Wansbeck Chiropractic Clinic

							         Wansbeck Chiropractic Clinic

Patient Outcome Measurement Statistic
              Review

                  Chronic Lower Back

                               2011




Wansbeck Chiropractic Clinic            1
TM2 Ref: office        ODI 639 – 1004




Title :             Patient Outcome Measurement Statistic Review

Author              Mr Gary Hall (Chiropractor & Clinic Proprietor )

Report Purpose      This report is to support clinical experience in the treatment of
                    Chronic Back Pain using manual manipulative therapy.
                    (This is not a study report, it is a statistical review of patient
                    outcome measures)

Target Audience NHS PCT Chairs, GPs PBC Groups, Allied Health
                Professionals, Chiropractic Colleges, College of Chiropractic
                Research Faculty, Practice Patients
Date:           1s Nov 2011
Contact details Wansbeck Chiropractic Clinic
                196 Milburn Road
                Ashinigton
                Northumberland
                NE63 0PH

                    Tel: 01670 813939
                    Email: info@wansbeckchiropractors.co.uk




Purpose Summary:

As an evidence based practice and accredited research clinic we endeavour to make

provisions for data to be freely available for other healthcare professions to establish a

greater understanding of the benefits of manual manipulative therapy in certain

musculoskeletal conditions. The purpose of this report is to support clinical

experience in the treatment of Chronic Lower Back Pain (CLBP questionnaires to

record and monitor patient’s outcome measurements throughout care. By doing so it

allows the clinic to evaluate and adapt care plans to incorporate both latest research

findings and clinical experience for a more patient centre care role while maintaining

an evidence based practice approach.




Wansbeck Chiropractic Clinic                                                             2
 Objectives of Report

       To support clinical experience in manipulative therapy

       Maintain best clinical practice in patient care

       Allow transparency in patient’s choice of care in relation to known measurable

        outcomes.

       Improve future integration with other healthcare professionals and allow

        greater patient autonomy.

       Continued development of evidence based practice.



 Outcome Measurement Questionnaires Used

 Oswestry Disability Index (ODI)

 The ODI has been used extensively used since its introduction in 1980 by Fairbank

 and co-workers in both research and clinical practice. Its validity and reliability has

 been well established, a reliability coefficient of 0.89 for same day retest reliability

 was reported making it more favourable than other questionnaires. Researchers

 suggest that a profile score reduction of 6 points is enough to show clinical

 improvement while others suggest as much as 15 points, I have used a profile score

 reduction of 12 points as a marker of improvement. Questionnaires are filled out on

 the initial visit, one month, three month and six month later. All data is entered onto a

 excel spreadsheet using ODI formula to calculate profile scores.



Oswestry Disability Index (ODI) % of Improvement

   Sample size 43            Patient Category             Improved score

Chronic (>12wks )                  N= 43                        82%




 Wansbeck Chiropractic Clinic                                                               3
ODI for Chronic LBP (>12 wks) 12 points déduction indicates clinical improvement)

  Oswestry         Baseline Score      Follow-up          Reduction in           95%
Chronic (12wk)      Mean - (SD)        Mean - (SD)           Score            Confidence
    Scores                                                Mean - (SD)          Interval
   1 month
  Follow-up        34.41 (15.81)     20.97 (17.07)        13.44
    N=43

   3 month
  Follow-up        33.85 (16.75)     14.85 (13.14)        19 .00
   N= 20


Chronic LBP patients receive nine treatments over a twelve week period there is an increased
improvement score recorded in the later stage of the care plan.




       End Note:

       The purpose of this analytical report is to provide a succinct but comprehensive

       summary of patient outcome measures that attended the Wansbeck Chiropractic

       Clinic for musculoskeletal conditions and received manual manipulative treatment.



       These findings concur with the very latest literature on the effectiveness of

       manipulative treatment for a range of musculoskeletal conditions. The most recent

       being Bronfort et al, 2009 Report where 49 relevant systematic reviews and 16

       evidence-based clinical guidelines plus an additional 46 RCTs not yet included in

       reviews and guidelines were systematically reviewed. The findings were, that spinal

       manipulation/mobilization is effective in adults for: acute, subacute, and chronic low

       backpain; migraine and cervicogenic headache; cervicogenic dizziness;

       manipulation/mobilization is effective for several extremity joint conditions; and

       thoracic manipulation/mobilization is effective for acute/subacute neck pain.




       Wansbeck Chiropractic Clinic                                                             4
Information for Patient

Back pain is very common; according to one survey almost half the adult population

of the UK (49%) reported low back pain lasting for at least 24 hours at some time in

the previous year. Up to 7% of people with acute back pain will develop chronic back

pain which lasts more than twelve weeks. Chronic back pain sufferers have

considerable discomfort and account for approximately 80% of the social and health

care costs. The figures above show that in 2010 we had considerable success in the

treatment of lower back pain in comparison to other forms of treatment.




Wansbeck Chiropractic Clinic                                                           5