Integrated musculoskeletal service ensuring patients choose the right treatment for their conditions

Physiotherapists across Morecambe Bay are using a framework based on the nationally developed ‘Shared Decision Making’ programme to help support patients with hip and knee pain to make the right decision about their treatment.

More than 100 patients so far, who have attended the Integrated Musculoskeletal Service (iMSK), have been given the opportunity to have a conversation with their physiotherapist and go through 12 questions together based on the Oxford Hip and Knee Score which indicates whether they may be a candidate for surgery.

Alison Parish, iMSK Practitioner Physiotherapy, based at Heysham Health Centre, said: “This type of approach, to give people options and go through the pros and cons of different interventions, is something we’ve been doing as physios for a long time but what we have done is develop a framework based on the national Shared Decision Making programme and have rolled this out to the iMSK service across the bay.

“Shared Decision Making is about having a grown-up discussion with the patient, not telling them what to do. It’s a collaborative process through which the physiotherapist supports a patient to reach a decision about their treatment.”

If a patient attending the service decided that they did not want to go down the surgery route they would be offered alternative treatments including:

• Physiotherapy/hydrotherapy
• Corticosteroid and local anaesthetic injections
• An Escape-pain programme which consists of 12 one-hour sessions, twice a week, over a six week period. The course is aimed at people over 45 years old with a diagnosis of osteoarthritis (chronic joint pain) of the hip and/or knee
• Referral to the orthopaedic service for consideration of a guided injection into the hip.

Patient feedback on the Shared Decision Making approach has included:

• “The outcome measure helps me to be honest about how it is affecting my life.”
• “Very good I don’t want surgery.”
• “Good to know what the alternatives are up-front.”

Jonathan Ashton, Consultant Physiotherapist, added: “This approach is not about stopping patients having hip and knee surgery but is about ensuring that the right patients are referred for surgery at the right time for them.

“We also have fortnightly multi-disciplinary meetings with an orthopaedic surgeon and pain management consultant which reflects our integrated way of working in iMSK. There we discuss more complex patients and whether surgery is really the best option for them.”

The team’s vision for the future is that the Shared Decision Making approach will be adopted by everyone across the multi-disciplinary spectrum including GPs, nurse practitioners, First Contact Physiotherapists and orthopaedic surgeons.

Jonathan added: “We are also looking to adapt the framework to cover other areas such as shoulder, elbow, wrist and spine pain.”

This new way of working is another example of Bay Health and Care Partners working together more effectively to provide better care in the community, which will keep people across Morecambe Bay healthier and at home for longer without having to come into hospital.

You can find out more about the national Shared Decision Making approach at https://www.england.nhs.uk/shared-decision-making/