The use of Patient Reported Outcome Measures with patients in a musculoskeletal outpatient physiotherapy setting to enhance Shared Decision Making

Purpose

The pilot was undertaken as part of a service evaluation. The aim was to benchmark the use of Shared Decision Making (SDM) in patient care within an integrated musculoskeletal setting. The objective was to determine how each person using a Patient Reported Outcome Measure (PROM) of the Oxford Knee Score (OKS) or Oxford Hip Score (OHS) scored and how the outcome of their consultation including SDM compared to their predicted level of intervention.

89% of patients
scored the SDM process as excellent or very good on the PREM score.
"I would trust the expert opinion...
....but would be nice to have an input".

Approach

The OHS and OKS were administered for 200 patients with degenerative hip and knee pain. Each patient independently completed the OHS for hip pain or OKS for knee pain, thus generating a score. Scores for the OHS and OKS are grouped, giving a predictor for intervention. Each score was evaluated against the grouping (predicting intervention) and compared with the patient decision for intervention after their SDM conversation surrounding the PROM. The study used a service evaluation approach with PROMs scores as a quantitative measure, a Patient Reported Experience Measure (PREM) for evaluation of whether patients found it useful and qualitative feedback from a group of participants on the process. Data collection is continuing within the service for all hip and knee OA patients.

Outcomes

Results: OHS and OKS predicted intervention groupings did not always correspond with the patient decisions after the SDM conversations. Of 79 patients in the lowest category where orthopaedic surgical review is recommended, over one quarter chose conservative management. Conservative management choices were mainly physiotherapy based interventions including standard physiotherapy, escape pain classes, home exercises and corticosteroid injections as ways of reducing pain and self-managing. Outcomes were based upon multiple factors and qualitative feedback from patients identified that using the PROM helped to encourage SDM and help them to make an informed and personal decision on their care. Qualitative feedback from patients included comments such as: "Good idea as patients have different ideas about treatment" and "I would trust the expert opinion but would be nice to have an input". 89% of patients scored the SDM process as excellent or very good on the PREM score.

Conclusion(s): Physiotherapy has a role to play even with patients with significant daily dysfunction. Making an informed choice was facilitated in this service evaluation by using PROMs scores to enhance the SDM conversation, helping patients make an informed decision on their therapeutic intervention. The use of PROMs to facilitate SDM is one method of encouraging patients to be at the centre of quality and individualised care. It encourages patients to make the right decision for them individually with help of their physiotherapist.

Cost and savings

Cost of paper provision and printing for initial PROMs reporting. Progressed to provision of laminated sheets for each clinician and wipeable markers to save on cost of paper and printing.

Implications

The physiotherapy community can implement the study findings into practice by using PROMs scores differently by involving the patient further and using PROMs for stimulating SDM. Use of PROMs for SDM has the potential for enhancing personalised and individual care for patients. Further research is needed to follow up patients over a longer time period to determine whether those managing with physiotherapy or conservative measures continued to do so longer term.

Top three learning points

No further information. 

Funding acknowledgements

No funding acknowledgements