Alexander L1, Mitchell D1, Williams H1, Cooper K1
1Robert Gordon University, Aberdeen, United Kingdom
Background: Demonstrating clinical and cost effectiveness is an important part of physiotherapy practice to identify effective services for patients. Currently, musculoskeletal physiotherapy is mainly provided in out-patient settings but there are other settings such as residential that are less common and lack evidence of their effectiveness.
Purpose: This service evaluation project aimed to evaluate the residential musculoskeletal physiotherapy service (in terms of clinical and cost effectiveness) provided at two sites in the UK.
Methods: All attendees of a two week residential musculoskeletal physiotherapy service were invited to take part. Following informed consent, all participants completed assessments at the initial physiotherapy session (baseline) and at the final physiotherapy session (end of the two week stay). A sub-group of participants also completed a further assessment six weeks after returning home. The main outcomes assessed were demographic data, work ability, disability, quality of life, pain as well as relevant clinical physiotherapy outcome measures.
The qualitative aspect comprised telephone interviews with a sub-group of participants six weeks after returning home from the PTC. Semi-structured interview guides were developed which consisted of the main outcomes as well as participants' views around their experience and expectations at the PTC. All interviews were audio recorded and later transcribed for content and thematic analysis.
The study also included a Cost Benefit Analysis (CBA) and Quality Adjusted Life Years (QALY) calculation to provide an economic evaluation of the PTC physiotherapy service.
Results: This project resulted in 644 (68% male, mean age 44 years) and 41 police officers participating in the quantitative and qualitative studies respectively. At the end of the two week stay, there was a significant improvement in work ability (p 0.01), quality of life (p 0.01), disability (p 0.01), pain (p 0.01) and in the majority of physiotherapy outcome measures. At the six week follow up, 104 out of 204 participants (51% return rate) responded to an online questionnaire. The main outcomes demonstrated work ability had improved slightly further (p 0.001) and quality of life had reduced slightly but was still significantly improved in comparison to baseline (p 0.001).
Four themes emerged from the analysis of the qualitative interviews: physiotherapy at PTC; work status; economics and overall PTC experience. The majority of participants were very positive about their experience at the PTC acknowledging that their expectations were met and often exceeded. The staff (especially physiotherapy) was noted for their professionalism and provision of person centred care.
The economic analysis demonstrated a significant improvement in QALYs from 0.67 to 0.78 (p 0.01) with estimates of CBA ranging from 0.89 to 3.66 (potential savings of £16,861 to £28,079). Participants also provided very positive feedback on the PTC in terms of value for money from the interviews.
Conclusion(s): Overall, the quantitative, qualitative and economic analysis provided evidence that the physiotherapy provision at the PTC is effective, highly regarded by recipients and cost-effective.
Implications: This service evaluation has demonstrated the effectiveness of musculoskeletal physiotherapy in the short-term. Further long term evaluations are warranted to investigate the effects at six and 12 months.
Keywords: Musculoskeletal physiotherapy, effectiveness, cost-effectiveness
Funding acknowledgements: This project was funded by the Police Treatment Centres, UK.
Purpose: This service evaluation project aimed to evaluate the residential musculoskeletal physiotherapy service (in terms of clinical and cost effectiveness) provided at two sites in the UK.
Methods: All attendees of a two week residential musculoskeletal physiotherapy service were invited to take part. Following informed consent, all participants completed assessments at the initial physiotherapy session (baseline) and at the final physiotherapy session (end of the two week stay). A sub-group of participants also completed a further assessment six weeks after returning home. The main outcomes assessed were demographic data, work ability, disability, quality of life, pain as well as relevant clinical physiotherapy outcome measures.
The qualitative aspect comprised telephone interviews with a sub-group of participants six weeks after returning home from the PTC. Semi-structured interview guides were developed which consisted of the main outcomes as well as participants' views around their experience and expectations at the PTC. All interviews were audio recorded and later transcribed for content and thematic analysis.
The study also included a Cost Benefit Analysis (CBA) and Quality Adjusted Life Years (QALY) calculation to provide an economic evaluation of the PTC physiotherapy service.
Results: This project resulted in 644 (68% male, mean age 44 years) and 41 police officers participating in the quantitative and qualitative studies respectively. At the end of the two week stay, there was a significant improvement in work ability (p 0.01), quality of life (p 0.01), disability (p 0.01), pain (p 0.01) and in the majority of physiotherapy outcome measures. At the six week follow up, 104 out of 204 participants (51% return rate) responded to an online questionnaire. The main outcomes demonstrated work ability had improved slightly further (p 0.001) and quality of life had reduced slightly but was still significantly improved in comparison to baseline (p 0.001).
Four themes emerged from the analysis of the qualitative interviews: physiotherapy at PTC; work status; economics and overall PTC experience. The majority of participants were very positive about their experience at the PTC acknowledging that their expectations were met and often exceeded. The staff (especially physiotherapy) was noted for their professionalism and provision of person centred care.
The economic analysis demonstrated a significant improvement in QALYs from 0.67 to 0.78 (p 0.01) with estimates of CBA ranging from 0.89 to 3.66 (potential savings of £16,861 to £28,079). Participants also provided very positive feedback on the PTC in terms of value for money from the interviews.
Conclusion(s): Overall, the quantitative, qualitative and economic analysis provided evidence that the physiotherapy provision at the PTC is effective, highly regarded by recipients and cost-effective.
Implications: This service evaluation has demonstrated the effectiveness of musculoskeletal physiotherapy in the short-term. Further long term evaluations are warranted to investigate the effects at six and 12 months.
Keywords: Musculoskeletal physiotherapy, effectiveness, cost-effectiveness
Funding acknowledgements: This project was funded by the Police Treatment Centres, UK.
Topic: Musculoskeletal
Ethics approval required: No
Institution: Robert Gordon University
Ethics committee: School of Health Sciences Research Review Group
Reason not required: this was a service evaluation and as such did not require ethical approval. However, good research practice was adhered to throughout the project to uphold ethical principles such as all participants were invited to take part, informed consent was recorded for each participant prior to audio interviews, all participants were assigned an ID code to ensure anonymity, and all research data was securely held on password protected computers.
All authors, affiliations and abstracts have been published as submitted.
