Physio Charlie

This was recently posted on iCSP:

Outcome Measures

Added by: rfergusonthomas
Posted: 28 October 2009 12:31

We have been asked to look at implementing an outcome measure that can be used from acute in-patient stay, through to intermediate care and then onto the domiciliary setting. As you can imagine this has stirred up a huge debate as to relevance, validity, etc so I was putting this out there to see if it something that has been done in other parts of the country?
The commisioners are wanting something that will measure patient satisfaction (with their outcomes/achievements, not the services involved) but we also feel we need to look objectively at the changes that occur. It needs to be multi-agency (health and adult community care) and multi-disciplinary and so needs to be easily understood and administered with inter-rater reliability.
I would appreciate any pointers!
Thanks,
Rhiannon

Title: euroquol
Added by: bwre002
Posted: 30 October 2009 08:38
Have you looked at euroquol? It has its own website - google it. Very generic so might be useful.
Title: Outcome measures
Added by: laurenreuter
Posted: 29 October 2009 18:25
How about PROMS/CROMS?

Patient-Reported Outcome Measures (PROMs)
Patient-reported outcome measures (PROMs) provide a means of gaining an insight into the way patients perceive their health and the impact that treatments or adjustments to lifestyle have on their quality of life. These instruments can be completed by a patient or individual about themselves, or by others on their behalf.

The CROMS is for clinicians.
Title: OCM
Added by: John Mclennan
Posted: 28 October 2009 14:24
have you considered the Patient Global Impression of Change? There has been widespread use of the PGIC in recent chronic pain clinical trials (e.g. Dunkl et al., 2000; Farrar et al., 2001), and the data provide a responsive and readily interpretable measure of participants’ assessments of the clinical importance of their improvement or worsening. Impression of change scores using different verbal outcome categories have also been used to determine the minimally important changes in quality of life measures (e.g. Guyatt et al., 2002; Hagg et al., 2003). These measures appear to have validity.

Guy, 1976 W. Guy, ECDEU assessment manual for psychopharmacology (DHEW Publication No. ADM 76–338), US Government Printing Office, Washington, DC (1976).
Farrar et al., 2001 J.T. Farrar, J.P. Young, L. LaMoreaux, J.L. Werth and R.M. Poole, Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale, Pain 94 (2001), pp. 149–158.
[sorry, don't have more refs]

Upper limb disorders Occupational aspects of management

This is a very up to date look at the evidence for the management of ULD's in the workplace.  As with a lot of research, the only good evidence they have found is that multidisiplinary treatment with a biopsychosocial approach for non specific arm pain and changing a keyboard for carpal tunnel are better than usual care.

I attended an Occupational health course on 30 sept - 2nd Oct 2009 run by Nicoloa Hunter and Amanda Jones.

It was very informative.  Things I learnt were:

1.  Occupational epidemiology - statistics relating to occupational health and musculoskeletal disorders, i.e. Nurses have statistically more back pain than many other professions.  In Lithuania whiplash does not exist as they have no compensation culture. NIOSH epidemiology of MSD's

2. Evidence based practice and LBP - there has been a republication of the NICE guidelines; non-specific low back pain that has lasted for more than 6 weeks, but for less than 12 months.  Back in work for NHS employes is also a good guide and has soem great assessment tools.  Functional restoration programmes are useful after 12/52 of LBP.  The OREBRO questionnaire is a good outcome measure, scoring. The OREBRO (ÖMPQ) is a ‘yellow flag’ screening tool that predicts long-term disability and failure to return to work when completed four to 12 weeks following a soft tissue injury2.  A cut-off score of 105 has been found to predict those who will recover (with 95 per cent accuracy), those who will have no further sick leave in the next six months (with 81 per cent accuracy), and those who will have long-term sick leave (with 67 per cent accuracy).

3. Evidence based practice and neck apin - there is no evidence for any clinical tests.  Level 1 evidence for advising incresed movement and reassurance.

4.  Confidentiality and consent - we must have the patient sign consent to discuss their problem with the occupational health dept.  We can document this in our notes.  The Disability Discrimination Act is important here.

I was reading iCSP today and came across a debate about red flags.  Something that came up was a "band of pain" across the abdomen and back as a red flag.  See articles below:

Henschke, N., Maher, C. G. and Refshauge, K. M. (2007). "Screening for malignancy in low back pain patients: a systematic review." Eur Spine J 16(10): 1673-9.
Henschke, N., Maher, C. G. and Refshauge, K. M. (2008). "A systematic review identifies five "red flags" to screen for vertebral fracture in patients with low back pain." J Clin Epidemiol 61(2): 110-118.
Jarvik, J. G. and Deyo, R. A. (2002). "Diagnostic evaluation of low back pain with emphasis on imaging." Ann Intern Med 137(7): 586-97.
Mylona, E., Samarkos, M., Kakalou, E., Fanourgiakis, P. and Skoutelis, A. (2009). "Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics." Semin Arthritis Rheum 39(1): 10-17.

http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=207...

M. J. Hancock, C. G. Maher, J. Latimer, M. F. Spindler, J. H. McAuley, M. Laslett, N. Bogduk

This is a good review suggesting just how hard it is for any test to accurately diagnose pathology.  It states that a combination of SI jt tests are relevant and that clinical reasoning is important...nothing we didn't already know really.

Just found some interesting evidence for an OA knee exercise programme:

http://www.kcl.ac.uk/content/1/c6/04/79/67/escapeprogramm...

The guide is very good and it gives ideas for handouts for patients, here is an outline:

Objective

Chronic knee pain is a major cause of disability and healthcare expenditure, but there

are concerns about efficacy, cost and side-effects associated with usual management.

Conservative rehabilitation may offer a safe, effective, affordable alternative. We compared the

efficacy of a rehabilitation programme (Enabling Self-management and Coping with Arthritic

knee Pain through Exercise, ESCAPE-knee pain) of improving function in people with chronic

knee pain better than usual primary care, delivered to individuals or groups of people.

Methods

This was a single blind, pragmatic, cluster randomised controlled trial. Participants aged

50 years and over, complaining of knee pain for more than 6 months, were recruited from a

random sample of 54 inner city primary care practices. Usual primary care was compared with

participation on a rehabilitation programme (integrating exercise, self-management and active

coping strategies) delivered to participants individually or groups of 8 participants. Primary

outcome was self-reported function (WOMAC-func) 6 months after completing rehabilitation.

Results 418 participants were recruited; 76 (18%) withdrew, only 5 (1%) due to adverse events.

Rehabilitated participants had better function than participants continuing usual primary care (-

3.33 WOMAC-func points, CI -5.88 to -0.78; p=0.01). Improvements were similar whether

participants received individual (-3.53, CI -6.52 to -0.55) or group rehabilitation (-3.16, CI -6.55

to -0.12). The number needed to treat was 7 (CI 4 to 27).

Conclusions

ESCAPE-knee pain provides a safe, clinically practicable intervention for chronic

knee pain, and is equally effective whether delivered to individuals or groups of participants.

I have a new website!!

http://physiocharlie.vpweb.co.uk

SI jt Ax:

http://www.youtube.com/watch?v=Eu9JaM9S0Ak&feature=PlayList&p=4C3ECA6E484A19AF&playnext=1&index=1

http://www.youtube.com/watch?v=ifO9SgdEfgk

http://www.youtube.com/watch?v=sPgVu2NjVHE&feature=related

I found this on youtube about SI manip; "Chicago"

http://www.youtube.com/watch?v=y9-dRk91AXI&NR=1

Also: Taping for anterior innominate

http://www.youtube.com/watch?v=QPppVRgdORE&feature=related

Piriformis release:

http://www.youtube.com/watch?v=UFXWrYoS9ho&NR=1

http://www.youtube.com/watch?v=uuozn0i-De8

Flouroscopically guided SI injections:

http://emedicine.medscape.com/article/96054-media

http://learn.clinicsinmotion.com/moodle/course/view.php?i... From the CSP conference 2008: