September 5th – 8th 2013
Nottingham Conference Centre, United Kingdom
www.nspine.co.uk
History
 Unique data collection system
 University of Berne and Eurospine 2002
 30,000 interventions in 29 centres
 2009 Spine Tango Conservative
 Comparative data
 Benchmarking
 Osteopaths at QMC are the first internationally
to record and input data
Spine Tango Conservative Questionnaires
Examiner Questionnaire
Course of Tx
Assessment
End of Tx
Therapy
Purpose of Spine Tango
 Records diagnostic findings and functional limitations
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(using ICD and ICF classifications)
Functional limitations become the goals for treatment
and form core outcome measures
Data extraction can be very specific
Which spine conditions and pathologies are most
effectively managed, and
When intervention is most effective, based on changes
in functional limitations
Benefits to Patients, NHS & Osteopathy
 Identifies spine pathologies and conditions that are
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most effectively managed.
Most effective point of intervention.
Optimum treatment duration.
Training aid for colleagues.
Treatment complications.
Overlay ODI and NDI to enhance data.
Comparison against pool i.e. Benchmarking.
Potentially reducing surgical conversion rate.
Initial data promising.
Spine Tango Conservative Questionnaires
Patient Questionnaires
COMI Low Back
COMI Neck
ODI
NDI
EQ-5D
Time Scales
 Greater numbers = valid and powerful results
 Currently n~80 new patients per annum
 At least 4-5 years for n=320-400
 On-going study
 Encourage others to become involved
 Continue to develop document with Bern
 Validation study with New York University
Sample Data – Change in ODI Scores
Pre to Post Treatment
ODI Change
70
60
ODI %
50
40
30
20
10
0
a
b
c
d
e
P a t i e nt
Pre1stTx
End2ndTx
f
g
Sample Data – Diagnostic Classification
Sample Data – Pre Treatment
Grade Classification
Grade 0 = No symptoms
Grade I = Symptoms, but
no care recommended
Grade II = Symptoms, no
radicular signs, treatment
recommended
Grade III = Symptoms,
radicular signs, treatment
recommended
Grade IV = Red Flags
Sample Data – Post Treatment
Grade Classification
Grade 0 = No symptoms
Grade I = Symptoms, but
no care recommended
Grade II = Symptoms, no
radicular signs,
treatment recommended
Grade III = Symptoms,
radicular signs,
treatment recommended
Grade IV = Red Flags
Sample Data – Pre Treatment History
Sample Data – Pre Treatment Functional Classifications
Department Background
 Osteopathy has been available as a service in the spinal
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unit since 1999.
Currently has 2 consultant spinal osteopaths & 2
osteopathic fellows.
Data collection since January 2012: Spine Tango
Conservative, ODI & NDI.
Validation of Spine Tango Conservative by NYU.
2012/2013 patient numbers:
 New patient appointments
 Follow up appointments
86
1012
Data Collection
 Every patient completes/has data recorded on:
 Spine Tango
 ODI/NDI
 COMI Low Back/COMI neck
 EQ-5D - a standardised instrument for use as a measure of
health outcome, it provides a simple descriptive profile and a
single index value for health status.
 Each form is completed at initial assessment, therapy
midpoint and at the end of the treatment cycle.
 Data is inputted manually into a central database &
analysed.
Functional Limitations Data
 Subjective record of functional limitations pre- and
post-treatment.
 Objective: setting goals to overcome functional
limitations with treatment.
 Goals at end of treatment may be fully achieved,
partially achieved or not achieved.
Latest Functional Limitation Data
Goal Achieved
Goal Partially Achieved
Goal Not Achieved
18%
43%
39%
n = 31
ODI Data
 ODI questionnaires are scored out of 100. A change of ≥ 10 pre-
post treatment is considered statistically significant – MCID.
 Latest ODI data for all spinal pathologies:
 Range Pre-Tx scores
 Range Post-Tx scores
78-16
66-6
 Mean Pre-Tx score 41
 Mean Post-Tx score
 Mean change
26.8
-15.8 – statistically significant
 59% of patients had a statistically significant reduction in their ODI
score following osteopathic treatment.
Latest ODI Data for all pathologies
ODI Pre Tx
ODI Post Tx
100
n = 22
90
80
ODI score
70
60
50
40
30
20
10
0
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
Latest ODI Data for Degenerative Disc
Disease in Lumbosacral Region
Pre Tx
Post Tx
100.0
n=10
90.0
80.0
ODI Score
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
A
B
C
D
E
F
G
H
I
J
Medication Data
 Start of treatment: pain medication taken specifically
for spinal condition is recorded.
 End of treatment cycle: same medication is recorded
as ‘discontinued’, ‘continued’ or ‘modified’.
 43% of patients had discontinued pain medication
relating to their spinal complaint by the end of
treatment.
Benefit of Data
 Robust data collection system ensures reliability of data.
 Validation of Spine Tango Conservative is expected by
November 2013 – this will ensure valid research is
universally recognised.
 Data will identify where & when osteopathic intervention
is most effective, & how treatment cycles can be optimised.
 Data will highlight areas in the referral pathway that are
optimal or where there is a need for improvement.