Pure Sports provide Sport, Exercise and Musculoskeletal Medicine services from 8 clinics in London, UK as well as a country-wide virtual clinic. With a focus on providing more innovative sports medicine solutions, they have become one of the UK’s leaders in MSK PROMs (Patient Recorded Outcome Measures). Here, their Head of Research, Simon Lack shares their learnings from their innovative and iterative PROMs journey.

Simon Lack wears two complimentary hats at Pure Sports. He’s splits his time between being a consultant physiotherapist working directly with patients, and leading the organisation’s research capability in his role as Head of Research. It is in this latter role where he is driving a culture of data driven insight to empower Pure Sports to deliver the best care company wide. 

“This is something that Pure Sports has really (gone into) bat for in the last few years. Its remit sits around trying to build a culture of research engagement at all of the levels at which research should be engaged with by clinicians, with a view to delivering the best evidence-informed care that we possibly can.”

Simon’s vision is that this culture of research informs the values and behaviours of every person within the organisation, now and into the future.

“...as the company grows, it's a case of ensuring that we're creating that culture and it permeates through everybody who joins and that that's how they behave or act. That's the vision.”

Pure Sports recognised early on the importance of great data in facilitating the best care for patients. Rather than making assumptions, they had the initiative to invest in research and innovation. While Simon’s role is not typical in many physio organisations yet, more and more MSK teams and organisations are seeing the advantages of investing in quality research to provide the best possible care for patients. 

As part of this drive to uncover valuable insights that can inform research conclusion and in turn inform decisions to drive optimal care delivery, in 2021 they implemented a robust Patient Reported Outcome Measures (PROMs) programme in partnership with Cemplicity. For Simon, Cemplicity was the right fit for two reasons. Firstly, it provides actionable insight and secondly, it’s a demonstration of Pure Sports’ commitment to delivering the best care.

“The PROMS initiative with Cemplicity is another example of innovation that aims to support and ensure that we're delivering the best care for our patients. That's genuinely the motivating point for this project.”

When Pure Sports created the research role, they looked deeply into what it was going to deliver. While they were already dipping their toes into including research studies into their practice - and there was some auditing already happening - they knew they could do a lot more. That’s when they embarked on their journey to create a shared philosophy of research in every corner of their organisation, something that has transformed the way their organisation operates.

“There's this cultural umbrella, this activity of research. It filters down to every single consultation and permeates out to company-wide understanding of how well we're performing”

Now all aspects of patient care are interrogated. From the micro view of individual diagnoses, care management, and patients’ experience of the organisation at a broader level; to the macro view of looking at outcomes across multiple patients and comparing outcomes for different diagnoses. Pure Sports is now able to make more evidence-led decisions and can understand the impact of them. Crucially, it’s also helped them challenge assumptions that may have been made in the organisation for years. 

“We are questioning if there are gaps in the evidence that don't support what we do on the ground. As a consequence, we're having to account for how we deliver. That close link between research activity and clinical activity.”

Prior to working with Cemplicity, Pure Sports did already have an outcome metric in place. However, they weren’t entirely confident that it was delivering the right insight for a few key reasons:

“So there's still this open-endedness to the end of official care for a particular problem. So we'd often get to the end and we'd be a bit like, oh, well they did pretty well. Okay, well we'll score that as they've done pretty well.”

So while what Pure Sports were doing was ahead of the curve, they came to the realisation that the bias and limitations of their existing outcomes tracking meant they were leaving valuable insight on the table. 

In Simon’s head of research role, he embarked on a journey to identify ways of improving what they were doing. That started with a broad look at what was available in the market and with conversation with peers in other organisations to understand how they were conducting research. This process led Simon to Cemplicity.

“When we had the conversations with Cemplicity, we knew that this was the most pragmatic approach and the easiest to optimally integrate into our current practices.” 

One of the advantages of having existing research was that Simon already had an understanding of what could impact the success or otherwise of an outcomes measurement programme. Through his research he’d identified that patients didn’t want to complete long and complex surveys and that this led to a drop off in engagement. So he was keen to take the approach of collecting big data at a shallow but really relevant level. Once that data then starts to show patterns, then could identify and deep dive into specific groups to better understand the factors impacting their outcomes . For him this was a far smarter approach than a one-size-fits-all lengthy up front survey.

“Anybody we'd spoken to who were adopting that type would say that their retention, their completion rates on those were really, really small.” 

Implementing a large-scale digital PROMs programme is a relatively new venture for both Pure Sports and the physiotherapy market. Working alongside Cemplicity, Pure Sports are now on a collaborative and iterative journey to fully integrating PROMs into their organisation, learning along the way and optimising the programme as they go. Given how new this is and with little in the way of sector examples to follow, this ability to embrace uncertainty and accept that there will be challenges is key to their success.

By collaborating closely with Cemplicity, they have crafted a programme to optimise patient engagement and maximise data value. Key features of the programme include:

Pure Sports starts the process by asking two simple questions, one around the individual level of symptom, and one that's centred around their functional limitation, which is captured using the patient specific functional scale (PSFS). Keeping it to two questions and using validated scales ensures high engagement rates and meaningful data collection.

Then at six weeks, three months, six months and 12 months, the patients are prompted to repeat the baseline questions and also some additional questions such as NPS and a binary “are you in an acceptable state” question. This last question contributes to answering if a patient is ready for discharge, or if more treatment is required. 

In addition, Pure Sports has integrated PROMs–based alerts. If a patient's responses to the survey decline when at home, an alert is sent to Pure Sports to bring them back into treatment to work towards a successful outcome for the patient.

“We have an alert built-in that when outcomes display a deterioration from one survey to the next, the clinician would be notified.”

This is an opportunity for clinicians to follow up on care in a meaningful way. It indicates their ongoing concern for a patient’s outcomes and moves to treat concerns before they escalate. It also plays an important role in keeping patients engaged and on their treatment plan, so Pure Sports can ensure they’re seen through to a successful outcome.

“I think it shows that we care and we genuinely do. It initiates a conversation — Are you doing all right? Was that a bit of a blip or is it something we can help with? Let's get that early. Let's not wait for that to become a big thing.”

Pure Sports has always been ahead of the curve, seeing the potential in evidence-led decision making and prioritising a culture of research.  But there were limitations in how they were uncovering patient outcome insight that were preventing them from fully realising this potential. By rearchitecting their PROMs programme with a focus on ensuring high engagement, consistent trackable measures and alerts to power clinical intervention, they have been able to unlock enormous value from their research efforts.