- Email: [email protected]
How Much Function Do Functional Restoration Programmes Restore?
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How Much Function Do Functional Restoration Programmes Restore? WE would like to thank George Peat (Peat, 2000) for taking an interest in our work (Frost et al, 2000) and raising important issues about functional restoration programmes (FRPs). The first is whether the changes measured by the Oswestry Disability Index (ODI) are clinically significant or not. We have used the guideline recommended by the authors of the Oswestry Low Back Pain Questionnaire (Fairbank et al, 1980) in interpreting the clinical significance of the changes that is based on nearly two decades of experience of using the measure. Dr Peat suggests an alternative could be to address the patients’ problem before treatment, set goals, and focus the intervention and outcome measurement accordingly. These ideas have already been incorporated into the programme, except the measurement of outcome. While this is conceptually an attractive approach to measuring outcome, the analytical difficulties are more complex than originally realised (Fitzpatrick, 1999). Additionally, individualised measures rely on patients selecting items based on their priorities. These priorities, although important, are not necessarily concordant with the potential wider public health impact of an FRP. In our future work we will study how threshold scores on various outcomes relate to important clinical and public health endpoints to understand better the potential impact of FRP and other approaches. The second issue is whether FRPs are worth while if there is no change in
disability. Disability and function should not be confused. The Oswestry ‘Disability’ Index (ODI) is a measure predominated by the subjective experience of pain. Such measures may not necessarily equate with observed function (for example Lamb et al, 2000). While the programme had little or no effect on pain-associated disability as indicated by the ODI, improvements in function and other measures were impressive, and this is why we suggest further development and testing of FRPs. The primary aim of FRPs is to restore function. We feel assured that an FRP can do this, and it is of interest that this seems not to depend on reducing pain symptoms. As all patients had already undergone physiotherapy on a one-to-one basis with little benefit, we think it unlikely this would be more effective than a group programme. To choose between treating different groups of patients requires knowledge of the public health impact of competing programmes, and should be made by people with experience in population health planning. It is contingent on us as a profession to participate in research that improves understanding of the clinical and public health impact of physiotherapy in clinical and cost-effectiveness terms. A large simple trial to establish the effects of FRPs within physiotherapy is feasible and we are keen to pursue this possibility. It would require the commitment of several centres to randomise enough patients into existing or planned FRPs, and adequate funding to support the research process.
Multiple Sclerosis – Clinical Management THE Multiple Sclerosis Research Group at the University of Ulster at Jordanstown was formed on June 1, 2000, with the financial support of the Multiple Sclerosis Society of Great Britain and Northern Ireland through the award of a grant totalling £341,000 to the University’s Rehabilitation Sciences Research Group. This five-year project has been designed to establish the current clinical management by the professions allied to medicine (PAMs) of people with multiple sclerosis (MS). Physiotherapy September 2000/vol 86/no 9
As part of the programme of work, a further survey will be conducted to assess the current management of people with MS by the professions allied to medicine. Depending on the results of the survey, further controlled studies will then be developed on the symptom management of MS. To facilitate this, we are developing a list of people in the PAMs who are specifically interested or directly involved in treatment of MS and who would be willing to participate in the survey. Anyone
If centres are interested in collaborating in such a trial, please contact us at the address below. Helen Frost MSc MCSP Sallie Lamb DPhil MSc MCSP Physiotherapy Subject Division, Coventry University, Priory Street, Coventry CV1 5FB. E-mail: [email protected] References Fairbank, J, Couper, J, Davies, J and O’Brien, J (1980). ‘The Oswestry low back pain questionnaire’, Physiotherapy, 66, 271-273. Fitzpatrick, R (1999). ‘Assessment of quality of life as an outcome: Finding measurements that reflect individuals’ priorities’, Quality in Health Care, 8, 1-2. Frost, H, Lamb, S E and Shackleton, C H (2000). ‘A functional restoration programme for chronic low back pain: A prospective outcome study’, Physiotherapy, 86, 6, 285-293. Lamb, S E, Guralnik, J M, Buchner, D M, Ferrucci, L M, Hochberg, M C et al (2000). ‘Factors that modify the association between knee pain and mobility limitation in older women: The Women’s Health and Aging Study’, Annals of Rheumatic Diseases, 59, 5, 331-337. Peat, G (2000). ‘How much function is restored by functional restoration programmes?’ (letter) Physiotherapy, 86, 8, 445.
interested is invited to contact our group through the address below. Andrea Lowe PhD Senior Research Fellow Gareth Noble PhD Research Officer Rehabilitation Sciences Research Group Room 50K 15 University of Ulster at Jordanstown Shore Road Newtownabbey Co Antrim BT37 0QB
How Much Function Do Functional Restoration Programmes Restore? WE would like to thank George Peat (Peat, 2000) for taking an interest in our work (Frost et al, 2000) and raising important issues about functional restoration programmes (FRPs). The first is whether the changes measured by the Oswestry Disability Index (ODI) are clinically significant or not. We have used the guideline recommended by the authors of the Oswestry Low Back Pain Questionnaire (Fairbank et al, 1980) in interpreting the clinical significance of the changes that is based on nearly two decades of experience of using the measure. Dr Peat suggests an alternative could be to address the patients’ problem before treatment, set goals, and focus the intervention and outcome measurement accordingly. These ideas have already been incorporated into the programme, except the measurement of outcome. While this is conceptually an attractive approach to measuring outcome, the analytical difficulties are more complex than originally realised (Fitzpatrick, 1999). Additionally, individualised measures rely on patients selecting items based on their priorities. These priorities, although important, are not necessarily concordant with the potential wider public health impact of an FRP. In our future work we will study how threshold scores on various outcomes relate to important clinical and public health endpoints to understand better the potential impact of FRP and other approaches. The second issue is whether FRPs are worth while if there is no change in
disability. Disability and function should not be confused. The Oswestry ‘Disability’ Index (ODI) is a measure predominated by the subjective experience of pain. Such measures may not necessarily equate with observed function (for example Lamb et al, 2000). While the programme had little or no effect on pain-associated disability as indicated by the ODI, improvements in function and other measures were impressive, and this is why we suggest further development and testing of FRPs. The primary aim of FRPs is to restore function. We feel assured that an FRP can do this, and it is of interest that this seems not to depend on reducing pain symptoms. As all patients had already undergone physiotherapy on a one-to-one basis with little benefit, we think it unlikely this would be more effective than a group programme. To choose between treating different groups of patients requires knowledge of the public health impact of competing programmes, and should be made by people with experience in population health planning. It is contingent on us as a profession to participate in research that improves understanding of the clinical and public health impact of physiotherapy in clinical and cost-effectiveness terms. A large simple trial to establish the effects of FRPs within physiotherapy is feasible and we are keen to pursue this possibility. It would require the commitment of several centres to randomise enough patients into existing or planned FRPs, and adequate funding to support the research process.
Multiple Sclerosis – Clinical Management THE Multiple Sclerosis Research Group at the University of Ulster at Jordanstown was formed on June 1, 2000, with the financial support of the Multiple Sclerosis Society of Great Britain and Northern Ireland through the award of a grant totalling £341,000 to the University’s Rehabilitation Sciences Research Group. This five-year project has been designed to establish the current clinical management by the professions allied to medicine (PAMs) of people with multiple sclerosis (MS). Physiotherapy September 2000/vol 86/no 9
As part of the programme of work, a further survey will be conducted to assess the current management of people with MS by the professions allied to medicine. Depending on the results of the survey, further controlled studies will then be developed on the symptom management of MS. To facilitate this, we are developing a list of people in the PAMs who are specifically interested or directly involved in treatment of MS and who would be willing to participate in the survey. Anyone
If centres are interested in collaborating in such a trial, please contact us at the address below. Helen Frost MSc MCSP Sallie Lamb DPhil MSc MCSP Physiotherapy Subject Division, Coventry University, Priory Street, Coventry CV1 5FB. E-mail: [email protected] References Fairbank, J, Couper, J, Davies, J and O’Brien, J (1980). ‘The Oswestry low back pain questionnaire’, Physiotherapy, 66, 271-273. Fitzpatrick, R (1999). ‘Assessment of quality of life as an outcome: Finding measurements that reflect individuals’ priorities’, Quality in Health Care, 8, 1-2. Frost, H, Lamb, S E and Shackleton, C H (2000). ‘A functional restoration programme for chronic low back pain: A prospective outcome study’, Physiotherapy, 86, 6, 285-293. Lamb, S E, Guralnik, J M, Buchner, D M, Ferrucci, L M, Hochberg, M C et al (2000). ‘Factors that modify the association between knee pain and mobility limitation in older women: The Women’s Health and Aging Study’, Annals of Rheumatic Diseases, 59, 5, 331-337. Peat, G (2000). ‘How much function is restored by functional restoration programmes?’ (letter) Physiotherapy, 86, 8, 445.
interested is invited to contact our group through the address below. Andrea Lowe PhD Senior Research Fellow Gareth Noble PhD Research Officer Rehabilitation Sciences Research Group Room 50K 15 University of Ulster at Jordanstown Shore Road Newtownabbey Co Antrim BT37 0QB