The effectiveness and efficiency of a primary care based osteopathy clinic for spinal pain

Spinal pain is common, disabling, costly to society, and a frequent reason for consulting a general practitioner (GP). Usual GP care involves the prescription of analgesia, advice about rest, activity and work, and orthopaedic or physiotherapy referral. Spinal manipulation is recommended by low back pain clinical guidelines, but recent Cochrane reviews found that manipulation has limited effectiveness compared with other treatments, although few trials comparing spinal manipulation with usual GP care were identified. A primary care osteopathy clinic was established in Llanfairfechan health centre by the author. The overall aims of this thesis were to determine whether this was more effective than usual GP care, and an efficient use of health service resources. Preparatory studies comprised an audit of the clinic to describe the treatment package, development of a set of condition-specific outcome measures for the whole spine, the Extended Aberdeen Spinal Pain Scales (EASPS), and their psychometric testing, as well as piloting other secondary outcome measures. The Randomised Osteopathic MANipulation Study (ROMANS) recruited 199 patients randomised to usual GP care, or an additional three sessions of osteopathic spinal manipulation. After two months all outcome measures had improved in both groups the osteopathic treatment group by more than the usual care group. This improvement was significantly greater in the primary outcome measure the EASPS (effect size 0.4) and the SF-12 mental score (effect size 0.6). At six months most outcome measures had continued to improve in both groups, and the improvement in the osteopathy group remained significantly greater for the mental score of the SF-12 (effect size 0.5) but not for the EASPS. The point estimate of the cost per improvement in QALY gain was less than £4,000. When these results were combined in a meta-analysis with similar trials, manipulation was significantly more effective. Compared to usual GP care spinal manipulation is an effective and efficient use of health service resources

A lifestyle management programme focused on exercise, diet and physiotherapy support for patients with hip or knee osteoarthritis and a body mass index over 35: a qualitative study

The Lifestyle Management Programme (LMP) is an exercise and weight management programme with physiotherapy support for people with hip or knee osteoarthritis (OA) and a body mass index (BMI) over 35. This qualitative study explored views and experiences of the LMP among patients and professionals, and offers insight for future programmes. Five referring clinicians and six delivering professionals participated in focus groups. Three referring GPs and nine patients who attended the LMP took part in semi-structured interviews. Topics included: referral, reasons for taking up and continuing the programme or not, and experiences and outcomes. Framework method was used to analyse the qualitative data. Overall, patients and professionals valued the multidisciplinary nature of the LMP. However, professionals explained feeling guilty about delaying patients on the orthopaedic waiting list and believed that the programme should be redirected to those with less severe OA and a lower BMI. Referring clinicians differed in their interpretation of the referral criteria and expressed varying levels of autonomy when making referrals. Patients referred after a consultation with their general practitioner appeared to be more satisfied with the referral process. Patients were also encouraged by the opportunity to improve health, their likelihood of surgery and social benefits. However, patients were discouraged by inconvenience, cost, lack of readiness to change and embarrassment. In conclusion, shared decision-making about lifestyle management without delaying orthopaedic opinion is preferable, and more psychological support may increase participation. Importantly, the programme may be better focused on rehabilitation for patients with a lower BMI and less severe symptoms

LEGO Serious Play for Health Research

Showcase of LEGO (C) Serious Play (C) core process applied to health researc

Understanding sciatica: illness and treatment beliefs in a lumbar radicular pain population. A qualitative interview study.

BACKGROUND:Several pathological processes contribute to lumbar radicular pain (LRP), commonly known as sciatica. It is not known how patients rationalise the experience of sciatica or understand the diagnosis. Providing clinicians with a better understanding of how patients conceptualise sciatica will help them to tailor information for patients on the management and treatment of the condition. AIM:To understand patients' beliefs regarding their illness following a diagnosis of LRP, how these beliefs were developed, and the impact of illness beliefs on treatment beliefs. DESIGN & SETTING:Qualitative interview study from a single NHS musculoskeletal interface service (in Wales, UK). METHOD:Thirteen patients recently diagnosed with LRP were consecutively recruited. Individual semi-structured interviews were recorded and transcribed. Data were analysed using a thematic approach. RESULTS:Four main themes were generated: (1) the illness experience (2) the concept of sciatica, (3) treatment beliefs, and (4) the desire for credible information. CONCLUSION:The diagnosis of LRP is often communicated and understood within a compressive conceptual illness identity. Explaining symptoms with a compressive pathological model is easily understood by patients but may not accurately reflect the spectrum of pathological processes known to contribute to radicular pain. This model appears to inform patient beliefs about treatments. Clinicians should take care to fully explain the pathology prior to shared decision-making with patients