Let's Talk Research Annual Conference - 24th-25th September 2014 (Carol Doyle)

‘Enhancing musculoskeletal research in primary care: engaging a community

musculoskeletal physiotherapy service in research studies’

Presented by : Carol Doyle On behalf of

Allied Health Services Primary Care Therapies Team

East Cheshire NHS Trust

Let’s Talk Research – 24th & 25th September 2014

Who are we?

• Adult Musculoskeletal Physiotherapy Service

• Part of Primary Care Therapies Team

• Within East Cheshire NHS Trust

• Based in Primary Care settings

• Patients referred by GPs (mainly)

What do we do?

• Assessment, treatment and management of musculoskeletal conditions

• 25% of GP Consultations are musculoskeletal conditions

• Physiotherapy as part of their management

• Estimated 53 out of 1000 patients referred for musculoskeletal physiotherapy*

*Holdsworth et al (2006): Are patients who refer themselves to physiotherapy different from those referred by GPs?

Are you getting the ‘best’ treatment for your back pain?

What do we know?

• Back pain is a common problem

• 8 out of 10 people will suffer an episode

• Majority of people nothing serious

• Patients suffer recurring episodes • Many go on to develop long term disability / work

problems • Huge costs to NHS and society – £10688 million!*

*Maniadakis et al (2000): The economic burden of back pain in the UK.

Why are we here?

• To share our ‘journey’ in developing a culture of evidence based practice

• To identify the ‘key’ elements

• To show the ‘results’ of our approach

• To look at the ‘impact’ to our service

‘Showcase our service’

How did it begin?

The Drivers - 2000 onwards

• Organisational change

– Restructuring Community Service in Primary Care

– Beginning commissioning era

• Physiotherapy undergraduate education

• Early implementer of Knowledge Skill Framework (KSF)

What were the key elements?

• Management culture shift

– ‘Open door’ approach

• Creating a culture of Evidence Based Practice

– Clinically and cost effective patient care

– ‘Futureproof’ service

• Involvement with research

– ‘Bridging the gap’ between academic and clinical communities

Who did we involve?

• Engagement at all levels of organisation

• Visionary Managers

• Committed Leaders

• Created links with Arthritis Research UK Primary Care Centre, Keele University

• New Physiotherapy Research Facilitator post

• Clinician involvement in high quality research studies

Which studies? Name of study Type of study Patients

Recruited

(2599)

Physios

involved

(138)

Stratified Care for Low Back Pain (IMPaCT Back) 2007 – 2010*

Implementation 922 26

Telephone assessment (PhysioDirect)

Multicentre RCT 527 (2249) 8

Exercises for OA knee (BEEP)

Multicentre RCT 141 (526) 10

Patient reported outcome measure (PROMS)

Feasibility 58 (428) 7

Patient self-referral (STEMS)

Pilot Cluster RCT 951 17

Hip OA survey (ABC Hip) National Physio survey

N/A 70 posted

IMPaCT Back (2007-2010)

• Implementing a stratified care approach for low back pain in primary care

• Subgroup (STarT Back tool) and targeted treatments according to risk of poor outcome

• Before and after design

• Conducted in South Cheshire (5 GP practices)

• 922 patients recruited

• 64 GPs and 16 Physiotherapists involved

IMPaCT Back Results

‘Stratified care for low back pain improves clinical outcomes and is cost-effective’*

• Reduced sickness certification

– 15% before versus 9% after

• Significant improvements in disability (RMDQ) at 6mths

– 0.71 (95%CI 0·06, 1.36), p<0.03

• Significantly less time off work at 6mths

– 50% reduction!

*Foster et al (2014): Effect of Stratified Care for Low Back Pain in Family Practice (IMPaCT Back): A Prospective Population-Based Sequential Comparison

“Stratified care for low back pain improves clinical

outcomes and is cost effective “*

What has been the impact?

• Staff – Empowerment, evidence based training, career

opportunities, retention

• Patients – Satisfaction, improved pathways, information,

outcomes

• Service – Quality indicators (CQUIN), commissioning,

innovation

‘Supports active engagement of staff in research in clinical setting, which raises standards of service delivery and effectiveness. Also supports wide range of staff training and development opportunities to support ongoing CPD’

Physiotherapy Manager

‘Raises the service profile and provides a unique selling point for service promotion in business cases and tenders……..Supports the development of quality indicators that drive service improvement’

Physiotherapy Manager

‘It has enabled us to change our practice for the better e.g. IMPaCT Back and STEMS, and the training that Keele provided and are still providing to our service is invaluable’

Physiotherapist

‘The interaction with Keele and the research facilitators has enabled me to enhance my skills and knowledge in research, the research facilitators have been key in making trials work seamlessly in clinical practice’

Physiotherapist

Acknowledgements

Thank you for listening!

Contact: c.doyle@keele.ac.uk