PRISM: The PRimary Care Individual Social Norms MSK Data Dashboard: a Feasibility Trial

NCT07112508 | Not Yet Recruiting DMC

• 1 other identifier: PRISM1
• Study Type: interventional
• Target: 60
• Locations: 0 countries
• Sites: N/A

Brief Summary

Background: 20 million people in UK have musculoskeletal (MSK) aches and pains. They commonly see their GP about this problem, but practices are so busy that it can mean a long wait for appointments. First Contact Practitioner (FCPs) are now working in the GP practices to see patients with MSK problems instead of their GP. A national evaluation has found this to be working well. For FCPs working in GP practices there is more clinical risk. The patients have not been previously screened by a doctor to ensure there is no medical cause for their pain. The Chartered Society of Physiotherapists (CSP) has advised that all FCPs be clinicians with the highest level of experience, known as Advanced Practitioners. However the demand for FCPs far outweighs the number of Advanced Practitioners available so physiotherapists being hired have less experience. Evidence shows that clinicians of different experience levels have different decision-making strategies which may cause unwarranted variation in care. A new method is needed for oversight and support of the FCPs. Clinical supervision is commonly utilised in the NHS and in physiotherapy teams. It is a space to reflect on a clinician's performance and create learning opportunities. This research suggests an individual data dashboard, shared only with individuals and their supervisor, that feeds back a clinician's own decision-making data to them, relative to their peers. For example, the participant is "in the top 20% of MRI requesters" or "in the top 20% of those referring to social prescribing". This type of feedback is known as 'social norms' feedback. It has been proven to be an effective way to change healthcare workers behaviour. The intervention will be called PRISM: Primary Care Individual Social Norms MSK Data Dashboard. Aims To explore the feasibility of a randomised clinical trial comparing the clinical decision-making behaviour of FCP services using the PRISM Dashboard and a usual service with no clinician feedback. Design \& Methods: This research is a feasibility trial, a process to assess whether a future full scale clinical trial within the NHS would work. It will take place across 4 different Primary Care commissioning areas to determine the possibility of recruitment, retention, outcome collection and whether people will use the intervention. PPIE for this research included one primary care PPI rep, one digital interventions PPI rep and 3 Healthwatch PPI reps. Engaging different PPI sources enabled participation from different social , cultural and ethnic backgrounds. Dissemination I will communicate research updates and outputs in conferences, via social media, blogs, newsletters and podcasts. I will use my own network as well as the reach of collaborators in this work, ie. Healthwatch, NHS England/Improvement, The (CSP), the physiotherapy digital network, Keele University and UCL research networks.

Conditions

Musculoskeletal Disorders

Keywords

Musculoskeletal; Primary Care; First Contact Physiotherapy; First Contact Practitioner; Digital Health; Behaviour change

Outcome Measures

Primary Outcomes (6)

• Feasibility - Number of Participants recruited to the study

  The investigators are measuring recruitment so that we can understand the probability that we could recruit to a future trial.

  0, 3 and 6 months

• Feasibility - Number of Participants retained to the study at 3 and 6 months

  The investigators are measuring retention as a measure of retaining participants to a future trial.

  3 and 6 months

• Feasibility - Number of clinician participants collecting data through a template.

  The investigators are measuring engagement with a template to assess the feasibility of participants collecting data this way in a future trial. We will report the proportion of patients whose data was collected through a template.

  3 and 6 months

• Feasibility of participants engaging with the dashboard intervention in a future trial

  The investigators are measuring engagement with the dashboard through collecting logins and pages visted and time spent on the dashboard for each user, as a measure of feasibility of a future trial.

  3 and 6 months

• Feasibility of recording the number of clinical supervision sessions that utilise the PRISM dashboard as recorded in a supervision log

  The investigators are measuring use of the intervention in clinical supervision via a supervision log, as a measure of feasibility of a future trial.

  3 and 6 months

• Completion of outcomes as a measure of feasibility

  The feasibility of collecting outcomes at each time point and the rate of completion of outcomes will give the investigators a measure of how feasible it will be to collect outcomes at a future trial. A completion rate for each outcome will be reported.

  0,3 and 6 months

Secondary Outcomes (5)

• Clinical Decision making data points

  3 and 6 months.

• Clinical Supervision Log

  3 and 6 months.

• Manchester scale of supervision

  0 3 and 6 months

• EQ5D5L

  0,3 and 6 months

• MSK HQ

  0,3 and 6 months

Study Arms (2)

PRISM Intervention Group

EXPERIMENTAL

This group will receive the PRISM dashboard on a monthly basis to be discussed in clinical supervision. It will show them where their clinical behaviours sits relative to their patients. The control will be treatment as usual.

Behavioral: PRISM dashboard is a data report

usual care group

ACTIVE COMPARATOR

This group will receive usual care and the clinicians will receive no information about their performance.

Other: THe usual care intervention is a first contact physiotherapy service.

Interventions

PRISM dashboard is a data report BEHAVIORAL

The PRISM dashboard captures a clinicians activity relative to their peers. It provides social norms feedback on an array of clinical interventions that an FCP makes.

PRISM Intervention Group

THe usual care intervention is a first contact physiotherapy service. OTHER

usual care

usual care group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• FCPs must be in regular supervision
• HCPC registered Physiotherapists
• NHS patients
• Able to send monthly data uploads
• Over 18 years of age
• Registered with an included GP practice
• Consented to routine MSK data collection

You may not qualify if:

• No supervision practice for FCPs
• Community service physiotherapy
• Unable to send data on a monthly basis
• Inappropriate for FCP due to age
• Non-MSK problem
• Already managed by GP
• Unable to consent for reasons of mental health, dementia or language barrier

Sponsors & Collaborators

• University College, London: lead
• Homerton University Hospital NHS Foundation Trust: collaborator
• National Institute for Health Research, United Kingdom: collaborator

Related Publications (14)

• Gould IM, Lawes T. Antibiotic stewardship: prescribing social norms. Lancet. 2016 Apr 23;387(10029):1699-701. doi: 10.1016/S0140-6736(16)00007-6. Epub 2016 Feb 18. No abstract available.

  PMID: 26898851 BACKGROUND

• Hallsworth M, Chadborn T, Sallis A, Sanders M, Berry D, Greaves F, Clements L, Davies SC. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Lancet. 2016 Apr 23;387(10029):1743-52. doi: 10.1016/S0140-6736(16)00215-4. Epub 2016 Feb 18.

  PMID: 26898856 BACKGROUND

• Tang MY, Rhodes S, Powell R, McGowan L, Howarth E, Brown B, Cotterill S. How effective are social norms interventions in changing the clinical behaviours of healthcare workers? A systematic review and meta-analysis. Implement Sci. 2021 Jan 7;16(1):8. doi: 10.1186/s13012-020-01072-1.

  PMID: 33413437 BACKGROUND

• Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O'Brien MA, Johansen M, Grimshaw J, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012 Jun 13;2012(6):CD000259. doi: 10.1002/14651858.CD000259.pub3.

  PMID: 22696318 BACKGROUND

• Gagliardi AR, Wright FC. Exploratory evaluation of surgical skills mentorship program design and outcomes. J Contin Educ Health Prof. 2010 Winter;30(1):51-6. doi: 10.1002/chp.20056.

  PMID: 20222034 BACKGROUND

• Brink P, Back-Pettersson S, Sernert N. Group supervision as a means of developing professional competence within pre-hospital care. Int Emerg Nurs. 2012 Apr;20(2):76-82. doi: 10.1016/j.ienj.2011.04.001. Epub 2011 May 28.

  PMID: 22483002 BACKGROUND

• Langridge N. The skills, knowledge and attributes needed as a first-contact physiotherapist in musculoskeletal healthcare. Musculoskeletal Care. 2019 Jun;17(2):253-260. doi: 10.1002/msc.1401. Epub 2019 Apr 17.

  PMID: 30993860 BACKGROUND

• Physiotherapists CSo. Principles of first contact physiotherapy: a resource to support service evaluation. 2021.

  BACKGROUND

• England N. Multi-professional framework for advanced clinical practice in England. 2017.

  BACKGROUND

• Stynes S, Jordan KP, Hill JC, Wynne-Jones G, Cottrell E, Foster NE, Goodwin R, Bishop A. Evaluation of the First Contact Physiotherapy (FCP) model of primary care: patient characteristics and outcomes. Physiotherapy. 2021 Dec;113:199-208. doi: 10.1016/j.physio.2021.08.002. Epub 2021 Aug 6.

  PMID: 34656297 BACKGROUND

• Goodwin R, Moffatt F, Hendrick P, Stynes S, Bishop A, Logan P. Evaluation of the First Contact Physiotherapy (FCP) model of primary care: a qualitative insight. Physiotherapy. 2021 Dec;113:209-216. doi: 10.1016/j.physio.2021.08.003. Epub 2021 Aug 6.

  PMID: 34583834 BACKGROUND

• England N. The NHS Long Term Plan 2019.

  BACKGROUND

• UK D. The Musculoskeletal Services Framework-A joint responsibility: doing it differently. Health, Editor. 2006:72.

  BACKGROUND

• Keavy R. The prevalence of musculoskeletal presentations in general practice: an epidemiological study. Br J Gen Pract. 2020 Jun;70(suppl 1):bjgp20X711497. doi: 10.3399/bjgp20X711497.

  PMID: 32554673 BACKGROUND

MeSH Terms

Conditions

Musculoskeletal Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This is a pragmatic feasibility cluster randomised controlled trial

Study Record Dates

• First Submitted: July 18, 2025
• First Posted: August 8, 2025
• Study Start: January 1, 2026
• Primary Completion (Estimated): September 30, 2026
• Study Completion (Estimated): January 1, 2027
• Last Updated: August 8, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share