Transforming MSK treatment in the NHS

Talking Point: By Chris Rowley, Scottish MSK Orthotic National Lead

Musculosketal (MSK) is a hot topic in UK health and if AHPs engage there is opportunity in abundance.

In my opinion, there is the potential to transform the ability of the NHS to deliver cost effective and timely MSK treatment to patients.

Given the diversity of UK health there are myriad ways of MSK services being delivered but whatever the approach taken, it is likely that there will be some form of measurement of performance.

Diverting patients away from medics will rightly face scrutiny, which means treatments offered to MSK patients by AHPs should, where possible, be underpinned by an evidence base.

Some AHP professions will potentially find this easier than others.

In orthotics I have heard it said that there is little evidence to support orthotic practice and I was interested to understand the reality.

I know that orthotists are well placed to deliver MSK services, as long as they get to see the patient at an early (acute) stage, but without an evidence base to draw on I do not think it would be easy to make the case that existing funding flows should change and patients be diverted.

As the Scottish MSK National Lead for Orthotics I applied for funding from Scottish Government to accelerate work on a Directory of Evidence Based Orthotic Practice.

In October 2014 funding was granted from the Transforming Orthopaedic Outpatient workstream with the proviso that the work was completed by the end of March 2015.

The gold standard for this type of work is the Scottish Intercollegiate Guidelines Network Guide No 50, otherwise known as SIGN 50.

This guidance was followed without deviation. The process involved Level 2 Library searches of all English language articles. Level 1 searches were also commissioned which would pick up all the grey literature and unpublished articles.

The work was coordinated in two phases by Nicola Munro and Fiona Monaghan and was loaded on to an electronic platform called The Clinical Knowledge Publisher hosted by NHS Education Scotland (NES).

The result is a Directory of Evidence Based Orthotic Practice (DEBOP). The Directory focuses on MSK conditions covering Upper Limb, Hip, Knee, and Foot and Ankle.  The work identifies specific differential diagnoses and the evidence base that supports orthotic management of that condition. There are live links to the full text articles. You may, however, need an Athens password to access some articles.

I was gratified to find that there was a wealth of evidence to support orthotic practice, 1100 references on forefoot alone.  All the evidence has been filtered for relevance, critically appraised to determine quality and arranged so that practitioners can access it live whenever needed.

The British Association of Prosthetists and Orthotists (BAPO) has agreed to coordinate maintenance of the directory to ensure that it remains current.

Developing and sharing resources like this delivers the powerful message that AHPs and, in this particular case, orthotists, are serious about driving forward the MSK health agenda in the UK.

Chris Rowley