A low-cost solution for the collection, scoring and use in real-time of the Musculoskeletal Health Questionnaire (MSK-HQ) as an electronic patient recorded outcome (ePRO) measure.

Purpose

This project was undertaken to provide a low-cost solution for the collection, scoring and use in real-time of the Musculoskeletal Health Questionnaire (MSK-HQ), a tool that has been co-produced with patients to measure prioritised outcomes for a variety of musculoskeletal conditions (Hill et al. 2016[1]).

Secondary objectives were to; 1) provide immediate MSK-HQ data for clinicians, as a tool for facilitating clinical assessment, and 2) allow for completion of the MSK-HQ remotely prior to either face-to-face or remote physiotherapy consultation, or in the reception area or clinic room using a tablet PC.

 

[1]Hill, Jonathan C., et al. "Development and initial cohort validation of the Arthritis Research UK Musculoskeletal Health Questionnaire… " BMJ open 6.8 (2016): e012331.

Approach

The various phases of this project are summarised below:

 

  1. Scoping and consultation with Oxford Innovations regarding the development of the MSK-HQ in ePRO format using Google Forms, part of Google Workspace for business software.
  2. Licence approval for use of the MSK-HQ was obtained (free for an individual practice).
  3. Development of the Google Forms form in line with the “Guide to ePRO Development for the MSK-HQ”.
  4. The developed MSK-HQ ePRO underwent Clinical Outcomes Assessments (eCOA) Review via an iterative process, culminating in certification and payment of the £250 eCOA review fee.
  5. Development of the results workbook associated with the MSK-HQ data collection Google Forms form to include an associated automated scoring spreadsheet; using Google Sheets functions to automate the scoring of individual questions and calculate the MSK-HQ total score. A sample of the Google Sheets scoring formulae is =IF(H3="Not at all",4,IF (H3="Slightly",3,IF(H3="Moderately",2,IF(H3="Fairly severe",1,IF(H3="Very severe",0))))).
  6. Development of a bespoke Google Apps Script programme associated with the results workbook that sends the results of the MSK-HQ to a specified email address.
  7. Use of Microsoft for Business Outlook software email rules to direct the email with the results for an individual patient to a specific email subfolder that is immediately available to the clinician.
  8. Use of the automated reminder email function for a physiotherapy appointment, provided for free by our practice management software (PracticePal, Astute Data Systems Limited) to provide a link to the remote ePRO version of the MSK-HQ, encouraging patients to complete the MSK-HQ within 48 hours of their appointment using their unique patient ID.
  9. A password protected tablet PC in the clinic waiting area, supported by our administrative team, to allow for completion and support for completion of the MSK-HQ for patients who have not completed the MSK-HQ remotely or where, for example, an email address was not recorded or available at the time of booking.

 

Although specific outcomes were not defined a priori, the fundamental requirements of the project were to develop a low-cost solution for the collection and scoring in real-time of the MSK-HQ, that:

  • Is compliant with ePRO development guidance and data protection regulations
  • Allows for remote and local options for completion
  • Is available in real-time for clinicians without the need for manual scoring

Outcomes

Since implementation on 2nd August 2021, 229 MSK-HQ ePRO questionnaires have been completed by patients using the specified method; 153 (of a possible 175) within 48 hours of initial consultation and 77 within 48 hours of follow up.

 

The MSK ePRO implementation method developed as part of this project was compliant with the specified ePRO development guidance, evidenced through successful approval and certification.

 

The method of data acquisition uses software that is compliant with national and international data protection regulations and any risk of data breach is mitigated through use of unique patient ID numbers.

 

The specified method provides patients the option of completing the MSK-HQ prior to attending their face-to-face or virtual appointment, or at the time of attendance; in the waiting area (facilitated by non-clinical staff) or through assistance of the clinician at the time of consultation.

 

A sample of the scoring output sent to the specified email address is provided below:

Email subject:

MSK HQ for 2186 Initial consultation on Tue Nov 30 2021 at 9:00:00 AM

Email body:

MSK HQ for 2186 Initial consultation on Tue Nov 30 2021 at 9:00:00 AM

** The MSK HQ total score for 2186 is 36

(0-56 with higher score being better and Minimal Important Change score of 5.5) This form was completed on Mon Nov 29 2021 11:03:58

* Pain/Stiffness in day is Moderately

* Pain/Stiffness at night is Moderately…

Cost and savings

The additional costs to Surrey Hills Physiotherapy Ltd for implementing this project were the £250 eCOA review fee and the time costs associated with the development stages described above.

 

The fees for the licencing of the Google Workspace software, the Microsoft for Business software, and the practice management software are costs that would otherwise be incurred as each of these systems are used for other practice functions.

 

Although not quantified, the automation of MSK-HQ data collection, using the methods described above, saves time related to MSK-HQ scoring and completion of the MSK-HQ outside of the clinical consultation appointment.

Implications

The successful completion and implementation of this project and the methods summarised, provides a framework for individual practices to implement a low-cost solution for the collection, scoring and use in real-time of the Musculoskeletal Health Questionnaire (MSK-HQ) as an electronic patient recorded outcome (ePRO) measure.

 

Future work could include the implementation of similar methods for the collation of other patient reported outcome measures (PROMs) to facilitate clinical assessment, with a view to monitoring and improving patient outcomes.

Top three learning points

  1. Development and implementation of the methods described above providea low-cost solution for the collection, scoring and use in real-time of the MSK-HQ
  2. Such methods can be used for remote and local completion of PROMs.
  3. MSK-HQ completion rates have the potential to be high using such methods.

Funding acknowledgements

Unfunded.

Additional notes

We would be happy to make available the Google Sheets scoring workbook and the Goggle Apps Script templates developed specifically for this project.