AN EVALUATION OF MUSCULOSKELETAL OUTPATIENT SERVICES USING THE PATIENT SPECIFIC FUNCTIONAL SCALE

J. Holt¹, S. Mistry¹, C. Newton¹, S. Palmer²

¹University Hospitals Coventry & Warwickshire NHS Trust, Physiotherapy, Coventry, United Kingdom, ²Coventry University and University Hospitals Coventry & Warwickshire NHS Trust, Centre for Care Excellence, Coventry, United Kingdom

Background: The Patient Specific Functional Scale (PSFS) is a patient-reported outcome measure (PROM). Patients self-identify up to five activities that are important to them but that they are having difficulty with due to their health condition. Each activity is then rated from 0 (“unable to inform activity”) to 10 (“able to perform activity at the same level as before injury or condition”). Where more than one activity is chosen, an average is calculated. Because the items are patient-generated, it could be a useful PROM to evaluate services such as musculoskeletal outpatients, where patients with a wide range of different conditions are managed. It has been successfully used for back (Maughan and Lewis 2010), neck (Westaway et al 1998), knee (Chatman et al 1997) and upper limb (Hefford et al 2012) conditions. It has also demonstrated reliability, validity and responsiveness (Horn et al 2012).

Purpose: To investigate if the PSFS could be used to evaluate the musculoskeletal outpatient services within one healthcare organisation in the United Kingdom (UK).

Methods: The PSFS was administered at baseline and discharge with patients attending musculoskeletal physiotherapy services at University Hospital Coventry between August 2021 and May 2022. Some patients completed alternative PROMs, such as the Lower Extremity Function Score or the Disability of the Arm, Shoulder and Hand questionnaire but only analysis of the PSFS data is reported here. The minimum detectable change of the PSFS is 3 points for the single score (i.e. one activity) and 2 points for the average score (i.e. more than one activity). Data was compiled in a central Microsoft Excel spreadsheet and analysed using descriptive statistics.

Results: A total of 515/673 patients on the database completed a PSFS score at baseline (76.5%) and 88.7% of these (457/515) also completed a PSFS score at discharge. There was a relatively even split between those who chose to complete the single score and average score at baseline (47.4% versus 52.6% respectively). Completion rates at discharge were also very similar (87.7% versus 89.7% for the single and average score respectively).
The 457 patients with complete data had a mean ± standard deviation age of 50.4 ± 19.4 years (range 6-94 years) and were 50% Female. They presented with a very wide range of musculoskeletal complaints, including acute, surgical, and long-term conditions. The mean improvement from baseline to discharge was +5.65 ± 2.85 and +5.27 ± 2.45 for the single and average scores respectively and 91.2% of patients met or exceeded the minimum detectable change.

Conclusions: Completion rates were very high for both the single and average PSFS score versions. The PSFS seems to successfully capture clinically relevant improvements in patients’ functional status.

Implications: The generic nature of the PSFS, because the items are patient-generated, makes it a potentially useful PROM for musculoskeletal outpatients. It was very successfully used within this setting, identifying important improvements in patients’ functional outcomes from accessing this service.

Funding acknowledgements: This work was unfunded

Keywords:
Patient Specific Functional Scale
Service evaluation
Patient-reported outcome measures

Topics:
Musculoskeletal
Service delivery/emerging roles

Did this work require ethics approval? No

Reason: This service evaluation did not meet the Health Research Authority’s definition of research and was therefore exempt from ethical approval.