The practice of working to align with the CSP’s Musculoskeletal (MSK) Physiotherapy Service Standards

The new MSK Physiotherapy Service Standards by the CSP

The Musculoskeletal (MSK) Physiotherapy Service Standards developed by the Chartered Society of Physiotherapy (CSP) will support the development and delivery of high quality MSK services in the public and independent sector. They are designed to demonstrate the value of MSK physiotherapy services and drive continuous quality improvement.

The eight standards aim to support the improvement of the structure (attributes of the service), process (how processes work to deliver a desired outcome) and outcomes (the impact on people with MSK) of MSK physiotherapy.

Michael Guard, EQL’s Head of Clinical Services, is a strong believer in the value of the new standards. “I welcome the new standards and I think they will serve to drive accountability and standards up across our profession, no matter the modality, locality or sector of delivery,” he said.

Quality Standard 7: Evaluation, audit and research- an overview

“Quality Standard 7: Evaluation, audit and research, is of particular interest to me as it speaks to the importance of using data-informed insights to drive service improvements. To quote Karl Pearson: ‘That which is measured improves. That which is measured and reported improves exponentially’”.

Standard 7 states that the collection of data to undertake audit, evaluation, research and quality improvement is essential to understand the needs of people with MSK physiotherapy services, assess the quality of service delivery, measure patient outcomes and experience and reduce health inequalities.

The standard has six recommendations:

1.     MSK physiotherapy services use data to understand the needs of people with MSK conditions, assess the quality of service delivery, measure patient outcomes and experience, and monitor for inequalities.

2.     Data are collected for a specific purpose and collection, analysis and reporting are planned.

3.     MSK physiotherapy services have robust systems of measurement, monitoring and audit that, where appropriate, are standardised to enable quality improvement and contribute to regional and national research priority setting.

4.     MSK physiotherapy services work in partnership with people with MSK conditions to evaluate, improve and redesign services and pathways.

5.     Good practice and lessons learnt are shared locally, regionally, nationally and internationally.

6.     MSK physiotherapy services are evidence-based, integrating research/evaluation findings into practice.

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Aligning to the standard in practice

In his previous role at Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Michael co-led the project ‘Implementing a digital and automated method of Patient-Reported Outcome Measure (PROM) Data Collection, Analysis and Reporting’, which involved the implementation of an automated system that disseminates, collects, analyses and reports PROMS and demographic data with the integrated-MSK department.

The integrated-MSK (iMSK) service at GSTT had previously collected multiple general and patient specific outcome measures, which were disseminated and collected on paper, a method that was time costly, inefficient and prohibitive to scale, and had very low completion rates. 

The drive towards a paperless service, compounded by the social distancing measures of the pandemic, meant the MSK service moved to remote sessions, which rendered paper collection of PROMS redundant and required a different method of capturing patient quality metrics to understand patients’ outcomes and experiences.

Michael co-led to explore the problem and validate and implement an automated system. Stakeholder surveys helped to understand the perceived importance of PROMS paper methodologies and the appetite for digital approaches, while a scoping review of the literature relating to outcome measures helped to see if reducing variation was feasible and clinically appropriate. 

The project took a year to implement, but the GSTT i-MSK department now digitally disseminates (by SMS), collects, analyses and reports PROMS and demographic data of services users. Information is collected while a patient is under active treatment, at discharge and at 1 and 2-year post-discharge. More than 6,000 Patient Reported Experience Measures (PREM) and PROMs have been completed with a 60% completion rate.

Improving data collection in this way ensures that people who have a lived experience of MSK conditions can be involved in the evaluation of services and develops inclusive participation by enabling people to be more involved with the services they use.  

The project was shortlisted in the NHSX Chief Allied Health Professions Officer (CAHPO) Awards 2021 in the AHP Digital Practice category and also presented to  the Health Innovation Network and at vPTUK 2021.

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Image: Draft 1 Dashboard: Presented at vPTUK- and presentations accessible via the CSP

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Ahead of the game

Michael has recently been accepted onto Cohort 3 of the NHS Health Education England Topol Digital Fellowship working on a project closely linked to the Musculoskeletal (MSK) Physiotherapy Service Standard 7. 

His work during the fellowship will involve overseeing the implementation of PROM and PREMS, alongside native data that is collected by EQL’s digital MSK product, Phio. The data will be used firstly to measure, validate, audit and improve EQL’s services. Then, by using EQL’s national reach, gathered to uncover AI-led population health data insights. 

Michael has always seen the opportunity of aligning data points to evaluate service quality across patient touch points in MSK physiotherapy services and he believes this work will help EQL to become the national ‘go-to’ technology provider when it comes to dissemination, collection and analysis of MSK services, across sectors.

EQL already has a robust clinical governance system in place which aligns with statutory requirements including (not obligatory for our service type) CQC standards, with which the new MSK Standards are aligned, so the majority of the Musculoskeletal (MSK) Physiotherapy Service Standards are already accounted for in our current practice or planned improvements. 

However, Michael will be using the insight and knowledge gained from working on the  GSTT project to help EQL’s collective team of domain specialists — developers, data scientists, product and other non-clinical team members — implement those planned improvements.

He is keen to stress that those involved in MSK need to start working towards these standards immediately and ensure their partners who are delivering services are working towards them and measuring themselves against national standards. 

“If you don’t have a designated team or person assigned to quality metric collection - find one, fast. Don’t be left behind in this space, as it’s only a detriment to patients. Knowledge is power, and having those insights means you’ll be ahead or moving along as our profession evolves,” he said.

EQL is working hard internally and is in the final stages of deploying data collection and analysis for current and prospective partners and is well positioned to fulfil any data-collection needs.