [3]. Throughout this paper the term psychometrics will be used and more generally the term measurement to refer to these fields.
From the standpoint of the healthcare provider, multiple contributors to a patients’ clinical presentation, difficulty with translating research trials into one’s practice, conflicting clinical practice guidelines, and an ever increasing volume of literature compounds the difficulty for clinicians to determine best care, which addresses the biological, psychological and sociological health domains. If clinicians are adopting a patient centred model of care –routine use of validated patient reported outcome measures (PROMs) which elicit patients’ views of their symptoms, their functional status, their health-related quality of life (HRQoL), all of which encompass several domains – are paramount. This commentary advocates for the use of PROMs on a wider scale than is currently described in the literature. Background information on PROMs is provided along with suggesting important questions to ask as a clinician when implementing these in practice. The current commentary addresses these questions and describes the implementation of PROMs using published case studies that describe osteopathy management for a variety of conditions.
The OPEn project investigating patients' expectations of osteopathic care
The General Osteopathic Council commissioned this research as part of a wider programme of work to enhance knowledge of the attitudes, needs and concerns of the public and patients who seek the care of osteopaths. The GOsC envisages that the findings the study will inform GOsC policy development, the provision of information to patients and the public, and guidance to osteopaths. The main aim of this study was to gain an understanding of the expectations of patients receiving osteopathic care, and to quantify the extent to which ...
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...
Physiotherapy Canada, 2019
Purpose: Patient-reported outcome measures (PROMs) have the potential to enhance the quality of health care but, as a result of suboptimal implementa tion, it is unclear whether they fulfil this role in physiotherapy practice. This cross-sectional study aimed to identify the factors influencing PROM use in Dutch private physiotherapy practices. Method: A total of 444 physiotherapists completed a self-assessment questionnaire and uploaded the data from their electronic health record (EHR) systems to the national registry of outcome data. Univariate and multivariate ordinal logistic and linear regression analy sis were used to identify the factors associated with self-reported PROM use and PROM use registered in the EHR systems, which were derived from the self-assessment questionnaire and from the data in the national registry, respectively. Five categories with nine independent variables were selected as potential factors for regression analysis. The similarity between self-reported and registered PROM use was verified. Results: On the basis of self-report and EHR report, we found that 21.6% and 29.8% of participants, respectively, used PROMs with more than 80% of their patients, and we identified the fac tors associated with PROM use. Conclusions: The factors associated with PROM use are EHR systems that support PROM use and more knowledge about PROM use. These findings can guide future strategies to enhance the use of PROMs in physiotherapy practice.
BMJ open, 2016
To determine whether an entirely electronic system can be used to capture both patient-reported outcomes (electronic Patient-Reported Outcome Measures, ePROMs) as well as clinician-validated diagnostic and complexity data in an elective surgical orthopaedic outpatient setting. To examine patients' experience of this system and factors impacting their experience. Retrospective analysis of prospectively collected data. Single centre series. Outpatient clinics at an elective foot and ankle unit in the UK. All new adult patients attending elective orthopaedic outpatient clinics over a 32-month period. All patients were invited to complete ePROMs prior to attending their outpatient appointment. At their appointment, those patients who had not completed ePROMs were offered the opportunity to complete it on a tablet device with technical support. Matched diagnostic and complexity data were captured by the treating consultant during the appointment. Capture rates of patient-reported and...
Patients’ expectations of private osteopathic care in the UK: a national survey of patients
BMC Complementary and Alternative Medicine, 2013
Background: Patients' expectations of osteopathic care have been little researched. The aim of this study was to quantify the most important expectations of patients in private UK osteopathic practices, and the extent to which those expectations were met or unmet. Methods: The study involved development and application of a questionnaire about patients' expectations of osteopathic care. The questionnaire drew on an extensive review of the literature and the findings of a prior qualitative study involving focus groups exploring the expectations of osteopathic patients. A questionnaire survey of osteopathic patients in the UK was then conducted. Patients were recruited from a random sample of 800 registered osteopaths in private practice across the UK. Patients were asked to complete the questionnaire which asked about 51 aspects of expectation, and post it to the researchers for analysis. The main outcome measures were the patients-perceived level of expectation as assessed by the percentage of positive responses for each aspect of expectation, and unmet expectation as computed from the proportion responding that their expectation "did not happen". Results: 1649 sets of patient data were included in the analysis. Thirty five (69%) of the 51 aspects of expectation were prevalent, with listening, respect and information-giving ranking highest. Only 11 expectations were unmet, the most often unmet were to be made aware that there was a complaints procedure, to find it difficult to pay for osteopathic treatment, and perceiving a lack of communication between the osteopath and their GP.