Robert Millett finds out how to get the best value from the evidence you collect
Research is in the spotlight as the prospect of GP commissioning makes service provision more competitive.
Collecting clinical evidence to demonstrate the value of physiotherapy is more significant than ever – and can be a visible sign of your CPD. But how can you ensure that your work has the right impact?
‘It is essential that all physiotherapists engage in the collection of data in a standardised way, and consider ways to integrate technology into their day-to-day work, as GPs have for many years,’ says CSP professional adviser Ruth ten Hove.
Not only can collected evidence highlight achievements, it may also act as useful clinical feedback. Objective data enables clinicians to evaluate the effectiveness of their interventions and improve their practice.
Yet many services do not collect enough relevant data. Others fail to make proper use of the evidence they do collect – often because they lack the clinical capacity and IT support to analyse or audit the research.
Reluctance to engage with evidence collection may stem from not knowing the best collection methods or what type of evidence to focus on.
To remedy this, a number of projects are under way. The CSP has embarked upon a three-year programme which aims to provide a reference point to support and share ideas on standardised data collection, patient-reported outcome measures and clinical audits.
‘Different services are using different instruments to collect data,’ says Professor Nadine Foster, professor of musculoskeletal health in primary care at Keele University. ‘That means we can’t compare the data across fields. We need some uniformity as we move forward.’
In response to this challenge, the CSP aims to complete a range of standard datasets, including one on continence, currently being piloted at locations across the country, and an outpatient musculoskeletal services dataset that will be completed by July. These will include a range of validated clinical and patient-reported outcome measures that will be recommended by the CSP.
‘Services routinely collect data on things like waiting times, numbers of patients seen or number of treatment sessions,’ says Professor Foster. ‘But when asked about clinical outcomes, they are often unable to provide that information because they are not routinely collecting outcome data.’
In Scotland, Professor Tracy Howe recently led a national consensus development exercise, to establish agreed key outcome measures for MSK conditions. This work will be published shortly.
A number of academic institutes are also developing specific ‘Physiotherapy patient-reported outcome measures’ (PPROMs). One such project, at Keele University, is led by physiotherapy lecturer Dr Jonathan Hill.
‘The first objective of the study is to work out what outcomes are the most important to consider in the measurement of MSK conditions,’ says Dr Foster. ‘Is it pain, is it daily function, is it coping with the problem, is it returning to work? Or could it be self-efficiency or confidence in managing the condition?’ fl
The CSP is keen to hear from members about good practice in data and technology usage, so it can be shared with the whole profession. Contact Ruth ten Hove, email@example.com
Researchers share their tips
- Accept that using data to demonstrate the value of your work is part of your job.
- Target areas where performance is not as good as expected.
- If the results of your research lead you to make changes in your practice, do a further evaluation later to ensure that any changes made have improved practice.
- Be really clear about the questions you want answered, and target only the data which will give you those answers.
- Understand your local population.
- Are there people that are not seen and ought to be?
- Are there groups of patients that are seen too often and could, without harm, be seen less often?
- Do you know how many referrals you get per 100,000 (or per 1,000) in your population or patient group?
When you are considering what data to collect, a starting point is to think about three areas:
- What overall experience has the patient had of your service?
- What effect has the physiotherapy intervention had on the particular problem that the patient presented with (specific outcome measure)?
- What effect has the intervention had on the patient’s quality of life (generic outcome measure)?
Ensure that you capture data showing the effects of your service, both for individuals and the patient group.
- Change in work status. (Is a patient on sick leave back at work by the end of treatment? Are they coping well or on restricted duties?What proportion of your patients return to work?).
- Prevent hospital admission or surgery
- Reduce length of stay
- Cut medication costs
- Link to reducing accidents or falls
- Increase in physical activity.
- Make good friends with your audit department if you work within a trust.
- They can ease the workload significantly and offer excellent advice.
The same is true of the IT department:
- a proper IT infrastructure will help.
- Collect data electronically. Find cheap hardware; many standard software programmes will support you.
- Make links to local patient organisations.
Carrying it out
- Measure change, so that you will be able to show a before and after.
- Collect and develop patient stories and experiences.
- Adherence to set sample sizes and limited time periods can make data collection much more manageable.
- Brief outcome measures can be used on every patient to evaluate clinical practice. However, a structured programme of audit, research and service evaluation – scheduled throughout the year – can make evidence collection more manageable and avoids overloading patients with questionnaires. This can be advantageous when you are looking at lengthier outcome measures, which need time to analyse.
- Some physiotherapy patient-reported outcome measures can be filled in by the patient and posted in, which can save time in the clinic.
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