Carol Fawkes

Patients' expectations of private osteopathic care in the UK: a national survey of patients.

BackgroundPatients’ expectations of osteopathic care have been little researched. The aim of this study was to quantify the most important expectations of patients in private UK osteopathic practices, and the extent to which those expectations were met or unmet.MethodsThe study involved development and application of a questionnaire about patients’ expectations of osteopathic care. The questionnaire drew on an extensive review of the literature and the findings of a prior qualitative study involving focus groups exploring the expectations of osteopathic patients. A questionnaire survey of osteopathic patients in the UK was then conducted. Patients were recruited from a random sample of 800 registered osteopaths in private practice across the UK. Patients were asked to complete the questionnaire which asked about 51 aspects of expectation, and post it to the researchers for analysis.The main outcome measures were the patients-perceived level of expectation as assessed by the percentage of positive responses for each aspect of expectation, and unmet expectation as computed from the proportion responding that their expectation “did not happen”.Results1649 sets of patient data were included in the analysis. Thirty five (69%) of the 51 aspects of expectation were prevalent, with listening, respect and information-giving ranking highest. Only 11 expectations were unmet, the most often unmet were to be made aware that there was a complaints procedure, to find it difficult to pay for osteopathic treatment, and perceiving a lack of communication between the osteopath and their GP.ConclusionsThe findings reflected the complexity of providing osteopathic care and meeting patients’ expectations. The results provided a generally positive message about private osteopathic practice. The study identified certain gaps between expectations and delivery of care, which can be used to improve the quality of care. The questionnaire is a resource for future research.

Development of a data collection tool to profile osteopathic practice: Use of a nominal group technique to enhance clinician involvement

INTRODUCTION Little is known about the profile of osteopathic care in the United Kingdom (UK). To address this, a standardised data collection (SDC) tool was developed to record patient-based data within private practice. METHODS The development of the SDC tool took place within a national network of research groups (hubs) created by the National Council for Osteopathic Research (NCOR); nominal groups were created from the hub network. A Nominal Group Technique (NGT) was used to promote maximum involvement by clinicians and increase ownership of the process: this approach encouraged generation of ideas around specific topics. Following several rounds of iteration, a draft tool was created, followed by a three stage testing process to identify omissions, unnecessary jargon, ambiguities, and any regional differences. RESULTS The tool developed for a national use by UK osteopaths consisted of 65 items. These were divided into specific sections for patient or clinician completion. The section for patient completion collected data concerning demographic and symptom data. Clinicians provided data concerning treatment provided, advice to promote self-management and avoidance of symptom recurrence, outcome information, service data concerned with waiting times, the number of treatments delivered, and the necessity for referral. CONCLUSION The tool development process produced a data collection tool aimed to collect snapshot data across the osteopathic profession. The national pilot of the tool will identify changes required, and any barriers to its use by busy professionals.

Responsiveness, Reliability, and Minimally Important and Minimal Detectable Changes of 3 Electronic Patient-Reported Outcome Measures for Low Back Pain: Validation Study

Background The Roland Morris Disability Questionnaire (RMDQ), visual analog scale (VAS) of pain intensity, and numerical rating scale (NRS) are among the most commonly used outcome measures in trials of interventions for low back pain. Their use in paper form is well established. Few data are available on the metric properties of electronic counterparts. Objective The goal of our research was to establish responsiveness, minimally important change (MIC) thresholds, reliability, and minimal detectable change at a 95% level (MDC95) for electronic versions of the RMDQ, VAS, and NRS as delivered via iOS and Android apps and Web browser. Methods We recruited adults with low back pain who visited osteopaths. We invited participants to complete the eRMDQ, eVAS, and eNRS at baseline, 1 week, and 6 weeks along with a health transition question at 1 and 6 weeks. Data from participants reporting recovery were used in MIC and responsiveness analyses using receiver operator characteristic (ROC) curves and areas under the ROC curves (AUCs). Data from participants reporting stability were used for analyses of reliability (intraclass correlation coefficient [ICC] agreement) and MDC95. Results We included 442 participants. At 1 and 6 weeks, ROC AUCs were 0.69 (95% CI 0.59 to 0.80) and 0.67 (95% CI 0.46 to 0.87) for the eRMDQ, 0.69 (95% CI 0.58 to 0.80) and 0.74 (95% CI 0.53 to 0.95) for the eVAS, and 0.73 (95% CI 0.66 to 0.80) and 0.81 (95% CI 0.69 to 0.92) for the eNRS, respectively. Associated MIC thresholds were estimated as 1 (0 to 2) and 2 (–1 to 5), 13 (9 to 17) and 7 (–12 to 26), and 2 (1 to 3) and 1 (0 to 2) points, respectively. Over a 1-week period in participants categorized as “stable” and “about the same” using the transition question, ICCs were 0.87 (95% CI 0.66 to 0.95) and 0.84 (95% CI 0.73 to 0.91) for the eRMDQ with MDC95 of 4 and 5, 0.31 (95% CI –0.25 to 0.71) and 0.61 (95% CI 0.36 to 0.77) for the eVAS with MDC95 of 39 and 34, and 0.52 (95% CI 0.14 to 0.77) to 0.67 (95% CI 0.51 to 0.78) with MDC95 of 4 and 3 for the eNRS. Conclusions The eRMDQ was reliable with borderline adequate responsiveness. The eNRS was responsive with borderline reliability. While the eVAS had adequate responsiveness, it did not have an attractive reliability profile. Thus, the eNRS might be preferred over the eVAS for measuring pain intensity. The observed electronic outcome measures’ metric properties are within the ranges of values reported in the literature for their paper counterparts and are adequate for measuring changes in a low back pain population.

Non-specific mechanisms in orthodox and CAM management of low back pain (MOCAM): theoretical framework and protocol for a prospective cohort study.

Introduction Components other than the active ingredients of treatment can have substantial effects on pain and disability. Such ‘non-specific’ components include: the therapeutic relationship, the healthcare environment, incidental treatment characteristics, patients’ beliefs and practitioners’ beliefs. This study aims to: identify the most powerful non-specific treatment components for low back pain (LBP), compare their effects on patient outcomes across orthodox (physiotherapy) and complementary (osteopathy, acupuncture) therapies, test which theoretically derived mechanistic pathways explain the effects of non-specific components and identify similarities and differences between the therapies on patient–practitioner interactions. Methods and analysis This research comprises a prospective questionnaire-based cohort study with a nested mixed-methods study. A minimum of 144 practitioners will be recruited from public and private sector settings (48 physiotherapists, 48 osteopaths and 48 acupuncturists). Practitioners are asked to recruit 10–30 patients each, by handing out invitation packs to adult patients presenting with a new episode of LBP. The planned multilevel analysis requires a final sample size of 690 patients to detect correlations between predictors, hypothesised mediators and the primary outcome (self-reported back-related disability on the Roland-Morris Disability Questionnaire). Practitioners and patients complete questionnaires measuring non-specific treatment components, mediators and outcomes at: baseline (time 1: after the first consultation for a new episode of LBP), during treatment (time 2: 2 weeks post-baseline) and short-term outcome (time 3: 3 months post-baseline). A randomly selected subsample of participants in the questionnaire study will be invited to take part in a nested mixed-methods study of patient–practitioner interactions. In the nested study, 63 consultations (21/therapy) will be audio-recorded and analysed quantitatively and qualitatively, to identify communication practices associated with patient outcomes. Ethics and dissemination The protocol is approved by the host institutions ethics committee and the NHS Health Research Authority Research Ethics Committee. Results will be disseminated via peer-reviewed journal articles, conferences and a stakeholder workshop.

Measuring patient outcome using data capture by mobile app

The use of Patient Reported Outcome Measures (PROMs) to measure effectiveness of care, and supporting patient management is being advocated increasingly in clinical and research settings. Current patient data capture involves completion of paper questionnaires which is costly and environmentally challenging. New innovations are required to balance the challenges of introducing data capture directly from patients while considering budgets, access to Information Technology, and the capability to use technological devices. The development of content for a mobile and web app for capturing PROM data has been informed by two qualitative studies, and a systematic review. The qualitative studies involved interviews and focus groups with patients and clinicians (osteopaths) concerning their views on using PROMs in clinical practice, and a selection of specific PROMs. The systematic review compared the measurement properties of three PROMs (the Roland Morris Disability Questionnaire, the Oswestry Disability Index, and the Bournemouth Questionnaire). Patients (N=18) have been enthusiastic about using PROMs in practice welcoming the opportunity to provide feedback, and undaunted by use of technology. It was shown to be important to include PROMs with numerical scales, and text descriptions of symptoms. Clinicians (N=30) also recognised the value of PROMs and the importance of outcome data being collected independently of their clinics. However, there were some concerns. Patients wanted clarity concerning the use of data, and to whom it would be accessible. In addition patients were concerned about the potential disruption to the consultation process. Clinicians were concerned about fitting the collection of PROM data into the consultation process, and how this could affect the relationship with patients. The findings of these three studies have informed the development of a mobile and web app. Both apps are currently being piloted in private and training clinics for osteopaths.