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Multi-centre evaluation shows community-based physiotherapy greatly improves pain and discomfort

09 July 2018

Our latest research paper on EQ-5D has been accepted for publication in Quality of Life Research, an academic journal covering research into quality of life from a medical and public health perspective.

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Connect Health is delighted to have their latest research paper “Changes in health-related quality of life (EQ-5D) dimensions associated with community based musculoskeletal physiotherapy”, accepted for publication in Quality of Life Research.

A fundamental aim of physiotherapy is to improve health related quality of life (HRQoL). In particular, pain and physical function is thought to improve but less is understood about how physiotherapy impacts on the individual EQ-5D dimensions and the potential implications on our clinical practice.

Therefore Connect Health and Northumbria University Newcastle, embarked on a multi-centre study to:

  • determine the association between community-based physiotherapy and changes in EQ-5D dimension scores
  • determine whether these can be used to predict which patients have the greatest chance of showing an improvement in overall EQ-5D index.

4112 patients that received community-based musculoskeletal physiotherapy in five NHS community services completed EQ-5D measure on entry into the service and upon discharge. EQ-5D indices for each patient were calculated using UK population norms, based on the score of each dimension.

In those who responded to treatment (2793 patients, 67.5%), there were improvements seen across all EQ-5D dimensions but different body areas saw different changes in individual dimensions

The largest changes in individual dimension scores were seen in:

  • Pain/discomfort
  • Anxiety/depression
  • Greatest improvement was in those who had lower limb or lumbar symptoms

Therefore, the results showed that patients presenting with high levels of pain and/or anxiety/ depression are more likely to have a positive clinical outcome as measured by EQ-5D. The most striking outcome of this study is that those likely to respond, in addition to having a high level of pain score at presentation also reported the highest levels of anxiety/depression at presentation.

Connect Health’s Medical Director, Dr Graeme Wilkes commented

“We are extremely pleased by the findings which suggest that those with higher levels of pain or anxiety have the greatest potential to improve their quality of life with physiotherapy. This may challenge thinking that those with high/levels of anxiety/depression predict poor response to treatment.”

Northumbria University’s Professor Nick Caplan, lead author of the paper stated

“The large volume of data analysed in this study from NHS centres across the UK is a great step forward in our understanding of the most relevant factors that impact on health related quality of life following community based physiotherapy.  Future research can now focus on these areas, and develop refined tools for their assessment to support treatment.”

These results suggest that clinicians should not assume that a patient with high levels of pain and anxiety/depression is unlikely to respond to treatment, as they may, in fact, show the best outcomes in terms of HRQoL.

This research builds on Connect’s previous study which showed that 68.4% of patients demonstrated a significant clinical improvement – the EQ-5D index improved significantly, by +0.203, setting a new benchmark for physiotherapy.

For more information:


About Connect

Connect Health is the largest specialised independent provider of community musculoskeletal (MSK) services (including orthopaedics, pain and rheumatology) in the UK serving over 250k NHS patients pa across 18 CCGs and 75 businesses. Connect effectively and efficiently delivers care in a lower cost community setting, transforming services around specific quality and financial objectives and dramatically reducing waiting times and improving access to treatment.

 About Northumbria University, Newcastle

Northumbria University, Newcastle, is a research-rich, business-focussed, professional university with a global reputation for academic excellence. Our research looks at shaping interventions that have impacts on a health, educational, behavioural, economic and social basis, at local, national and international levels. Northumbria is ranked in the top 30 for excellence in sport and exercise science research power, making it the best rated university in the North East in this discipline.

Notes for Editors

EQ5D is a widely used Patient Reported Outcome Measure (PROM) or Clinical Outcome in the NHS, it provides a measure of quality of life across five dimensions:

  • Anxiety/Depression
  • Washing and dressing ability
  • Ability to perform usual activities
  • Pain level
  • Mobility level

Connect has developed a unique set of clinical guidelines covering the top 10 most common conditions in order to deliver and measure the most clinically effective care. See infographic here.

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