September 5th – 8th 2013Nottingham Conference Centre, United Kingdom

www.nspine.co.uk

Spine Tango: Data Collection in the

Spinal Unit at QMC

HistoryUnique data collection systemUniversity of Berne and Eurospine 200230,000 interventions in 29 centres 2009 Spine Tango ConservativeComparative dataBenchmarkingOsteopaths at QMC are the first

internationally to record and input data

Spine Tango Conservative Questionnaires

Assessment

Therapy

Course of Tx

End of Tx

Examiner Questionnaire

Purpose of Spine TangoRecords diagnostic findings and functional

limitations (using ICD and ICF classifications)Functional limitations become the goals for

treatment and form core outcome measuresData extraction can be very specificWhich spine conditions and pathologies are

most effectively managed, andWhen intervention is most effective, based on

changes in functional limitations

Benefits to Patients, NHS & OsteopathyIdentifies spine pathologies and conditions

that are most effectively managed.Most effective point of intervention.Optimum treatment duration.Training aid for colleagues.Treatment complications.Overlay ODI and NDI to enhance data.Comparison against pool i.e. Benchmarking.Potentially reducing surgical conversion rate.Initial data promising.

Spine Tango Conservative QuestionnairesPatient Questionnaires

COMI Low Back

COMI Neck

ODI

NDI

EQ-5D

Time ScalesGreater numbers = valid and powerful

resultsCurrently n~80 new patients per annumAt least 4-5 years for n=320-400On-going studyEncourage others to become involvedContinue to develop document with BernValidation study with New York University

Sample Data – Change in ODI ScoresPre to Post Treatment

ODI Change

010203040506070

a b c d e f gPatient

ODI %

Pre1stTx End2ndTx

Sample Data – Diagnostic Classification

Sample Data – Pre TreatmentGrade ClassificationGrade 0 = No symptomsGrade I = Symptoms, but no care recommendedGrade II = Symptoms, no radicular signs, treatment recommendedGrade III = Symptoms, radicular signs, treatment recommendedGrade IV = Red Flags

Sample Data – Post TreatmentGrade ClassificationGrade 0 = No symptomsGrade I = Symptoms, but no care recommendedGrade II = Symptoms, no radicular signs, treatment recommendedGrade III = Symptoms, radicular signs, treatment recommendedGrade IV = Red Flags

Sample Data – Pre Treatment History

Sample Data – Pre Treatment Functional Classifications

Clinical Audit of the Osteopathic Service

at CSSS

Department BackgroundOsteopathy has been available as a service in

the spinal unit since 1999.Currently has 2 consultant spinal osteopaths &

2 osteopathic fellows.Data collection since January 2012: Spine

Tango Conservative, ODI & NDI.Validation of Spine Tango Conservative by NYU.2012/2013 patient numbers:

New patient appointments 86Follow up appointments 1012

Data CollectionEvery patient completes/has data recorded on:

Spine Tango ODI/NDI COMI Low Back/COMI neck EQ-5D - a standardised instrument for use as a measure of

health outcome, it provides a simple descriptive profile and a single index value for health status.

Each form is completed at initial assessment, therapy midpoint and at the end of the treatment cycle.

Data is inputted manually into a central database & analysed.

Functional Limitations DataSubjective record of functional limitations

pre- and post-treatment.

Objective: setting goals to overcome functional limitations with treatment.

Goals at end of treatment may be fully achieved, partially achieved or not achieved.

Latest Functional Limitation Data

43%

39%

18%

n = 31

Goal Achieved Goal Partially Achieved Goal Not Achieved

ODI DataODI questionnaires are scored out of 100. A change of ≥ 10

pre-post treatment is considered statistically significant – MCID.

Latest ODI data for all spinal pathologies: Range Pre-Tx scores 78-16 Range Post-Tx scores 66-6

Mean Pre-Tx score 41 Mean Post-Tx score 26.8 Mean change -15.8 – statistically significant

59% of patients had a statistically significant reduction in their ODI score following osteopathic treatment.

Latest ODI Data for all pathologies

A B C D E F G H I J K L M N O P Q R S T U V0

10

20

30

40

50

60

70

80

90

100

n = 22

ODI Pre Tx ODI Post Tx

OD

I sco

re

Latest ODI Data for Degenerative Disc Disease in Lumbosacral Region

A B C D E F G H I J0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

n=10

Pre Tx Post Tx

OD

I Sco

re

Medication DataStart of treatment: pain medication taken

specifically for spinal condition is recorded.

End of treatment cycle: same medication is recorded as ‘discontinued’, ‘continued’ or ‘modified’.

43% of patients had discontinued pain medication relating to their spinal complaint by the end of treatment.

Benefit of DataRobust data collection system ensures reliability of data.

Validation of Spine Tango Conservative is expected by November 2013 – this will ensure valid research is universally recognised.

Data will identify where & when osteopathic intervention is most effective, & how treatment cycles can be optimised.

Data will highlight areas in the referral pathway that are optimal or where there is a need for improvement.