How you can use NIHR's review to change your practice
In part two, Lisa Osborn-Jenkins explains how the evidence in the Moving Forward themed review can be used by any physiotherapist to change practice
Evidence for all physiotherapy settings
We all see patients with musculoskeletal pain and dysfunction. One in four people is affected by musculoskeletal conditions and it is the leading cause of pain and disability in the UK. As the number of people living with multimorbidity grows, we need to share skills and knowledge between our physiotherapy specialities. Four out of five people with osteoarthritis have at least one other long-term condition such as cardiovascular disease or depression. Equally, we know that pain can limit patients’ ability to engage in other physiotherapy rehabilitation. All physiotherapists could use the Moving Forward review to help them to work with their patients on managing pain, increasing activity and self-efficacy.
Outcome measures: why are they important?
Patient-reported outcome measures (PROMs) may seem like a strange place to start, but without this baseline, how do we know how effective we are? Choosing an effective tool to use can be difficult. The Moving Forward review highlights the Musculoskeletal Health Questionnaire (MSK-HQ) which identifies key domains for monitoring musculoskeletal health status. This measure is helpful in assessing changes in patient outcome and promoting quality improvement.
The MSK-HQ has good reliability and validity, is acceptable to patients and clinicians and has been tested in different settings. The trust I work for quickly adopted this PROM in our musculoskeletal therapy outpatient settings. Having embedded this in practice, we have a data set to demonstrate effectiveness, promote our services, cement a culture of audit and service improvement, and drive in-service training programmes. Analysing data enables us to study outcomes trends in certain patient groups, which may shape future services.
As a clinician, using the MSK-HQ has changed my practice, offering a starting point for a patient-centred discussion on problems, goals and tailoring care. Patients have commented that it helped them identify and prioritise concerns to address in their treatment sessions. For others who are less attuned to their needs, it helps us to explore issues together, set goals and monitor progress, especially for those with long-term conditions.
Screening and stratifying care
Efficiency of services is essential to ensure that those who need our care can access the right treatment at the right time. Matching patients to treatments is a great place to begin. You may be aware of the STarT Back training tool and know that stratified care for patients with back pain leads to significant improvement in disability and time off work. The STarT Back tool is proven to be more clinically- and cost-effective than usual care. It is recommended in the NICE low back pain guideline to enhance informed shared decision making.
Building on the success of the STarT Back tool, a current research programme is refining and validating a tool for people with other common MSK conditions. The tool assesses risk of poor outcome and enables a matched treatment option to be agreed with the patient. The Keele STarT-MSK Tool is available for use and research is under way to test whether or not matching treatments to the different categories of risk is better than usual care.
What resources are available to clinicians to upskill themselves or for patients to manage their MSK condition? Sometimes we don’t know what we don’t know and the Moving Forward review is a focused collection of resources at our fingertips.
Using a combined physical and psychological approach can be challenging but help is at hand. Have you considered the Back Skills Training Programme. You can access it online free of charge for up to eight weeks. Previously, the training was only open to UK NHS healthcare professionals. This has changed and the training is open to all. The website has been updated recently and you can now register to start the training on a convenient date from 25 February onwards.
You will be contacted on that date to start the training and informed when the course goes live. This could upskill you and enable you to deliver an evidence-proven cognitive behavioural approach.
Thinking about patient resources, do you know where your local ESCAPE-pain class is? Enabling Self-management and Coping with Arthritic Pain through Exercise (ESCAPE-pain) is a rehabilitation programme for people with chronic joint pain that integrates education, self-management and coping strategies with an individualised exercise programme. It can be delivered by physiotherapists but is also offered in gyms and community halls by other healthcare and exercise professionals. Check this map to find your nearest class. If, there isn’t one near you yet, training is available to become a facilitator. Also, consider signposting your patients to the ESCAPE-pain app for free exercise and self-management videos.
Researchers have a responsibility to disseminate the evidence base, and clinicians to use it in their practice. How are you going to implement the findings of this review?
- Moving Forward: Physiotherapy for Musculoskeletal Health and Wellbeing
- Versus Arthritis: The State of Musculoskeletal Health 2018 Report
- Musculoskeletal Health Questionnaire
- Keele University: STarT Back screening tool
- NICE Guideline CG59. Low back pain and sciatica in over 16s: assessment and management.
- Keele STarT-MSK Tool
- Back Skills Training Programme
- Lisa Osborn-Jenkins is a clinical academic, with an NIHR Pre-Doctoral Academic Fellowship and 2 clinical roles: specialist musculoskeletal physiotherapist (University Hospital Southampton NHS Trust) and first contact practitioner (with FirstPointPhysio). Contact email Lisa.Jenkins@uhs.nhs.uk
Using Moving Forward: top tips for clinicians
- Personal continuing professional development
- In-service training programme/journal clubs
- Recruitment process for musculoskeletal clinical roles
- Returning to practice or moving into musculoskeletal speciality
- Signposting patients to resources and services
- Evaluating your clinical practice
- Benchmarking your service against best evidence recommendations
- Planning service development and quality improvement
- Approaching and engaging managers/commissioners to influence service development
- Inspiration for developing future research ideas.
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