Is it feasible and effective to provide osteopathy and acupuncture for patients with musculoskeletal problems in a GP setting? A service evaluation

Abstract

BackgroundSpinal manipulation and acupuncture can be helpful in reducing the symptoms of musculoskeletal (MSK) pain. Both approaches are currently recommended by NICE as treatment options for patients with persistent low back pain. However, there has been no previous evaluation of a GP service using them together for MSK pain. The purpose of this study was to evaluate acceptability and outcomes for an osteopathy and acupuncture service (delivered by complementary therapy practitioners) for patients with MSK problems provided within a General Practice.MethodsPatients were asked to complete a questionnaire before and after their course of treatment. Outcome measures included the Bournemouth Questionnaire (measuring MSK problems), EuroQoL-5D (measuring quality of life), medication use, physical activity and general well-being. Non-parametric tests were used to compare pre- and post- treatment variables. Qualitative data, regarding participants' views on the service, were collected from patients via a service survey and healthcare professionals via interviews. Qualitative data were analysed using thematic analysis.Results123 adults with MSK problems were referred into the service (79 female and 44 male, mean age 49 years). Complete patient questionnaire data sets (pre- and post- treatment) were available for 102 participants; 91 completed a service survey. All healthcare professionals involved in the service participated in interviews including all seven GPs and the administration manager at the practice, as well as the three acupuncture/osteopathy practitioners.Patient outcomes: comparisons between pre and post-treatment revealed a statistically significant improvement in MSK pain (p < 0.0001) and quality of life (p < 0.0001), and a statistically significant reduction in medication use (p < 0.0001). Qualitative analysis found that patients reported improvements in their MSK pain, mobility, other physical health conditions, well-being and self-management of their MSK problem.Acceptability of the service: overall patients and healthcare professionals were satisfied with the service and its provision within the Practice. Patients reported wanting increased appointment availability and flexibility, and more sessions. Complementary therapy practitioners reported finding the high number of referrals of chronic patients challenging, and wanting increased communication with GPs.ConclusionsProvision of acupuncture and osteopathy for MSK pain is achievable in General Practice. A GP surgery can quickly adapt to incorporate complementary therapy provided key principles are followed.

Predicting adherence to acupuncture appointments for low back pain: a prospective observational study

“…Patients’ reasons for stopping acupuncture can include financial considerations (although some patients make sacrifices elsewhere to enable on-going access) and perceived lack of effect [13, 18]. In the NHS in particular, patients are dissatisfied with inflexible appointment times and fixed (short) courses of treatment [13, 16, 20] which could lead to poor attendance.…”

Pragmatic Model for Integrating Complementary and Alternative Medicine in Primary Care Management of Chronic Musculoskeletal Pain

“…In the range of different integrative models as described by Boon et al [25], the integrative model on which consensus was reached was somewhere between a consultative model (expert advice is given from one professional to another) and a collaborative model (professionals who normally practice independently from each other, share information concerning a particular patient). The added value of the presented integrative model to those previously published in literature, is that the current model was developed together with patients [26][27][28][29]. Their perspectives were in many cases leading as to decide on the final model.…”

“…These models were designed according to the different health care delivery systems in the respective countries (UK, USA, Canada and Sweden) and are therefore not easily implemented in countries with other health care systems. More importantly, up till now, strategies on integration of CAM therapies largely rely on opinions and experiences of clinicians and researchers, rather than on criteria from the patient's perspective [26][27][28][29]. Evaluation of such a model in practice has therefore demonstrated a mismatch between what patients wanted and what was estimated by the ones designing the model [26].…”

“…More importantly, up till now, strategies on integration of CAM therapies largely rely on opinions and experiences of clinicians and researchers, rather than on criteria from the patient's perspective [26][27][28][29]. Evaluation of such a model in practice has therefore demonstrated a mismatch between what patients wanted and what was estimated by the ones designing the model [26]. Nowadays, health care is evolving more and more toward a 'patient-centered model' , in which patients become active participants and where care is designed to their individual needs and preferences [30].…”

“…In these models, the provision of conventional and CAM therapies varies from parallel practices, to consultative, collaborative, coordinated, multidisciplinary, interdisciplinary and totally integrated practices. Models for integrative primary care management of CMP, such as low back and neck pain, have been developed [26][27][28][29]. These models were designed according to the different health care delivery systems in the respective countries (UK, USA, Canada and Sweden) and are therefore not easily implemented in countries with other health care systems.…”