Musculoskeletal Conditions: A Scottish Flavour Developing consensus on outcome measures for community musculoskeletal c

1. Musculoskeletal Conditions: A Scottish FlavourDeveloping consensus on outcome measures for community musculoskeletal conditions Professor Tracey Howe Musculoskeletal Review Group Healthcare of Older People Field The Musculoskeletal Elf

2. Introduction • Why did we undertake this project? • Recommendations of the Rehabilitation Framework. • Large variation in practice across Scotland in the type and timing of clinical assessment • What do we mean by minimum data sets? • A core set of standardized outcome measures • What was the purpose of the project? • Collection of such standardised data should facilitate: • analysis of community musculoskeletal rehabilitation activity and capacity planning both within and between NHS Boards • enable us to argue for resources much more affectively.

3. What were the stages of the project? Develop a profile of current practice across Scotland Convene an ‘expert panel’ to review the evidence and formulate draft recommendations Examine the international evidence base for instruments. Develop a series evidence summaries and assess the quality of the evidence Present the draft recommendations at a consensus event involving international experts and relevant stakeholder groups in May 2010 where final draft recommendations were decided Publish the draft recommendations for consultation across Scotland Make final recommendations for minimum data set of outcome measures for Community Musculoskeletal Rehabilitation in Scotland to the Scottish Government

4. The ‘expert panel’ • 41 ‘experts’. Membership based on their knowledge of the topics. • members of the public and representatives of consumer groups • healthcare professionals • researchers • policy makers • Task 1:Scope the topics and developed key questions for investigation • Task 2:Review scientific literature and assess whether instruments met the quality threshold • Task 3:Prepare draft report and present at consensus event • Task 4:Finalise draft report for consultation • Task 5:Complete final report

5. Scoping Lower back pain non-specific lower back pain, and radiculopathy Hip osteoarthritis and trochanteric bursitis Knee osteoarthritis, ligament injuries, meniscal lesions and patello-femoral pain Foot and ankle soft tissue injuries, osteoarthritis, tendon injuries, Achilles tendinopathy, mechanical heel pain, neural entrapment Shoulder acromio-clavicular joint pain, sub acromial impingement syndrome, adhesive capsulitis, rotator cuff tears, and osteoarthritis Pain and quality of life

6. Review of scientific literature • Development of sensitive search strategies • Development and piloting of data extraction forms • Number of titles screened = 48,428 • Full papers reviewed = 836 • Included studies = 180

7. Review of scientific literature • Number of instruments assessed for scientific quality = 130 • Developed a series of evidence summaries to cover each of the anatomical regions • Application of quality filter • Number of instruments meeting quality threshold = 19

8. Instruments meeting quality threshold Pain and quality of life SF-36 SF-12 Brief Pain Inventory Low back pain Oswestry Disability Index Roland and Morris Disability Questionnaire (24 item) Tampa Scale of Kinesiophobia Occupational risk factors for low back pain Obstacles to Return to Work Questionnaire (ORTWQ)

9. Instruments meeting quality threshold Hip and knee Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) Timed Get Up and Go (TUG) Test Lysholm Knee Scale Patellofemoral Pain Syndrome Severity Scale (PSS) WOMET Foot and ankle Foot and Ankle Ability Measure (FAAM) Manchester Foot Pain and Disability Index American Academy of Orthopaedic Surgeons Lower Limb Outcomes Assessment Instrument Shoulder American Shoulder and Elbow Surgeons (ASES) Subjective Shoulder Scale Disability of Arm, Shoulder and Hand (DASH or quick DASH) Shoulder Pain and Disability Index (SPADI) Oxford Shoulder Score

12. The conference delegates • It is important that we had views from a wide range of people • How did the delegates contribute? • Electronic voting system using a key pad. • Send us text messages throughout the sessions. • Send us a comment on a postcard. • Ask a question or make a comment during the session. • Who are the delegates? • a member of the public; a healthcare professional; a researcher; or another group. • What was being voting on? • asked to score each instrument on a scale from 0 to 6, • 0= the instrument does not meet any of the criteria, • 6= the instrument meets all the criteria.

15. Consultation process

16. Respondents N=170 N=64

17. Report

18. Recommendations Those outcome measures that fail to meet the scientific quality threshold are not used in routine clinical practice. Eight outcome measures and a record of working status are recommended for specific use in clinical practice and will comprise the initial minimum data set of outcome measures for community musculoskeletal conditions for Scotland. An implementation plan should be developed with the involvement of the public and patients and other key stakeholders to ensure data collected are both relevant and useful: the licensing costs of outcome measures; additional training needs of staff; and consideration of important data management issues

19. Final recommendations • Back-specific disability the Roland and Morris Disability Questionnaire • Fear of movement the Tampa Scale for Kinesiophobia • Pain intensity the Brief Pain Inventory • Quality of life SF-12 –NB now EQ5D • Impact of osteoarthritis of the hip or knee the WOMAC • Soft tissue conditions of the knee the Lysholm Knee Scale • Pain and functional limitations in patients with shoulder conditions the Oxford Shoulder Score • Higher levels of function, and including participation in work and other social activities the shortened form of the Disability of Arm Shoulder and Hand instrument, quick-DASH • Record the work status of all patients at the beginning and end of the episode of care

20. Tracey Howe1, Sarah L Mitchell2, Lesley Dawson1,3, Heather Gray1,4 1HealthQWest, 2Scottish Government, 3NHS Forth Valley, 4School of Health, Glasgow Caledonian University Introduction The Delivery Framework For Adult Rehabilitation (Scottish Executive, 2007) outlined an improvement strategy for community based rehabilitation in Scotland. Emphasising multi-disciplinary involvement in an integrated process of assessment, goal setting, intervention and evaluation, a key process is collection and interpretation of data to aid intervention choice and subsequent reassessment. However there are no recommended guidelines for what data to collect, when, or indeed who should do this. In the absence of a standard data set or outcome measures mapping the patient journey it is difficult to assess whether patients receive the right treatment at the right time. Without centralised information on the decision making process or the timing of assessment clinicians and service users are unable to access information for research, evaluation or compare outcomes to find best practice. Developing a Minimum Data Set for Community Musculoskeletal Rehabilitation in Scotland Minimum data set Methods We will use a modification of the Consensus Development Programme technique utilised by the King’s Fund and National Institutes for Health (USA) Topics This project will focus on anatomical regions as they relate to the largest numbers of referrals and subsequent clinical workload: Low Back Pain, Shoulder, Hip, Knee, Foot and Ankle. Further emphasis will relate to economic cost, pain, psychosocial, quality of life and vocational aspects of musculoskeletal conditions

21. Implementation

22. Musculoskeletal Review Group Healthcare of Older People Field The Musculoskeletal Elf