Digital self-management and self-referral for musculoskeletal complaints in London

Common musculoskeletal (MSK) conditions often do not need specific or specialist treatment and may resolve if people follow simple, evidence-based advice. Digital technology can be used to provide immediate day-to-day support, while connecting people to their local MSK pathway and support services. By using technology, people are able to access trusted, evidence-based advice in a consistent and standardised way.

Situation

Patients lack appropriate digital resources to actively self-manage their condition.

Aspiration

Using digital technology to provide immediate day-to-day support whilst connecting people to their local MSK pathway and support services has the potential to deliver trusted, evidence-based advice in a consistent and standardised way.

Solution and impact

The physiotherapy department at St George’s University Hospitals NHS Foundation Trust has scaled the use of an evidence-based self-management digital platform called getUBetter across South West London.

getUBetter is designed to be prescribed during a consultation by GPs, physiotherapists, nurse practitioners, first contact physiotherapists (FCPs) or via physiotherapy providers to support waiting lists. It can be provided wherever a patient interacts with the system, for example self-referral, primary care, minor injury units (MIUs), A&E, physiotherapy, secondary care, or from work. It promotes safe self-management but also automates referrals for treatment appropriately (planned care, unscheduled and local support services). getUBetter has been evaluated at level 2 of the NICE Digital Health Technology Evaluation Framework.

Functionality

Digital tool available on a number of devices that includes:

  • all common MSK conditions
  • new or recurrent injury or conditions
  • prescribed or self-referral
  • symptom checker
  • management advice
  • video exercises
  • advice when to seek further help
  • connection for patients to their local health service

Capabilities

  • Supporting remote healthcare
  • Stratification and outcome measures to guide patients
  • Symptom tracker
  • Virtually connecting with a healthcare practitioner
  • Promoting behaviour change to reduced healthcare utilisation and promote self-management
  • Provision of locally configured clinical self-management pathways to patients
  • End to end Integrated care pathway

Scope

  • Easily accessible, targeted and personalised self-management information to help patients day-to-day and step by step
  • Exercises based on patient’s stage of recovery
  • Direct booking of local treatments such as physiotherapy and wellbeing services within Wandsworth
  • Reassurance and support to self-manage
  • Supports - Recovery, prevention and re-occurrence
  • Standardised care

Key figures/quotes

  • Reduces physiotherapy referrals by 20%
  • Reduces GP appointments by 13% (Wanless B., McClellan C. 2019)
  • Early data shows 5-fold reduction in prescriptions
  • Demonstrated behaviour change (Berry et al. 2020)

Summary of getUBetter from user groups / focus groups / user surveys:

86% of patients would recommend to family and friends. 73% felt the app would provide a better GP service (none disagreed). 100% of patients felt the app would help recovery.

Clinician feedback

“I think it is a fantastic resource on its own but also because patients can then be referred on through the Wandsworth pathway directly”.
Dr Ali Hassas, GP, Wandsworth

“We see the ever-expanding app as a major part of our service redesign going forward”.
Jim Fenwick, CEO, Battersea Healthcare

Published evidence

Berry et al. (2020).  Evidencing the behaviour change model underpinning a personalised and tailored app for low back pain.  Virtual Physiotherapy UK conference.

Wanless B, McClellan C (2019) Developing technology though co-design.  Wandsworth - lower back pain, focus group themes.   Presentation COPA conference.

Wanless B., McClellan C. (2018).  Delivering self-management for LBP via a digital solution in Primary care – a sustainable solution for a growing problem.

Poster presentation at Chartered Society of Physiotherapists annual congress, Birmingham.

Find out more

Clinicians can read more about getUBetter here

Key contact

Ben Wanless, consultant MSK physiotherapist, St George's University Hospital NHS Foundation Trust

benwanless@nhs.net

Carey McClellan, clinical director, getUBetter

contact@getubetter.com