The Development of a Musculoskeletal Screening Tool for Adults with Cystic Fibrosis

1. The Development of a Musculoskeletal Screening Tool for Adults with Cystic Fibrosis Ashbrook, J. MCSP, Taylor, J. MCSP, Johnson, S. MCSP, Jones, A.MD Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Manchester, UK

2. Musculoskeletal support system failure • 3 P’s! • Negative impact on quality of life. •  Reduced respiratory function.

3. What happens in Manchester? • 53% of patients complain of msk pain or postural abnormalities (Whitfield, 2008). • 53% of female patients complained of back pain and 58% complained of stress UI (Ashbrook, 2010). • Oct 2010 to Mar 2011: 67 new patient referrals were assessed by the Msk team. 75% presented with spinal pain and 24% presented with peripheral joint pain. • How do we decide which patients require treatment and when to intervene? 

4. Why screen? • Identify objective indicators prior to onset of symptoms. • Prevent failure of the Msk support system. • Identify problems with 3 P’s early in all patients. • Prevent deterioration of Msk support system. • Promote the msk service and increase patient awareness that expertise is available. • Keep long term records of msk problems.

5. Developing the Tool • Looked at other screening tools: eliminated subjective and objective measures in order of perceived importance. • Kept only the essentials: • 3 P’s. • Thoracic posture and range of movement key to the identification of Msk dysfunction prior to symptom onset.

6. Screening Tool Data from Initial pilot study involving 20 patients. Data up to March 2011 involving 86 patients. Plan to continue to screen all patients 1-2 yearly.

7. Results Screening part 1. Screening part 2.

9. Conclusions • 90% of patients failed the screening tool and were referred for a specialist Msk assessment. • Part 2 of the screening tool identifies problems more frequently (90%) than questioning alone in part 1 (80%). • The screening tool has been rolled out to all patients at annual review and in-patient admission. • The screening tool has lead to an increase in MSK intervention in the presence of postural abnormalities and spinal stiffness prior to the onset of pain. • Further research: is early intervention as a result of the screening tool effective in preventing the onset of MSK pain and stress UI and is it possible for this to impact on respiratory function?

10. Discussion • The screening tool has been designed for use in a CF centre that employs MSK specialists. The tool can be adapted to suit the needs of individual CF centres. • The tool is designed to flag up Msk problems that require attention and does not need to be completed by a specialist. • Section 2 of the tool is more time consuming to complete and requires additional training. • The results of the pilot are biased towards patients with pre-existing Msk conditions.

11. March 2011: Results • 86 patients screened. • 78% (67) failed part 1 and were offered Msk assessment. • 6 failed part 2 and were offered Msk assessment. • In total 85% (73) of patients failed the screening tool and were offered referral for a specialist Msk assessment.

12. Thank you Questions?