Objective The use of Patient Reported Outcome Measures (PROMs) to evaluate care is being advocate... more Objective The use of Patient Reported Outcome Measures (PROMs) to evaluate care is being advocated increasingly in clinical settings. Electronic data capture is both resource and environmentally friendly and convenient. This purpose of this study was to test and implement a nationwide system to collect routine PROM data from osteopathic patients using a web and mobile app. Methods A prospective study design was used to monitor outcomes of care for patients attending osteopathic clinics. Demographic and service data were collected, the primary outcomes were the Bournemouth Questionnaire and a Global Rating of Change score. Data concerning patients’ satisfaction and experience of care were collected also. Data were collected at baseline, one week, and six weeks post-treatment. Results A total of 1721 patients completed the PROM app questionnaire. The majority (65.8%) of patients who used the PROM app were between 40 and 69 years old with 11% being 70 years and over. At baseline 39.8% ...
Journal of Bone and Joint Surgery-british Volume, 2016
Background to the study: The use of Patient Reported Outcome Measures (PROMs) to measure effectiv... more Background to the study: The use of Patient Reported Outcome Measures (PROMs) to measure effectiveness of care, and supporting patient management is being advocated increasingly. PROMs data are often collected using hard copy questionnaires. New technology enables electronic PROM data collection. Purpose of the study: To identify patient and practitioner perceived opportunities and challenges to implementing electronic PROM data capture as part of the process for developing a PROM phone and online app. Methods: Interviews were undertaken with patients (N=18), and clinicians (N=46). Patients and clinicians were recruited through practice advertisement, in printed healthcare media, social media, and professional networks. Semi-structured interviews were used. Data were analysed using the Framework approach. Themes, sub-themes, and models were developed from the analysed data. Results: Patient themes included relevance of data collection, data protection, and confidentiality. Practitio...
Notwithstanding the limitations outlined above, piloting the SDC in practice produced a set of pi... more Notwithstanding the limitations outlined above, piloting the SDC in practice produced a set of pilot data that could represent a useful first step to developing a profile of UK osteopathic practice. Key findings about the SDC tool included: The SDC tool developed with and by the profession performed extremely well. The tool was clear and easy to complete and generated meaningful data. Practitioner compliance was high with 86% of those volunteering actually collecting data, and data collection forms were completed thoroughly and validly. Practical issues for completion were cited including that some patients were in considerable pain and, understandably, did not want the added burden of having to complete a form prior to their consultation. Other reports included that patients were simply short of time either attending in their lunch time or on the way to other appointments. The data collection form has been amended to reduce the burden on patients. A few questions were reported to have ambiguous wording and these have been reworded to make the meaning clearer. Key findings from the SDC pilot data included: Patient demographics 56% of patients were female and 43% were male 93.9% of patients were white The age range of patients was from 5 days old to 93 years old Occupational data showed that 47.9% were in full time employment, and 10.9% selfemployed full time; 19% were retired, and 14.2% worked part time as either employed or selfemployed, and 6.3% were not currently employed GP referral was reported by 6.3% of patients A total of 48.1% of patients reported between 1 and 4 visits to their GP concerning their current symptoms, and 29% had undergone previous NHS treatment or investigation Access to treatment was rapid. A total of 16.8% of patients were offered an appointment on the same day; a further 54.2% were offered appointments within the next 72 hours. Symptom profiles Space was provided to record up to three symptom areas. Lumbar symptoms were the most common (36%), followed by cervical spine (15%), sacroiliac/pelvic/groin (7.9%), head/facial area (7%), shoulder (6.8%), and thoracic spine (6%) Additional symptoms were recorded in 2.9% of patients Symptom duration for the current episode was categorised and included acute (<6 weeks) in 51%; subacute (7-12 weeks) in 15%, and chronic (13 weeks or more) in 32%. A total of 2% of patients did not respond A total of 797 patients reported the presence of comorbidities, as diagnosed by their medical practitioner. The most common of these was hypertension (11.7%), followed by asthma (6.6%), and arthritis (5.7%) Osteopathic patient management Practitioners recorded that 97% of patients were suitable for osteopathic treatment Treatments given to patients were varied and complex. Soft tissue treatment was the most common (78%), followed by articulation (72.7%), and HVLA thrust/manipulation techniques (37.7%). These were followed in frequency by cranial osteopathy (25.8%), muscle energy (18.3%), and functional technique (13.7%) Additional interventions in patient management included education (35.8%), and exercise (22.6%). A variety of self-management strategies were discussed with 88% of patients Outcomes of treatment Simple patient-reported outcomes were recorded on the data collection sheet. These were drawn from the literature but are not validated measures and their findings should be treated with caution. After the first appointment, the majority of patients (59.4%) reported no complications of treatment. The most common complications within the first 24-48 hours after treatment were increased stiffness (18%), increased pain (14%), and fatigue (6.6%). After the second and subsequent appointments, 77.3% of patients reported no complications of treatment. Only a small number of patients (10.4%) were off work at first presentation; of these 5.3% were able to return to work after one treatment, and 3.1% after two treatments. In cases where patients underwent onward referral, 88% were to their GP for further investigation, and 13% were to a hospital consultant.
ObjectivesContextual components of treatment previously associated with patient outcomes include ... more ObjectivesContextual components of treatment previously associated with patient outcomes include the environment, therapeutic relationship and expectancies. Questions remain about which components are most important, how they influence outcomes and comparative effects across treatment approaches. We aimed to identify significant and strong contextual predictors of patient outcomes, test for psychological mediators and compare effects across three treatment approaches.DesignProspective cohort study with patient-reported and practitioner-reported questionnaire data (online or paper) collected at first consultation, 2 weeks and 3 months.SettingPhysiotherapy, osteopathy and acupuncture clinics throughout the UK.Participants166 practitioners (65 physiotherapists, 46 osteopaths, 55 acupuncturists) were recruited via their professional organisations. Practitioners recruited 960 adult patients seeking treatment for low back pain (LBP).Primary and secondary outcomesThe primary outcome was ba...
The General Osteopathic Council commissioned this research as part of a wider programme of work t... more The General Osteopathic Council commissioned this research as part of a wider programme of work to enhance knowledge of the attitudes, needs and concerns of the public and patients who seek the care of osteopaths. The GOsC envisages that the findings the study will inform GOsC policy development, the provision of information to patients and the public, and guidance to osteopaths. The main aim of this study was to gain an understanding of the expectations of patients receiving osteopathic care, and to quantify the extent to which ...
Monitoring of patients' physical and psychological problems during and after cancer treatment is ... more Monitoring of patients' physical and psychological problems during and after cancer treatment is essential in modern oncology practice. Traditional clinical methods can be supplemented by Patient-Reported Outcomes Measures (PROMs) measures. The potential role of PROMs is recognised and endorsed by national and international practice guidelines. The introduction of formal measurement of PROMs in clinical practice is a complex health care innovation requiring careful planning, design and successful implementation of a number of essential components, such as choosing the patient questionnaire(s), a convenient affordable electronic method for reporting and display in hospital records and engaging clinicians to use and act on the reports. There is mounting research evidence that using PROMs in individual patient care in oncology is beneficial to patients, but this approach has not found a place in routine clinical practice. A brief overview of this evidence will be provided. Following this, the presentation will focus on examples of incorporating PROMs and eHealth interventions into routine patient care during and after cancer treatment, drawing on 20 years' experience in Leeds of using electronic systems for capturing patient reported data in oncology settings. Examples will be given of: 1) Monitoring toxicity during systemic cancer treatment using online PROMs integrated with Electronic Patient Records (randomized trial part of NIHR eRAPID programme); 2) Service development project-Remote follow-up of testicular cancer patients using online PROMs plus community-based investigations. Examples of other online PROMs systems will be presented. The values and challenges of PROMs integration in routine oncology practice will be discussed.
Objective The use of Patient Reported Outcome Measures (PROMs) to evaluate care is being advocate... more Objective The use of Patient Reported Outcome Measures (PROMs) to evaluate care is being advocated increasingly in clinical settings. Electronic data capture is both resource and environmentally friendly and convenient. This purpose of this study was to test and implement a nationwide system to collect routine PROM data from osteopathic patients using a web and mobile app. Methods A prospective study design was used to monitor outcomes of care for patients attending osteopathic clinics. Demographic and service data were collected, the primary outcomes were the Bournemouth Questionnaire and a Global Rating of Change score. Data concerning patients’ satisfaction and experience of care were collected also. Data were collected at baseline, one week, and six weeks post-treatment. Results A total of 1721 patients completed the PROM app questionnaire. The majority (65.8%) of patients who used the PROM app were between 40 and 69 years old with 11% being 70 years and over. At baseline 39.8% ...
Journal of Bone and Joint Surgery-british Volume, 2016
Background to the study: The use of Patient Reported Outcome Measures (PROMs) to measure effectiv... more Background to the study: The use of Patient Reported Outcome Measures (PROMs) to measure effectiveness of care, and supporting patient management is being advocated increasingly. PROMs data are often collected using hard copy questionnaires. New technology enables electronic PROM data collection. Purpose of the study: To identify patient and practitioner perceived opportunities and challenges to implementing electronic PROM data capture as part of the process for developing a PROM phone and online app. Methods: Interviews were undertaken with patients (N=18), and clinicians (N=46). Patients and clinicians were recruited through practice advertisement, in printed healthcare media, social media, and professional networks. Semi-structured interviews were used. Data were analysed using the Framework approach. Themes, sub-themes, and models were developed from the analysed data. Results: Patient themes included relevance of data collection, data protection, and confidentiality. Practitio...
Notwithstanding the limitations outlined above, piloting the SDC in practice produced a set of pi... more Notwithstanding the limitations outlined above, piloting the SDC in practice produced a set of pilot data that could represent a useful first step to developing a profile of UK osteopathic practice. Key findings about the SDC tool included: The SDC tool developed with and by the profession performed extremely well. The tool was clear and easy to complete and generated meaningful data. Practitioner compliance was high with 86% of those volunteering actually collecting data, and data collection forms were completed thoroughly and validly. Practical issues for completion were cited including that some patients were in considerable pain and, understandably, did not want the added burden of having to complete a form prior to their consultation. Other reports included that patients were simply short of time either attending in their lunch time or on the way to other appointments. The data collection form has been amended to reduce the burden on patients. A few questions were reported to have ambiguous wording and these have been reworded to make the meaning clearer. Key findings from the SDC pilot data included: Patient demographics 56% of patients were female and 43% were male 93.9% of patients were white The age range of patients was from 5 days old to 93 years old Occupational data showed that 47.9% were in full time employment, and 10.9% selfemployed full time; 19% were retired, and 14.2% worked part time as either employed or selfemployed, and 6.3% were not currently employed GP referral was reported by 6.3% of patients A total of 48.1% of patients reported between 1 and 4 visits to their GP concerning their current symptoms, and 29% had undergone previous NHS treatment or investigation Access to treatment was rapid. A total of 16.8% of patients were offered an appointment on the same day; a further 54.2% were offered appointments within the next 72 hours. Symptom profiles Space was provided to record up to three symptom areas. Lumbar symptoms were the most common (36%), followed by cervical spine (15%), sacroiliac/pelvic/groin (7.9%), head/facial area (7%), shoulder (6.8%), and thoracic spine (6%) Additional symptoms were recorded in 2.9% of patients Symptom duration for the current episode was categorised and included acute (<6 weeks) in 51%; subacute (7-12 weeks) in 15%, and chronic (13 weeks or more) in 32%. A total of 2% of patients did not respond A total of 797 patients reported the presence of comorbidities, as diagnosed by their medical practitioner. The most common of these was hypertension (11.7%), followed by asthma (6.6%), and arthritis (5.7%) Osteopathic patient management Practitioners recorded that 97% of patients were suitable for osteopathic treatment Treatments given to patients were varied and complex. Soft tissue treatment was the most common (78%), followed by articulation (72.7%), and HVLA thrust/manipulation techniques (37.7%). These were followed in frequency by cranial osteopathy (25.8%), muscle energy (18.3%), and functional technique (13.7%) Additional interventions in patient management included education (35.8%), and exercise (22.6%). A variety of self-management strategies were discussed with 88% of patients Outcomes of treatment Simple patient-reported outcomes were recorded on the data collection sheet. These were drawn from the literature but are not validated measures and their findings should be treated with caution. After the first appointment, the majority of patients (59.4%) reported no complications of treatment. The most common complications within the first 24-48 hours after treatment were increased stiffness (18%), increased pain (14%), and fatigue (6.6%). After the second and subsequent appointments, 77.3% of patients reported no complications of treatment. Only a small number of patients (10.4%) were off work at first presentation; of these 5.3% were able to return to work after one treatment, and 3.1% after two treatments. In cases where patients underwent onward referral, 88% were to their GP for further investigation, and 13% were to a hospital consultant.
ObjectivesContextual components of treatment previously associated with patient outcomes include ... more ObjectivesContextual components of treatment previously associated with patient outcomes include the environment, therapeutic relationship and expectancies. Questions remain about which components are most important, how they influence outcomes and comparative effects across treatment approaches. We aimed to identify significant and strong contextual predictors of patient outcomes, test for psychological mediators and compare effects across three treatment approaches.DesignProspective cohort study with patient-reported and practitioner-reported questionnaire data (online or paper) collected at first consultation, 2 weeks and 3 months.SettingPhysiotherapy, osteopathy and acupuncture clinics throughout the UK.Participants166 practitioners (65 physiotherapists, 46 osteopaths, 55 acupuncturists) were recruited via their professional organisations. Practitioners recruited 960 adult patients seeking treatment for low back pain (LBP).Primary and secondary outcomesThe primary outcome was ba...
The General Osteopathic Council commissioned this research as part of a wider programme of work t... more The General Osteopathic Council commissioned this research as part of a wider programme of work to enhance knowledge of the attitudes, needs and concerns of the public and patients who seek the care of osteopaths. The GOsC envisages that the findings the study will inform GOsC policy development, the provision of information to patients and the public, and guidance to osteopaths. The main aim of this study was to gain an understanding of the expectations of patients receiving osteopathic care, and to quantify the extent to which ...
Monitoring of patients' physical and psychological problems during and after cancer treatment is ... more Monitoring of patients' physical and psychological problems during and after cancer treatment is essential in modern oncology practice. Traditional clinical methods can be supplemented by Patient-Reported Outcomes Measures (PROMs) measures. The potential role of PROMs is recognised and endorsed by national and international practice guidelines. The introduction of formal measurement of PROMs in clinical practice is a complex health care innovation requiring careful planning, design and successful implementation of a number of essential components, such as choosing the patient questionnaire(s), a convenient affordable electronic method for reporting and display in hospital records and engaging clinicians to use and act on the reports. There is mounting research evidence that using PROMs in individual patient care in oncology is beneficial to patients, but this approach has not found a place in routine clinical practice. A brief overview of this evidence will be provided. Following this, the presentation will focus on examples of incorporating PROMs and eHealth interventions into routine patient care during and after cancer treatment, drawing on 20 years' experience in Leeds of using electronic systems for capturing patient reported data in oncology settings. Examples will be given of: 1) Monitoring toxicity during systemic cancer treatment using online PROMs integrated with Electronic Patient Records (randomized trial part of NIHR eRAPID programme); 2) Service development project-Remote follow-up of testicular cancer patients using online PROMs plus community-based investigations. Examples of other online PROMs systems will be presented. The values and challenges of PROMs integration in routine oncology practice will be discussed.
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Papers by Carol Fawkes