- At 14 days 70.23% of patients are feeling better
- At 30 days this increases to 78.07% which then at
- At 90 days increases further to 84.38% (the last set of online questions) showing that patients continue to improve in symptoms, but the last 5% occurs at a slower rate as the Patients Global Impression Of Change (PGIC) line graph below shows.
Satisfaction with their care
- 92% report to be ‘very satisfied’
- 8% report to be ‘satisfied’and
- 0% have reported to be ‘unsatisfied’.
The average patient improves 83.48% over a 90 day period,this takes just 4.50 visits and costs £174 (1 x £55 + 3.5 X £34).
The majority of the patients who come to see us (and fill out the Patient Reported Outcome Measure – PROM/Patient Reported Experience Measure -PREM) do so because of low back pains. Our above figures do include all mechanical problems not just low back pains, however if we compare our results to a year long study looking at GP treatments for low back pain (the majority of our patients) alone it found that :-
- At 3 months only 21% of GP patients reported to be better in terms of pain and disability and
- At 12 months this rose only slightly slightly to 25%.
From the GP study at 3 months 79% of patients will still be suffering yet at the same point for our Chiropractic patients 84.38% are reporting to be feeling better compared to how they felt at the initial consultation.
Patients often tell us that they have been told Chiropractic treatment does not work and it is a waste of time and money as they will get better anyway on their own – look at the data – we will let you decide.
Patients feeling better by time (Patient Global Improvement of Change – PGIC)
Percentage of patients feeling better
- Days from the 1st visit
This graph tells us in percentage terms how much better patients are over time compared to their initial consultation.
- At 14 days after the first consultation 70.23% of patients reported feeling better.
- At 30 days it has risen to 78.07% and
- At 90 days or 3 months down the line 84.38% of the patients are feeling better.
Patients feeling better by treatment number (Patient Global Improvement of Change – PGIC)
Percentage of patients feeling better
- Treatment numbers
This graph tells us how much better patients feel in percentage terms at a specific treatment number compared to their initial consultation (IC on the graph)
Average treatment numbers
- Days from the 1st visit
You can see from the results that the average number of visits over a 90 day period was to 4.45. This equates to an average cost of £174 (1 x £55 + 3.5 x £34)
Patient satisfaction with care (Patient Reported Experience Measures – PREM)
- Very satisfied %
- Satisfied %
- Not satisfied %
At 30 days patients, through a series of questions, voice their satisfaction or dissatisfaction with the service and treatment results. So far not one person was dissatisfied with us. Everyone was either very satisfied or satisfied with their outcome – in fact the majority were ‘very satisfied’ as the purple part of the chart shows.
Questionnaire compliance summary
Number of assessments
- Not completed
This shows the total number of online questionnaires sent out over 3 months (green bars),how many were completed (purple bars) and how many were not completed (red bars). The completion drop off rate is consistent with many other studies. The actual percentage of completed questionnaires are :-
- Day 1 = 89.46%,
- Day 14 = 49.90%,
- Day 30 = 39.29%,
- Day 90 =35.16%.
How do we get the results?
- All new patients who are suitable for our care are asked if they would participate in our online PROM and PREM research study and if they agree at the initial consultation they fill out an online questionnaire.
- A survey is then automatically emailed to the patient 14, 30 and 90 days after the first consultation to report on their progress.
- The PROM/PREM we use is CARE RESPONSE – it has passed the UK NHS data assessment standard test for security of its systems and processes.
- Care response is endorsed by the Royal College of Chiropractors
Why choose a PROM/PREM?
- The data is filled out online by the patient, not by us.
- The results are stored on a secure ‘cloud based’ computer which we have no access to so we cannot change or manipulate the findings in any way.
- A PROM/PREM gives us results from an individual patient or from many patients whose results are added together (as shown below) to give a more unbiased result.
- PROMS/PREMS can tell us how:-
- Patient’s feel about their own improvement and care.
- How satisfied patients were with their care .
- On average, how many treatments are needed to feel better. From this we can say what the average cost of treatment will be.
Why are we doing this research?
Our aim/objective is to be an ‘Evidence Based Medicine’ (EBM) practice. What this means to you is that where possible we treat you with treatment techniques and protocols that have be proven to work in research studies. We combine this with our vast shared clinical experience of over 50+ years i.e. what we have found during our years of practice actually ‘gets people better’. In our opinion this means you get the ‘best of the best’.
We frequently hear from patients that when they have seen medical professionals about a problem and asked them if a Chiropractor could help them they have been:-
- Advised not to see a Chiropractor – often without a reason (why? Perhaps a lack of information / prejudice/ preconceived ideas of what what do/don’t do?) or
- Told Chiropractic won’t work and don’t waste your money (Don’t worry about that – read our 100% money back guarantee).
- Told Chiropractic will make you worse – despite government reports and research concluding Chiropractic treatment is very safe, as a comparison look at safety in the NHS. Chiropractic is a manual therapy and so is not without risk, but serious events are very rare, whereas a period of soreness and stiffness after treatment is quite normal. Not withstanding this, there are conditions that are not suitable for Chiropractic treatment, so if you are unsure if it is suitable for you, please call and ask to speak to Ian or Richard 01332 224820 first .
- Told there is a lack of evidence to show what we do actually works (actually there is an ever increasing amount of clinical research showing positive patient outcome results and basic science research explaining why and how theses improvements occur) so Chiropractic treatment on this basis is not suggested.
In retort in particular to the final bullet point, gathering research evidence is very costly and very demanding on all resources. The medical establishment are in the very fortunate position that a vast amount of their evidence gathering is carried out by or funded by Pharmaceutical companies, equipment manufacturers and large research organisations e.g Cancer Research UK. Millions of pounds and dedicated resources are made available solely for the the task of funding research and gathering evidence of effectiveness of treatment. The Chiropractic profession does not have this luxury.
So for a small independent clinic like ours, funding and and ensuring the resources are in place to undertake any sort of research is not for the faint hearted. However, so strongly do Ian and Richard feel about this subject that they have have personally re-invested resources and organised their clinic to get the research evidence to show what we do at WellBeing Clinics really does work.
In the clinical setting, a proven method for gathering research (see references below) evidence is to use a PROM – a Patient Reported Outcome Measure and PREM – a Patient Reported Experience Measure.
What have we learned so far?
We have now put in place procedures to alert us when follow up surveys are not filled in so we can contact the patient to remind them – this means we do not have a drop off in data collection over the weeks. We are all ‘time poor’ and whilst the surveys are automatically sent to the patient by email, and only take a few minutes to fill out it may not be convenient for them to do it so this runs the risk of the email being lost in an ‘inbox’. This ongoing data collection is a challenge for all researchers and as a clinic we have to tread a fine line between chasing up surveys for our benefit and running the risk that a patient will feel pestered or harassed.
Research papers using Care Response data
Peer reviewed papers:
Newell, D., and Field, J. 2007. Who will get better? Predicting clinical outcomes in a chiropractic practice. Clin Chiropr, 10(4), p.179–186.
Field, J., Newell, D., and McCarthy, P. 2010. Preliminary study into the components of the fear-avoidance model of LBP: change after an initial chiropractic visit and influence on outcome. Chiropr & Osteopat, 18(1), 21-30.
Williams, J., Hag, L. and Lee, R. 2010. ‘Is pain the cause of altered biomechancial functions in back pain sufferers?’ Hum Mov Sci, 29(2) p.311-25
Newell, D. and Bolton, J. 2010. ‘Responsiveness of the Bournemouth questionnaire in determining minimal clinically important change in subgroups of low back pain patients.’, Spine, 35, no. 19, p.1801–1806.
Field, J., and Newell, D. 2012. Relationship between STarT Back Screening Tool and prognosis for low back pain patients receiving spinal manipulative therapy. Chiropr Man Therap, 20(1), 17.
Newell, D., Field, J., and Visnes, N. 2013. Prognostic accuracy of clinicians for back, neck and shoulder patients in routine practice. Chiropr Man Therap, 21(1), 42-9
Irgens, P., Lothe, L., Kvammen, O., Field, J., and Newell, D. 2013. The psychometric profile of chiropractic patients in Norway and England: using and comparing the generic versions of the STarT Back 5-item screening tool and the Bournemouth Questionnaire. Chiropr Man Therap, 21(1), 41-51.
Newell, D., Field, J., and Pollard, D. (2014). Using the STarT Back Tool: Does timing of stratification matter? Man Ther, 20(4), p.533-9
Newell, D., Byfield, D., Osbourne, N., and Field, J. 2017. Using patient reported outcome measures (PROMs) to inform clinical decisions during chiropractic undergraduate clinical training: Barriers and opportunities (pp. 1–1). Presented at the ECU Conference, Athens.
Newell, D., Bolton, J. and Diment, E. 2015. Using an electronic Patient Reported Outcome Measures system in UK chiropractic practices: a feasibility study of routine collection of outcomes and costs. J Manipulative Physiol Ther, 20(4) p.533-9
Field, J. and Newell, D. 2016. Clinical Outcomes in a Large Cohort of Musculoskeletal Patients Undergoing Chiropractic Care in the United Kingdom: A Comparison of Self- and National Health Service-Referred Routes. J Manipulative Physiol Ther, 39(1), 54–62.
Use in Post Graduate study:
Jonathan Williams. PhD Programme. ‘Is pain the cause of altered biomechancial functions in back pain sufferers?’ Brighton Medical School, University of Brighton
Kernan Barnard. MSc Dissertation. The STarT Back Programme: The Perspectives of ‘Low Risk’ Participants. Brighton and Sussex Medical School, University of Brighton
Michelle Holmes. PhD Programme. Reconceptualising Patient-Reported Outcome Measures as Active Components of Complex Interventions. Faculty of Social, Human and Mathematical Sciences. University of Southampton
Emma Karen. PhD Programme. GLITtER (Green Light Imaging Interpretation to Enhance Recovery): A novel psychoeducation intervention to reduce chronic pain. Body in Mind Research Group, School of Health Sciences, University of South Australia
Other Research papers referenced
Outcome of low back pain in general practice: a prospective study. Peter R Croft, professor,a Gary J Macfarlane, senior lecturer,b Ann C Papageorgiou, studies coordinator,b Elaine Thomas, research statistician,b and Alan J Silman, director. BMJ. 1998 May 2; 316(7141): 1356–1359.