Paula Williamson and Tracey Howe: Scottish minister links standardised outcome set to improvements in health

It was great to hear Shona Robison, minister for public health and sport in Scotland, suggesting that “developing datasets will enable Scotland to be the first country to develop such a rich source of data which will in turn help develop better services for patients.” The minister was speaking at the start of the musculoskeletal consensus conference in Glasgow on 12 May. The meeting was organised by Professor Tracey Howe, director of HealthQWest, to bring together clinicians, researchers, policy makers, and patients and the public with a common interest in community musculoskeletal rehabilitation (the photo shows the conference organisers and panel chairs, l-r: Nadine Foster, Lesley Dawson, Sarah Dean, Heather Gray, Abiodun Temitope , Jacqui Lunday, Sarah Mtichell, Shona Robison, Tracey Howe, Grant Syme, Danielle van der Windt, Fraser Ferguson, Ogechi Ernest-Amaziro).

The Scottish government’s 2007 rehabilitation framework outlined an improvement strategy for community based rehabilitation in Scotland. Emphasising multidisciplinary involvement in an integrated process of assessment, goal setting, intervention and evaluation, a key process is collection and interpretation of data to aid intervention choice and subsequent reassessment. However there are no recommended guidelines for what data to collect, when, or indeed who should do this.

In the absence of a standard data set or outcome measures mapping the patient journey it is difficult to assess whether patients receive the right treatment at the right time. Without centralised information on the decision making process or the timing of assessment clinicians and service users are unable to access information for research, evaluation or compare outcomes to find best practice.

This project focused on the following anatomical regions as they relate to the largest numbers of referrals and subsequent clinical workload for community musculoskeletal rehabilitation; low back pain, shoulder, hip, knee, foot, and ankle as well as global measures of pain and quality of life.

The initial phase of the project developed a profile of current practice for community musculoskeletal rehabilitation across Scotland. This was followed by a systematic search of the international scientific literature, screening of almost 50,000 titles for relevance to the clinimetric properties of outcome measures on this topic. Over 800 full papers were reviewed in detail and evidence summaries were produced from the 180 papers that met the inclusion criteria. These evidence summaries detailed information on 130 outcome measures and the scientific quality of each was scrutinised by members of an “expert panel” comprising 40 members from various clinical professions, members of consumer groups, policy makers, and methodologists.

Those outcome measures that met the scientific quality threshold were presented at the consensus conference to more than 170 people including clinicians, international experts, relevant stakeholder groups and members of the public. The day proved to be a great opportunity to discuss the feasibility of each outcome measure for use in routine clinical practice, taking account of the burden on both the clinician and the patient. The audience gave their opinion on each through an electronic voting and text messaging system. This information has also been produced as a consensus document on the Scottish government website for wider consultation.

The results of this project will be the development of a Scottish data set for community based musculoskeletal rehabilitation. This will enable Scotland to present a more detailed view of the pattern of strengths and areas for development in the system which will facilitate local clinical governance and strategic planning and will enable clinicians to present information for resources allocations more effectively. A full report from the project should be available soon at

Paula Williamson is director, MRC North West Hub for Trials Methodology Research.
Tracey Howe is director of HealthQWest.