Published on 06-Dec-2011
Validated on 03 Jun 2013
"We used to have to enter the data from the paper questionnaires into a spreadsheet by hand, but now with the SPSS solution it’s fully automated." - Adele Barnard, Clinical Research Manager at Metro Spinal Clinic
Metro Spinal Clinic
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Established in Melbourne in 1988, Metro Spinal Clinic is a specialist facility devoted to the treatment of musculoskeletal disorders. Its practitioners utilise the latest research and techniques for the diagnosis, treatment and management of painful conditions that may involve the spine, muscles and/or joints, from headaches and neck pain to lower back pain and disc pain, as well as other more complex pain syndromes. The clinic employs around 30 people, including the three founding partners and six other physicians.
The treatment of pain is a complex challenge for physicians and medical researchers, as symptoms can be the result of many different underlying causes. Accurate diagnosis requires a precise understanding of the pain’s location and intensity – and since there is no objective external way of measuring pain, the patient must be carefully questioned. Metro Spinal Clinic found that traditional paper questionnaires were imprecise and difficult to interpret, and decided to find a better solution.
Clinical Intelligence, an organisation founded by clinical specialists from Metro Spinal Clinic and IT professionals, developed a new online questionnaire using IBM® SPSS® Data Collection Web Interviews software. Patients use a graphical point-and-click interface that makes it easy to pinpoint painful areas and estimate the intensity of the pain. The results are automatically imported into a central database for statistical analysis, identifying common patterns that assist with diagnosis and research.
Post-treatment follow-up rates have increased from 60 percent to 85 percent or higher. One study on occipital nerve stimulator implants achieved a follow-up rate of 100 percent. Automation cuts the time spent on survey management by 75 percent. Printing and postal costs have been all but eliminated, reducing the cost per questionnaire by 89 percent.
Metro Spinal Clinic gains unique insight into the causes of pain and the effectiveness of treatments. Pre-treatment questionnaires give physicians a valuable diagnostic tool even before they have met the patient.
Established in Melbourne in 1988, Metro Spinal Clinic is a specialist facility devoted to the treatment of musculoskeletal disorders. The Clinic brings together a team of highly experienced practitioners which include musculoskeletal and sports physicians. Its practitioners utilise the latest research and techniques for the diagnosis, treatment and management of painful conditions that may involve the spine, muscles and/or joints, from headaches and neck pain to lower back pain and disc pain, as well as other more complex pain syndromes. The Clinic employs around 30 people, including the three founding partners and six other physicians.
The importance of quantification
“We have a passion for research, and we have always believed that quantification is extremely important,” explains Dr Paul Verrills, interventional pain physician and co-medical director of Metro Spinal Clinic. “In general, although medicine is a science, physicians and researchers have found it difficult to measure the success of treatments, and in many cases clinical decisions are still made on anecdotal evidence. We realised that if we could build accurate measurements into our clinical processes, we could amass a body of data that would be hugely valuable in assessing the effectiveness of different treatment methods.”
As a result of this desire to quantify, several of the physicians at Metro Spinal Clinic decided to form a new organisation called Clinical Intelligence, which would unite their medical expertise with the knowledge of skilled IT professionals to develop innovative solutions for clinical data collection and analysis.
Understanding patients’ pain
One of the most important initiatives undertaken by Clinical Intelligence has been the creation of a new online questionnaire that helps patients communicate the location and intensity of the pain that they are feeling.
“We used to have paper questionnaires which included an outline of a human body, and patients were supposed to mark the painful areas in pencil,” explains Adele Barnard, Clinical Research Manager at Metro Spinal Clinic. “Different people did this in different ways, which made the results difficult to interpret, and there was no good way to indicate the level of pain in each area. Moreover, since these questionnaires were paper-based, we had to mail them out to patients when we wanted to follow-up on the results of their treatment. The printing and postage costs were high – more than 10 dollars per questionnaire – and often we wouldn’t get a full response because patients would lose the forms or forget to fill them in. Our follow-up rate averaged between 60 and 80 percent.”
Dr. Verrills explains the importance of a high follow-up rate: “When you’re doing a research project about the effectiveness of a treatment, you need as much follow-up data as possible to show that your results are reliable. If there are too many gaps in the record, it increases the risk that you are only seeing part of the picture. A follow-up rate of 80 percent is generally considered excellent, and we were reaching that level much of the time. However, we knew that Clinical Intelligence could give us the tools we needed to do even better.”
Harnessing IBM SPSS software
Clinical Intelligence deployed IBM SPSS Data Collection Web Interviews software and built a new online survey that provides patients with a simple graphical interface that helps them communicate the location and intensity of their pain much more precisely. Patients are presented with front and back views of a human body, each of which is divided into dozens of small areas. If they are suffering from pain in one of these areas, they can click on it and then assign a value from zero (no pain) to ten (worst imaginable pain) on a numerical rating scale. Once they have finished selecting all the relevant areas, the data is automatically saved in a database where it can be analysed by IBM SPSS Statistics software.
“We used to have to enter the data from the paper questionnaires into a spreadsheet by hand, but now with the SPSS solution it’s fully automated,” comments Adele Barnard. “Even in rare cases where we need to do interviews by phone or on paper, the data entry is much faster and more standardised with the new system. We’ve reduced the time we used to spend on survey administration by 75 percent, and we’ve eliminated the majority of the printing and postal expenses, so the cost per survey has been cut by 89 percent.”
Patients are asked to fill out a questionnaire before their first consultation, and then at six, 12 and 18 months after their treatment. The initial questionnaire is compared with data from other patients to identify patterns and suggest possible diagnoses.
“Diagnostically, it’s not a one-to-one relationship between the areas of pain and the causes, but there are certain patterns that correlate very well,” explains Dr Verrills. “For example, we’ve seen that where patients pinpoint the dimples in their lower back, there is about a 65 percent chance that the root cause of the problem lies in their sacroiliac joints. Other patterns indicate other causes and suggest possible treatments, and we are able to route patients to the most appropriate specialists for a full diagnosis.”
Boosting the follow-up rate
The follow-up questionnaires are used to assess the effectiveness of the treatment over time, which is critical both for the ongoing care of individual patients and for the many research projects that the Clinic is engaged in. Since the questionnaires are quick and easy to complete, and can be accessed either at the Clinic or via the internet from a patient’s home PC, completion rates are much higher than with the old paper-based system.
“We’re now averaging 85 percent for our follow-up rate, which is excellent,” says Adele Barnard. “In several high-profile studies, we have even achieved 100 percent follow-up, which is almost unheard-of. This gives the results of our research much more weight, because we aren’t missing any results that might be significant.”
Dr Verrills adds: “We have recently published the results of a major clinical study in the peer-reviewed journal, Pain Medicine. The study focused on peripheral nerve field stimulation in the treatment of chronic craniofacial, thoracic, lumbosacral, abdominal, pelvic and groin pain. We were able to provide the results of 100 consecutive cases where we’d used these implants, and we showed that in the vast majority of cases the treatment had been very successful. Our data could help to get these implants licensed for wider use, which could potentially benefit thousands of patients worldwide.”
Looking to the future
In the near future, Clinical Intelligence will roll out a new web portal that will enable physicians to access and analyse the questionnaire data in real time – even while they are in consultation with a patient. The ability to directly interrogate the data and find patterns should enable even more accurate diagnoses, as well as helping doctors communicate more effectively about possible treatments and outcomes.
“One thing we’re hoping to be able to do is take a more predictive approach to the possible outcomes of different types of treatment,” says Dr Verrills. “The model’s there: if we can look at the pain pattern in an initial questionnaire and compare it to similar previous cases, we could then look at the different treatments used in those cases and how effective they were. Then we could potentially give the patient some idea of the possible treatment options and their likely outcomes. It’s what doctors do all the time: the difference is that we’d be basing our advice on hard numbers, not just anecdotal evidence. This is really exciting, and could be a potential game-changer for the whole healthcare sector.”
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