1. The MSK-HQ
Developing a generic Musculoskeletal Patient Reported Outcome Measure
Policy & Public Affairs Team, Arthritis Research UK e.
04 April 2019

2. The MSK-HQ The Context and Challenge
Musculoskeletal conditions have significant impact on those living with them, on the health service and on wider society
There are over 200 different musculoskeletal conditions. They include:
Long term conditions such as rheumatoid arthritis and osteoarthritis which are painful, life-long and often fluctuate in severity
Short term conditions such as sprained joints
Musculoskeletal conditions are the single biggest cause of disability in the UK
In 2009/10 there were 21 million primary care consultations for MSK conditions
In 2011/12 musculoskeletal treatments accounted for £5.06 billion in the NHS, making it the 4th largest area of current programme spend

3. The MSK-HQ What are PROMs?
Patient reported outcome measures (PROMs) are a way of recording how people rate their own health status
Before and after surgery
At regular intervals for people with long term conditions to track health status over time
PROMs provide patient level data to allow quality improvement across health services
Informing clinical care
Above all, PROMs are person centred, and enable people to self manage their own health

4. The MSK-HQ Developing the ‘Arthritis Research UK MusculoSkeletal Health Questionnaire’ (MSK-HQ)
PROMs are of particular value in musculoskeletal conditions where few biological markers are available to assess the effect of disease on a person’s health
PROMs are not yet consistently adopted in musculoskeletal care partly due to the complexity of the field:
The complexity of care pathways for musculoskeletal conditions
The number of care settings used to treat people with musculoskeletal conditions
There is need for a measure which is of utility throughout the patient pathway, proving joined up care

5. The MSK-HQ Who is involved in the care of people with a musculoskeletal condition?

6. The MSK-HQ Community consensus meeting
A meeting was held in Birmingham, July 2012, with people with arthritis, research teams, professional-representative organisations, patient-representative organisations, teams with experience of PROMs delivery and Department of Health and NHS Information Centre
What the community wants - seven key themes emerged:
The MSK-HQ is feasible, welcome and worthwhile
MSK-HQ and data must be meaningful to patients
MSK-HQ should sit along EQ5D (± OEQ) with a multidimensional core
Clearly define and test MSK-HQ audience
Base MSK-HQ on existing work where possible
Adopt condition-inclusive approach and test
Work needed to understand PROMs use in LTCs

7. The MSK-HQ A multi-dimensional tool: What modules may be needed?
Pain
Mood
Dexterity
Fatigue
Mobility
Self-efficacy

8. The MSK-HQ Future aims for a generic MSK-HQ
There is value in developing a generic MSK-HQ: Potential to enable people across a number of musculoskeletal conditions to report their health status.
People can track their own health
The instrument can be used across full range of health professionals
This ensures no gaps in coverage
Inclusion of an MSK-HQ in strategic approaches such as the national PROMs programme and national outcomes frameworks: Potential to drive improvement in health services for people with musculoskeletal conditions
Providing benefits to commissioners
Providing a longitudinal measurement throughout the pathway
Integration of an MSK-HQ into clinical practice: Potential to support improvement in clinical practice, and self-management
Enabling more effective monitoring of health status
Standardised and simplified throughout NHS
Providing a holistic view of the impact on a person’s health
Over time we would like to see inclusion of the MSK-HQ in clinical practice, in the national PROMs programme and in national outcomes frameworks

9. The MSK-HQ Anticipated benefits of the MSK-HQ
In clinical practice and self-management
In health service improvement
Improving patient level and service clinical outcomes
Providing patients and clinicians with real time feedback
Supporting self-management throughout the whole patient pathway
Providing a single measure for use across a range of musculoskeletal conditions
Providing a measure of utility to a range of healthcare professionals
Simplifying a complex field in which a variety of outcomes measures are used
Benchmarking opportunities e.g. comparison of clinical outcomes across and between a range of services
Identifying variation in care quality / demonstrating QIPP adherence
An instrument to measure high quality commissioning
Pathway evaluation / redesign
Providing reporting opportunity for contextual data to commissioning structures, including the NHS England Commissioning Board
Producing patient data to inform future research questions

10. The MSK-HQ Where next? Development of the MSK-HQ tool:
Arthritis Research UK launched an open research call in March 2013.
Following a peer-review process of all applications, the award was made in August 2013 to a joint application between Keele University Primary Care Sciences Research Centre, led by Dr Jonathan Hill, and Oxford University’s Nuffield Orthopaedic Centre, led by Professor Ray Fitzpatrick.
With the completion of phase one, phase 2 was initiated in June 2014, and led by Oxford University’s Professor Andrew Price.
Other activity:
A Stakeholder Reference Group for the MSK-HQ has been established.
In December 2013, a group meeting was held to discuss research progress.
A Stakeholder meeting is planned for May 2015 where the initial findings from phase 2 will be discussed and will outline thinking on next steps.

11. The MSK-HQ Phase 1 & 2 Phase 1: Phase 2:
The first phase is the development of a candidate MSK-HQ instrument, including the input from patients, researches and health care professionals. This phase was completed in Summer 2014.
Phase 2:
The second phase is the longitudinal testing of this instrument in a range of clinical pathways and settings, including general practice, community physiotherapy, orthopaedics, rheumatology and a local health care economy, to address its logistical aspects as well as the more scientific aspects of its practical validity and interpretation. This phase is expected to last around months and is funded jointly by Arthritis Research UK and NHS England.

12. Policy & Public Affairs policy@arthritisresearchuk.org
For more information on the MSK-HQ, or to request a PowerPoint version of the slides, please contact the Policy and Public Affairs Team at the following address:
Policy & Public Affairs
04 April 2019