Is it Feasible and Effective to Provide Osteopathy and Acupuncture For Patients With Musculoskeletal Problems in a GP Setting?

A Service Evaluation

Anna Cheshire; Marie Polley; David Peters; Damien Ridge

Disclosures

BMC Fam Pract. 2011;12(60) 

In This Article

Background

Chronic pain currently affects 7.8 million people in the UK and it has been estimated that back pain alone costs the economy £12.3 billion per year.[1] A survey of adults registered with GPs in the UK found that 38% of respondents were affected by musculoskeletal (MSK) pain.[2] Dealing with MSK problems places a heavy burden on primary care services and resources.[3] However, treatment for MSK problems is perceived by GPs and other health professionals as an 'effectiveness gap' within the NHS.[4,5] Furthermore, the Chief Medical Officer's 2008 report recommends that much more needs to be done to improve outcomes for patients with pain, arguing that patient-centred services are essential, yet current systems and infrastructure are inadequate to meet patient needs and demand.[1]

Despite NICE guidelines recommending manual therapy (which can be conducted by osteopaths) and acupuncture for persistent low back pain,[6] there has been no previous evaluation of a GP practice using them together for this common problem. Yet there is good evidence for the potential benefits of providing osteopathy and acupuncture within primary care as treatment options for people with common MSK problems. Evidence from randomised controlled trials (RCTs), meta-analyses and a Cochrane review demonstrate that acupuncture can be useful in reducing lower back and neck pain [e.g., [7–10] chronic shoulder pain,[11] chronic knee pain[12] and reducing symptoms of knee and hip osteoarthritis [e.g. [13–15]] RCTs have also shown that osteopathy may reduce non-specific neck and low back pain, and improve patients' quality of life (QoL) compared to control groups,[16,17] and that manual therapy can reduce shoulder pain[18,19] and symptoms of knee and hip osteoarthritis.[20] Initial data from RCTs indicate that for acupuncture and osteopathy modest clinical benefits are achievable for a relatively small additional cost.[21,22]

It is therefore timely and appropriate to consider how osteopathy and acupuncture treatments could effectively be provided by the NHS to treat pain. A number of general evaluations have demonstrated favourable results for the provision of complementary and alternative medicine (CAM) within the NHS [e.g. [4,23–27]]. However, the specific effectiveness (i.e. how well interventions work in the real world[28]) of providing osteopathy and acupuncture for MSK problems in the NHS has yet to be determined. Evaluation is needed to determine how to deliver these treatments effectively, and assess clinical outcomes and acceptability to patients and practices. The current paper reports on a service evaluation of an osteopathy and acupuncture service (delivered by complementary therapy practitioners) for patients with a range of MSK problems provided within a large GP practice in central London. The service design follows current guidelines which recommend the provision of manual therapy and acupuncture as a treatment option for persistent low back pain,[6] and that GPs should act as gatekeepers to CAM services.[29] The evaluation examines patient outcomes, patient satisfaction, acceptability to stakeholders and the mode of provision (i.e. within general practice).

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