Clinical Audit
Here at the Ashfield Practice, we maintain detailed anonymous clinical audit information to measure the effectiveness of Osteopathic treatment. The data that we collect covers the following categories:
- presenting problems (problem area, time with symptoms)
- patient characteristics (gender, age range)
- results of treatment (effective?, number of treatments required, improvement in pain levels)
The following summary is based on data collected between 1st July 2007 and 14th June 2011.
Presenting Problems
The figure shows that osteopaths at the Ashfield Practice treat people with pain or dysfunction affecting all parts of the body.
The most common problem treated is low back pain, which may also be accompanied by nerve irritation (eg. sciatica).
The pie chart also shows that, in addition to the more well-known problem areas that osteopaths treat such as neck, shoulder and upper back pain, and
joint problems affecting the arms and legs, some patients also attend the Ashfield Practice complaining of other problems such as
jaw pain, headaches, infantile colic, digestive problems (eg. IBS) and respiratory problems (eg. asthma).
The following graph illustrates the length of time between the onset of the symptoms (eg. pain, restricted movement) and the first
visit to the osteopath.
As can be seen, the largest proportion of patients tend to visit within 3 months of initial onset. Often, the osteopath
is the first course of action taken by the patient.
Others have already seen their GP or another health professional and have found that pain-killers
(eg. paracetamol or co-codamol) and/or NSAIDs (eg ibuprofen) are not really resolving the problem.
There is also a reasonably large group of patients who have been suffering for over a year. This group of patients have generally seen their GP, have tried
pain-killers, NSAIDs and possible stronger medication, but have not found any relief. Often, patients in this group will have had x-rays or MRI scans that
have either shown no significant problem that explains their pain, or have shown up "degenerative changes" (ie wear and tear) but surgery is not an appropriate
or recommended course of action.
Patient Characteristics
As can be seen, patients visiting osteopaths at the Ashfield Practice range in age from the newly born right through to the over 80s. There really
is no minimum nor maximum age where osteopathic treatment is appropriate. The split between male and female patients is roughly equal.
The range and quality of movement of joints and muscles will vary from person
to person, depending on their age, the length of time with their problem and the severity of the problem. Osteopaths tailor their treatment
to each individual, and use techniques ranging from very gentle, subtle movements through to stronger massage and muscle energy techniques and
joint manipulations.
The type of treatment and its purpose is always explained beforehand and not performed without patient consent.
Results of Treatment
The effectiveness of treatment is primarily measured using patients' own reported improvements in their pain. This is achieved using a scale from 0 to 10 where 0 equates to no pain and 10 equates to severe pain. This is known as a visual analogue scale (VAS-10). In addition, patient reported improvements in mobility and quality of life are also accounted for.
The data collected at the Ashfield Practice shows that of all patients who have completed their course of treatment:
- 95% have benefited from treatment
- 5% have shown no improvement
The following graph illustrates the change in patient reported pain levels on completion of treatment and shows that, in most cases there is between a 90% and 100% improvement.
Patients who show no benefit from osteopathic treatment are referred where appropriate to another health professional such as their GP, usually for onward referral to an orthopaedic consultant.
Until the osteopath has carried out a complete assessment of the patient, including full case history and physical examination, it is not possible to say how many treatments will be required to resolve the problem.
In most cases, however, the osteopath will be seeking to resolve the problem, or improve the condition significantly, within 3 or 4 treatments. Occasionally, only 1 or 2 treatments are required, and occasionally 5 or more are required. Progress is reviewed each session to ensure that the treatment goals are being met or whether they need to be modified. The graph illustrates the number of treatments required by osteopaths at the Ashfield Practice.
Patients should always be wary of practitioners attempting to sign them up for very lengthy periods of treatment. Sometimes this is necessary, but should always be associated with a clear management plan with goals where progress is reviewed at each session.
Sometimes, it is not possible completely to resolve the cause of pain or completely free up a restricted joint. For example, where the problem is caused by moderate or severe degenerative change (ie. wear and tear), a realistic goal may be to reduce the pain to manageable levels and to improve the range of movement of a joint sufficiently to allow reasonable quality of life. Often the problem is a result of postural strains - for example, a sedentary job - and is therefore likely to re-occur in the future. In every case, the osteopath will explain their findings and discuss treatment and management goals with each patient - this may include exercise or lifestyle advice and may include a recommendation for periodic "maintenance" treatments.