Simple tool could help GPs more accurately assess musculoskeletal
21 June 2013
A simple set of generic questions could help GPs more accurately
predict the likely progression of disease in patients with
musculoskeletal conditions, research funded by Arthritis Research UK
Asking patients how long their pain lasts; whether it affects
their daily activities; and if more than one joint is affected, was
found to be more effective in predicting disease outcome than a GP
relying on their prognostic judgement alone, according to lead
author Professor Christian Mallen from the Arthritis Research UK
Primary Care Centre at Keele University in the UK.
The improvement in prognostic accuracy was attributable to
correcting the GPs’ tendency to have an over-optimistic expectation
of the outcome of disease. The aim is to encourage GPs to take a
more of a systematic and structured approach to ensure that key
prognostic information is gathered.
Adding three simple questions (duration of their present episode
of pain; whether pain interfered with their daily activities; and
whether the pain was in one of more joints) into their initial
consultation improved the ability of GPs to predict the outcome of
patients conditions in 69% of cases. When GPs relied on their own
prognostic judgement it was only 62%.
The research is published in the online Journal of the American
Medical Association Journal, Internal Medicine (JAMA).
The primary care centre is spearheading research to increasingly
‘stratify’ patients according to their need so that higher risk
patents who are likely to do badly and have a poor long-term
prognosis can be offered care specifically tailored to their needs.
Professor Mallen carried out a prospective observational cohort
study of patients aged 50 or over presenting with non-inflammatory
conditions in one of five participating general practices.
Professor Mallen commented, ”Estimating the likely future course
of musculoskeletal conditions is an important consideration on
primary care consultation for both patients and health
professionals, as it enables them to plan and manage the condition.
An accompanying commentary in JAMA said: “In order to tailor care
by impact and prognostic risk, we need brief assessment tools which
are suitable for routine use in primary care clinics. Simple generic
questions could make routine prognostic evaluation of diverse
patients with musculoskeletal pain more practical and efficient.”