Reforming our relationship with Evidence
MSK Reform (www.mskreform.org.uk) is a movement which has recently published their manifesto. It is the culmination of 2 years of collaboration recognising that MSK is a huge area of healthcare spending and work days lost, and that there is a need to reform MSK practice to improve patient care. There needs to be more consistency of care, more preventative work and professions working together to improve MSK care in the UK.
This project emphasises joined up working between healthcare professions striving for MSK reform. In this article I seek to apply the manifesto principles to demonstrate the importance of reform for osteopathy and that we can contribute to this discussion. There are 5 areas of reform in the manifesto – Evidence, clinical governance, education, clinical excellence and exerting influence as well as reforms for different stakeholders. I hope to cover all of these in separate articles.
This is a conversation. This is the beginning of the discussion but I really hope you will be motivated to join in with your knowledge and contribute to the discussion as well as join in with MSKreform.
Do you think reform is needed? What reforms do you think are important?
Reforming our relationship with Evidence
Evidence based practice is established on the three pillars of the patient’s values and preferences, clinical experience and expertise and research evidence. The aim is for safer, more consistent, and cost-effective care.
What does this look like in Osteopathy as part of the MSK professions?
DEVELOPING AN EVIDENCE INFORMED CULTURE
The Manifesto for Reform makes proposals to support an evidence-based culture, reduce variation in clinical practice, address measurement and accountability, narrow the clinical-academic divide, enhance patient-centred decision-making. I’ve gone through these proposals and added an osteopathic perspective where appropriate – feel free to add your thoughts.
1. MSKR advocate a roll out of the Oxford EBP framework with each clinicians’ involvement evidenced in personal appraisals and integrated into performance measures.
This basically means all staff actively involved in research but at different levels – actively involved in research, supporting research, demonstrating evidence based practice using clinical audit. Is this something we can aspire to in osteopathy? We certainly need more research evidence. You will see from responses below there are lots of opportunities to get involved with research, reading and applying evidence and supporting research.
You can easily support research by responding to survey requests from students, GOsC, iO and other research projects.
2. MSKR will aim for all MSK service providers to ensure at least 5% of clinical staff’s working week is for protected learning time – approximately two hours full-time equivalent – to be annualised and stated in job descriptions.
Osteopaths could easily incorporate protected learning time into their week. We already have a 30 hour requirement. This proposal raises the bar to around 90 hours per year (allowing for holidays) – focussed learning that could potentially make quite a difference to your clinical practice.
3. MSKR propose a move to cooperative-contracts between universities and service providers for each MSK service employing 20 or more clinical staff.
Could there be opportunities for more links between the education providers and osteopaths in practice. Many osteopaths have undertaken Masters degrees and some PhDs – is there a forum for sharing that research learning with practice? Some will be published in journals but not all.
How do the education providers link with osteopaths in clinical practice?
4. MSKR will encourage universities to grant full literature access to a named research champion in all services employing 20 or more clinical MSK staff.
There is a huge amount of published literature every day – clinical guidelines, journal articles, health papers, blog posts, podcasts, videos, articles shared on social media. It can be over-whelming and it is impossible to keep up to date with it all. Research champions could be a great way to disseminate research evidence – but they would need funding somehow.
REDUCING UNWARRANTED VARIATION IN CLINICAL PRACTICE
5. MSKR will promote the need for additional NICE guidelines relating to MSK disorders.
Everything NICE has said on musculoskeletal conditions: https://pathways.nice.org.uk/pathways/musculoskeletal-conditions
NICE Clinical Knowledge Summaries https://cks.nice.org.uk/clinicalspeciality#?speciality=Musculoskeletal
We are very fortunate to have NCOR. Other professions do not have a focussed research organisation. NCOR has produced some helpful snapshot evidence summaries and has its research hubs to get involved with too. www.ncor.org.uk
Making the most of the resources we have will help us to recognise where there are gaps and take appropriate action.
6. MSKR propose increased use of knowledge translation strategies.
This encourages communities of good practice specialising in developing EBP such as the OHPM headache group, and OCC. There is potential to develop more of these groups. If you know of others, let me know and I’ll add them in.
7. The MSKR evidence working group will be available for consultation with MSKR spokespeople, journalists and members of the public interested in wider promotion of best practice.
There are a number of media specialists who have trained to speak up for the profession. Other MSK professions have had some successful campaigns sharing evidence-based care such as the CSP ‘Back Pain Myth Busters’.
MEASUREMENT AND ACCOUNTABILITY
8. MSKR advocate mandating the universal use of patient-orientated outcome measures in UK MSK healthcare.
NCOR has worked hard at developing the PROMs measure but uptake is relatively low. MSK reform suggest the use of the Patient Specific Functional Scale and MSK-HQ questionnaires.
The culture of measuring outcomes is very poor in osteopathy. I’m not sure if it is improving amongst new graduates. It is really important that we start making changes to this culture so that we can collect data easily and effectively and have evidence of effectiveness.
9. MSKR support Clinical Audit Awareness Week (CAAW) and pledges to produce specific MSK service audit resources as well as examples of MSK service audits to coincide with CAAW on an annual basis
NCOR provides a lot of help and support to carry out audits. There are great resources available here: http://www.clinicalauditsupport.com/
If you have ever carried out an evidence based audit it would be great to hear about it.
NARROWING THE CLINICAL ACADEMIC DIVIDE
10. MSKR advocate for the development of more clinical academic posts across the UK
11. MSKR proposes the development of an up to date directory of resources for MSK funding streams.
12. MSKR support the proliferation of open access journals and will lobby for a reformed business model to improve clinician’s access to evidence.
I don’t know how many osteopaths work in academia, I know there are several. Clinical academic posts brings together research and practice but how can research information be better disseminated so it is applied in practice. How could we fund more research and PhD students?
We have access to several journals through the OZone:
IJOM, Clinical Biomechanics, Journal of Bodywork and Movement Therapies, Journal of Manipulative and Physiological Therapeutics, The Lancet, Manual Therapy – now Musculoskeletal Science and Practice, and Spine Journal.
There are still often journal articles that we can’t access full-text. There are a few helpful Open Access journals and some journals release articles as open access for a limited period.
PATIENT-CENTRED DECISION MAKING
13. MSKR propose accessible mechanisms for patients to contribute to service audits and research projects relevant to their condition, circumstances and interests.
14. MSKR support the integration of patients into decision-making structures in order to improve patient-centred care and governance in MSK services.
Patients can contribute enormously to service development. The manifesto benefitted from patient input and there are several patients who helpfully share their views through blogs and social media. (Joletta Belton www.mycuppajo.com Tina www.livingwellpain.net )
How could the patient voice be heard more in practice. We have the very helpful GOsC Yougove survey which provided some useful information available here: https://www.osteopathy.org.uk/news-and-resources/research-surveys/gosc-research/public-and-patient-perceptions/
How could patients be more involved in how we plan our practices and understand their values and needs in practice? Motivational Interviewing is very much in vogue as a method for enhancing patient interactions. Learning resources are available here:
This is widely promoted as a most helpful book: Rollnick, S., Miller, W.R., & Butler, C.C. (2008). Motivational interviewing in health care: Helping patients change behavior. New York: Guilford Press.
There are many more resources available.
There are also a number of resources for learning more about shared decision making:
As you can see there are a lot of resources available for osteopaths. It struck me that this was developing into a useful list of CPD. For me some of the significant gaps and areas for development are:
- Improving the academic – clinical divide and the university-clinical divide
- Involving patients more
- Developing a culture data collection
- Developing more specialist groups, and research champions to communicate with practitioners
What are your thoughts? It would be great to hear. I’m hoping a discussion will start in the Mint Osteopaths Group