Balance Performance Physiotherapy, part of the MSK Partners Network, has integrated Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) into their clinical practice through Cemplicity's platform. This initiative, led by Dr. Lucy Goldby, a renowned spinal physiotherapist, aims to generate meaningful data to improve patient outcomes and refine clinical practices. This case study explores the transformative impact of this initiative and highlights key insights and benefits observed by the clinic for their service, clinicians, and patients alike.

Balance Performance Physiotherapy, a member of the MSK Partners Network, is committed to improving the quality and standards of musculoskeletal care. The clinic, renowned for its specialised spinal care, is spearheaded by Dr. Lucy Goldby. Lucy, who holds a Ph.D. and is a spinal care consultant recognised by the Chartered Society of Physiotherapy (CSP), has over 25 years of experience in clinical spinal disorders. She has dedicated her career to researching and implementing the best treatment approaches for low back pain management. Lucy's commitment to combining academic research with hands-on clinical practice has positioned Balance Performance Physiotherapy as a leader in the field. This integration allows the clinic to assess the impact of evidence-based medicine in real-world settings and track patient outcomes beyond the clinic.

Lucy emphasised the importance of evidence-based medicine in physiotherapy, noting that while physiotherapists often rely on promising research findings, they sometimes fail to implement the full breadth of recommended practices. The integration of PROMs and PREMs through Cemplicity has allowed the clinic to move beyond selective data and understand the real-world impact of their treatments on patients. This capability enables the clinic to collect and view patient outcomes on a large scale, free from clinician influence or bias.

"What I've found from working in back pain for the last 30 years is very rarely do people employ the whole of the programme. They often cherry-pick and assume they're going to get the same results."

The primary driver for adopting Cemplicity's platform was the ability to collect a significant volume of standardised and validated data. Lucy highlighted the necessity of having a large data set to derive meaningful insights and ensure the reliability of the findings. This comprehensive data collection helps the clinic understand how their team is performing in the patients' eyes.

"For me particularly, it's been very interesting with PREMs and PROMs because everything else I've done has been very specific to the problems I've been looking at in back pain and the clinical issues. So actually looking at how things work in our clinic with our cohort of clients is very important."

One of the significant challenges in the physiotherapy sector has been the lack of consistent and comprehensive data collection. Traditional methods often involved small sample sizes, incomplete data and clinician bias, leading to skewed results with limited applicability. The introduction of Cemplicity's platform has revolutionised this approach by enabling Balance Performance Physiotherapy to collect large volumes of standardised data, essential for assessing evidence-based medicine's real-world impact.

One of the unexpected advantages of using Cemplicity's platform was the powerful feedback mechanism it provided. The creation of word maps and direct feedback from patients to individual clinicians has been immensely valuable. Importantly, this isn’t just negative feedback; it’s also about sharing positive stories of patient gratitude. This feedback significantly boosts clinician morale and shows what patients value about their care.

"I think the most surprising one is the word maps. I love those for our individual clinicians. We give feedback to the individual clinicians direct from the patients so the clinicians can see exactly what they think of them, how appreciative they are of the work they do on their behalf, their skill, and their knowledge base."

For the first time, clinicians could receive detailed, objective feedback from their patients, also providing management with a clear view of clinician performance from the patient's perspective. Lucy shared how she didn’t know how much patients loved a particular clinician with whom she’d worked with for 10 years until his patient feedback came through.

"As one physiotherapist said to me, you go to bed at night worrying about the one person you are concerned about or the one person who's not doing very well or did you do the right thing. You don't go to bed smiling thinking about the ones who have said thanks very much and here's a box of chocolates."

The data collected through PROMs and PREMs has enabled them to tailor their training programmes more effectively. Instead of a one-size-fits-all approach, the clinic can now identify specific areas where individual clinicians excel or need additional support. This personalised approach enhances clinician development and ensures targeted training that addresses specific needs.

"At the moment, we train en masse so we decide what lectures people want, what areas they want their learning to go in, what's new, what they don't know about. What we have now is we can see who's doing very well in certain parts of the body, who perhaps needs a bit more training in other parts, who's not as confident in other parts of the body."

Additionally, they incorporate individualised personal data for each clinician in their 360 reviews. Clinicians now have access to their GROC scores, NRS and PSFS scores, and, most importantly, a word map highlighting all client comments from the past 12 months. One team member, who serves as a Youth Consultant, has particularly benefited from this data. Given the limited availability of youth-related data, he now has his own client data to present in his upcoming lectures.

"We do a 360 review with all of the team, and that's an opportunity for them to sit down and say, this is where I want to go or I'm not very confident here. Having that data behind us to say, well, actually your Cemplicity scores do show that you are getting lower scores in that area so I can see you need to go on that course. Or well done, you're doing very well there if you want to go further in that area. And that's very nice because before all you had was somebody's enthusiasm and desire. If you've got things backed up with objective data, it's a lot easier for the clinic to put money behind it."

The integration of PROMs and PREMs has also positively impacted non-clinical teams. For example, practice managers use Cemplicity's alerts to engage with patients and address any issues that arise promptly. This allows the clinic to track patient outcomes outside of treatment, ensuring timely interventions when necessary.

These alerts help the team identify patients whose outcomes have decreased, allowing them to intervene and provide additional support as needed. This proactive approach not only improves patient outcomes but also helps maintain high levels of patient satisfaction.

"There's all kinds of reasons for the alert and I think that's great because we never had this system before. We never had an engagement system whereby the patient would engage with us automatically whether they were thinking of coming back in to see us or not and we didn't have the opportunity to phone up and say, look, what's happened?"

One critical strategy implemented by Balance Performance Physiotherapy is using PROMs data to personalise patient interactions from the first consultation. Clinicians review the data before meeting patients, enabling them to address specific concerns immediately and establish a strong rapport. This approach enhances patient engagement and ensures personalised care.

"The most important thing they need to do is read the report, read the PROMs before they meet the patient. That's really key because they are going to understand why the patient's walking through the door before the patient walks through the door and then they can start talking to the patient about their problems straight away before they've taken them into the room."

This approach improves the patient experience and ensures that clinicians are fully prepared to address each patient's specific needs and concerns from the outset.

"In terms of adding value in physiotherapy, bang, you've got it straight away. They walk through the door and they've been greeted with - I can see there's this big problem. Come with me, let's see what we can do about it. And that's a great starting point really."

The objective data provided by Cemplicity has also proven invaluable in supporting insurance claims. Lucy recounted a case where a patient's functional score improvement rather than pain score was used to secure additional funding for continued treatment. This use of data highlights the practical benefits for patients in securing necessary support and ongoing care.

"It's very helpful for things like writing reports because you've got all your PSFS scores that can't be argued with. There was one very interesting case of one of our clients whose PSFS (function) scores had improved 26, but the PMI had said they wouldn't fund the patient anymore because their pain scores hadn't changed. And so we said to the patient, can you please phone the PMI? This is one of their preferred outcome measures... so they funded another three months' worth of treatment which in his particular pathology was very important."

By providing clear objective data, they can demonstrate the effectiveness of their treatments and secure the necessary support for their patients. This capability is essential for improving patient outcomes and ensuring continued care.

The journey of integrating PROMs and PREMs at Balance Performance Physiotherapy has provided several valuable lessons that can benefit other clinics looking to implement similar programmes.

Full Clinical Buy-In

Engaging clinicians from the outset is crucial for the success of a PROMs programme. Lucy emphasised the importance of clinicians understanding and utilising the data to improve patient care.

Engaging Patients

Explaining the purpose of data collection to patients is essential for ensuring their cooperation and buy-in. Patients need to understand how their data will be used and the benefits it can provide.

"We try and engage with people as much as possible so that they understand what we're doing with their data, why we're collecting it, why it's important. It's their data, it's not going to anybody else. And then patients generally are very happy to help you out."

Example of Balance's in clinic patient poster:
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Trust the Process

Clinicians should trust the data collection process and be patient as they gather enough data to make meaningful analyses.