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Raising the quality of MSK services

Representative physiotherapy organisations world-wide are aware of a gap in the evidence-base for community
physiotherapy based on poor data collection capability, something that Connect has addressed with its new Data
Warehouse. Connect now has an abundance of data which is being formally interrogated and released openly to
inform all interested parties.

Connect’s first interrogation of the data looked at a 5-year retrospective multicentre study of EQ5D data from 2011
to 2016 in partnership with Northumbria University.

Why is EQ5D important?

EQ5D is a widely used Patient Rated Outcome Measure (PROM) or Clinical Outcome in the NHS. It provides a measure of “Quality of Life” (QOL) across general health and wellbeing. It asks patients about five “dimensions”

  1. Anxiety/Depression
  2. Washing and dressing ability
  3. Ability to perform usual activities
  4. Pain level
  5. Mobility level

Each dimension is scored and converts into a number which has a maximum score of 1 (perfect health) but would usually be expressed as a number below 1 e.g. 0.36. Studies measure the change in EQ5D score as a PROM.

Studies of EQ5D in MSK care to date

Prior to this study, Connect/ Northumbria University could find no studies that have documented EQ5D across a community service. Where studies exist they have often considered small elements in a physiotherapy service. The benchmark for mean improvement in amalgamated community physiotherapy studies prior to this is +0.16. Data on Orthopaedic EQ5D outcomes has largely centred on Hip and Knee arthroplasty which are considered highly successful interventions. Latest UK EQ5D data (2015) demonstrate EQ5D changes of:

Knee Arthroplasty +0.31

Hip Arthroplasty +0.42

In contrast studies of EQ5D for general (non-arthroplasty) Orthopaedic surgery are few. The only one using EQ5D for multiple Orthopaedic operations documented the mean gain from general Orthopaedic interventions as +0.18 at 12 months. Only 49% had maintained a significant improvement in quality of life at that point so 51% patients were not improved at a year post-surgery.

 

Connect is leading the way – building the evidence base

In 2016, Connect commissioned the University of Northumbria to carry out a retrospective, multi-centre study of EQ5D outcomes for more than 4,000 NHS patients receiving physiotherapy treatment from Connect from January 2011 to April 2016.

Data was collected on EMISWeb/ SystmOne clinical systems and covered centres in Camden, SW Essex, Gateshead, Newcastle West and Northumberland.

The Results

The results, which will be presented at “Physiotherapy UK” 2017 national conference and are submitted for publication in a peer-reviewed journal, are:

  1. Overall, the EQ5D index improved significantly by + 0.203
    Compared to the mean of previous studies of +0.16 this is a large increase that suggests Community Physiotherapy from Connect services significantly increases quality of life and raises the bar for physiotherapy services
  2. 68.4% of patients demonstrated a significant clinical improvement to the “minimum clinically important difference” (MCID)– this is a statistical measure of significant improvement
EQ5D data

EQ5D has improved by + 0.203 and 68.4% of patients have experienced significant clinical improvement

Summary

  • This will be the only large multi-centre study published of community physiotherapy to date (note Tier-2 CATS is NOT included in this study)
  • This study demonstrates almost 70% of patients have a significant Quality of Life improvement after a course of community physiotherapy with Connect Health
  • The mean score improvement is + 0.203 which sets a new benchmark for physiotherapy
  • Differences in body area provide data to look at why some areas are performing better than others and lead education and further audit and research
  • Connect is now able to distil PROMS to individual clinicians and benchmark each clinician with overall score and to individual
    body area and share good practice and address performance through education and mentoring

  • Connect introduced a major new programme of Clinical Guidelines in August 2016 (10/10) and is already seeing significant better EQ5D outcomes than this retrospective data set
  • This study should provide confidence to Commissioners that physiotherapy services make a difference
  • The results in this study and subsequent even better results now (one service is achieved +0.25 between Jan-March 2017)
    suggesting physiotherapy services from Connect may compete favourably against changes in QOL from surgical procedures at
    significantly lower cost
  • This study shows for the first time that physiotherapy services make a definite impact on people’s quality of life and therefore are a worthy investment
  • Further data and studies will follow from Connect to evidence the value of all Community MSK services – the data is already looking very favourable including Tier-2 MSK CATS services.

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