Purpose of the MSK toolkit
The main purpose of this report is to define and guide service provision for MSK podiatry.
The primary audience is NHS departments where clarity, unity and provision of care vary throughout the four nations.
Aims of the MSK toolkit
The three objectives:
Collate dataTo tabulate specific outcomes from data collected from NHS trusts and Health Boards on MSK interventions.
Lead analysisLead analysis on the data collected.
Develop a narrativeWork with a health economist/data analyst to develop a narrative around cost-effectiveness of podiatric MSK interventions with commissioners as the key audience.
What are MSK conditions?
Musculoskeletal (MSK) conditions are the most common form of physical disability worldwide, with a suggested range of 3-26% of the population experiencing foot-related MSK pathologies
MSK pathologies include:
MSK toolkit - six themes
Theme 1: Point of referral and patient journey
Referrals into an MSK podiatry service can be via the GP, self-referral or by another medical/healthcare professional.
Completing the correct initial referral into services can be the main hurdle to access care.
Therefore there is a case to provide a national programme to raise awareness of MSK podiatry skills.
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Theme 2: Treatment outcomesThe main aim of podiatry is to get the patient better; therefore measuring patient outcome measures (PROMS) is essential.
The Manchester-Oxford Foot Questionnaire (MOXFQ) is the most reliable and repeatable clinical tool of available PROMS.
The podiatry audit tool PASCOM-10 has developed a new short form which allows the practitioner to collate information specifically around MSK activity.
Utilisation of this tool will build on the supportive evidence available to promote efficacy of MSK podiatry intervention.
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Theme 3: Case studies
Service provision for MSK podiatry generally fits into one of three formats:
- Within a community service, with several podiatric roles at different competency levels with set pathways for referrals and conditions treated
- Within a hospital multi-disciplinary team or musculoskeletal clinical assessment and treatment service where advanced practice provides care for complex cases.
- Within primary care networks where first point of contact (FCP) podiatry MSK sits in a triage role for patients in GP surgeries.
Theme 4: Costing
Establishing a costing model for MSK podiatry services is a difficult task due to:
- Historical and geographical negotiated contracts and previous agreements in service provision
- Funds being managed under the umbrella of podiatry as a whole, making it difficult to distinguish MSK costing from diabetes, nail surgery and general care
- The newer role of first point of contact podiatrist working in MSK is funded by the employing PCN
- In addition to wages, a cost model needs to factor in running costs of materials, equipment, training and access to other facilities.
Theme 5: Treatment protocolsA vast array of conditions are observed in adult MSK podiatry. A recent review of treatments in managing the most common conditions has led to the development of evidence-based treatment protocols.
The protocols have been developed with research-based information and guide the practitioner on diagnosis, assessment, intervention and prognosis of the condition.
Lack of research means that not all conditions will have a evidence-based care pathway. However, the application of underlying biomechanical prinicples allows an MSK podiatrist to provide intervention in a range of mechanical and inflammatory conditions.
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Theme 6: SpecialitiesSeveral specialities exist within MSK podiatry in which podiatrists can practice at an advanced and consultant level where their learning, practice, leadership and research focus on a subset of pathology.
Specialities include: paediatric care, rheumatology, sports medicine, neurology and surgical interventions.
Suitable pathways of training need to be established to equip and support this higher level of practice, enabling lead podiatrists to develop suitable specialities with appropriate service training.
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Conclusion and summary
The MSK toolkit makes the following recommendations:
MSK toolkit: Appendices
The MSK toolkit has four appendices of supporting information grouped under four headings:
MSK: UK, Dr Emma Cowley and Dr Jill Halstead have reviewed this work as the special advisory group.