Are We Providing Timely Access to Musculoskeletal Outpatient Therapy Services? an Exploratory Study (MSk EATS)

February 11, 2025 updated by: Cardiff and Vale University Health Board

Waiting times for NHS services are of growing public interest. This is because accessing some services is getting more difficult, and we know that longer waits can result in negative impacts for those waiting.

People in Wales waiting for care for their musculoskeletal problems are deemed to be cared for in good time if they get an appointment in less than 14 weeks. This target has been set by Welsh Government, for everyone who waits, no matter what condition they are waiting with and how that condition is affecting them.

We know that impact of wait for people with MSK problems can vary, from complete recovery, to worsening of their pain and function. The impact experienced seems to be influenced by factors such as their age and their mental health statusz\. This suggests that setting one target for all may not be the right thing to do. However, we don't yet know whether waiting over 14 weeks has a big effect on impact. We also don't know about the lived experience of those waiting, while they wait, despite knowing that learning this is vital to informing change.

We plan to study the impact of waiting for these services by asking those waiting to complete a survey that measures the impact of their msk problem, at the start and end of their wait, and then understanding how the scores correlate with length of time waited. We will also ask some of these people to document their experience as they wait. We hope that this will provide an understanding of how effective the current target is at measuring access to these services, and whether we need to think differently. People will be able to complete this work in their own home.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Access to NHS and social care services has been of increasing public interest for many years. Increasing waits to services has been long documented, and the COVID-19 pandemic saw waiting times soar to an all time high. This is not favourable because of the known negative impacts experienced by the waiter, when waiting longer for the services they need. Improving access to services is not only a National Driver featured throughout policy (A Healthier Wales, 2018) but a legal obligation (Duty of Quality, 2023). Access to services in Wales has been studied by Welsh Government for decades. This is usually measured by the time taken in weeks from referral to treatment, and is supported to be necessary in some areas, whereby increased waiting time can result in morbidity, or mortality, for example, heart attacks and strokes.

Literature exploring impact with wait is lacking when considering many areas of health, for example musculoskeletal conditions. However, such services are also duty bound to report their waiting times to Welsh Government.

Outpatient MSk Therapy Services, for example, report how long each person waits before an initial appointment is offered, in number of weeks. An appointment offered within 14 weeks of referral is considered 'timely' and people waiting over this time are considered to be 'breaching'. How this target became to be considered significant is not publicly justified. The impact of those waiting over 14 weeks on the person waiting, is not known.

Impact exploring those waiting for treatment for musuculoskeletal disorders is extremely limited. However, preliminary, retrospective study during COVID-19 suggests that those waiting for these services during this time, experienced a diversity of impact, from symptom recovery to deterioration of condition. The variables observed differed between individuals, as opposing to differing lengths of wait, and seemed to be influenced by personal factors such as socioeconomic and mental health status. This provides an insight that impact of wait is variable between individuals and does not align with current study of accessibility subjecting all people to the same arbitrary target without knowing what happens around this time. We know that future health and social care services need to be sustainable for the NHS to survive. We know that we need to look at things differently, considering the quality of the care that is provided rather than the quantity, and we are duty bound to explore how the NHS is doing with respect to quality, using both qualitative and quantitative information, involving all stakeholders. We know that this is vital to inform positive system change. However, there is no current exploration into the experience of waiting for MSk services, in the eyes of the waiter, as they wait.

Understanding this may help us to understand what a future model of MSk Outpatient healthcare should look like with respect to accessibility, and implement a sustainable solution for future generations. This is assuming that our current understanding of wait is inadequate, or not appropriate, based on the information available communicating accessibility through use of an arbitrary, unjustified blanket target for all, which remains an unknown.

This research project aims to understand the impact of chronological wait for people waiting for Musculoskeletal Therapy Outpatient Services, with reference given to under and over 14 weeks, to understand if the current target is effective at communicating how we are doing in this domain. It will also explore the lived experience of waiting in the eyes of the waiter, and seeks to understand whether this understanding aligns with what we see when studying impact of wait chronologically, with a view to provide a quality rich understanding of the impact of waiting for these services, and provide a direction of travel for future study.

Study Type

Observational

Enrollment (Estimated)

135

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

people residing in the remit of Cardiff and Vale University Health Board, entering the waiting list of Outpatient Musculoskeletal Physiotherapy, Occupational therapy or Podiatry

Description

Inclusion Criteria:

  • aged 18 years or over
  • have entered a waiting list for outpatient podiatry, occupational therapy or physiotherapy with a musculoskeletal complaint
  • able to provide informed consent
  • be able to read and write english

Exclusion Criteria:

  • are considered a vulnerable adult
  • exhibit additional communication needs, to include but not limited to, language barrier

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
service users entering waiting lists for outpatient musculoskeletal physiotherapy, podiatry and OY
Procedure: wait for outpatient appointment
this is an observational study measuring impact of pain and function at start and end of wait for those waiting for care from outpatient physiotherapy occupations therapy and podiatry

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
musculoskeletal Health Questionnaire
Time Frame: from enrolment until the end of wait - currently up to 14 weeks
from enrolment until the end of wait - currently up to 14 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cardiff and Vale University Health Board

Collaborators

Cardiff University

Investigators

  • Principal Investigator: Sara P James, MSc, Cardiff And Vale University Health Board

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 4, 2025

Primary Completion (Estimated)

April 1, 2025

Study Completion (Estimated)

September 1, 2025

Study Registration Dates

First Submitted

February 11, 2025

First Submitted That Met QC Criteria

February 11, 2025

First Posted (Actual)

March 25, 2025

Study Record Updates

Last Update Posted (Actual)

March 25, 2025

Last Update Submitted That Met QC Criteria

February 11, 2025

Last Verified

February 1, 2025

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 8851

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

CI handling all participant information. Feasibility study

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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