1. Evidence

PROMs are questionnaires which can be used in a variety of ways. One of their applications is to evaluate how a patient has responded to a course of treatment such as osteopathy. They can measure change in function, pain and quality of life for example, and can provide information about the response to a therapeutic intervention.

The Evidence project has developed an online and smartphone app that can be used to collect information about the outcomes of people who consult an osteopath. The app contains a Patient Reported Outcome Measure (PROM) and other measures of change relevant to osteopathic care.

Why are PROMs relevant to me as an osteopath?

Osteopaths can use the PROMs app to monitor and improve the service that they provide to their clients. This information can be used in marketing materials, to inform learning and to demonstrate compliance with the ‘objective feedback on practice’ requirement of the new CPD scheme.

PROMs are vitally important to the wider profession too. If all osteopaths collected PROMs it would produce a significant data set that could be used to describe osteopathic practice and raise awareness among potential patients, and other healthcare professionals.

For more information on how to use PROMs, click here.

Why are PROMs important for the development of the profession?

The collation of independently collected outcome data by osteopaths has many potential benefits:

  • to identify the patient population attending a practice
  • to identify how successful patient management is in terms of a range of different outcomes e.g. global change, satisfaction, and patient experience
  • to provide outcome data to insurers and commissioning groups
  • to identify CPD opportunities for osteopaths
  • to encourage reflection on patient management.

The PROMs app has been developed by the National Council for Osteopathic Research. It is very simple to use in busy practices whether group based or single-handed. Osteopaths tell us that integrating PROMs into practice is neither burdensome nor time-consuming, and that patients respond very positively to being asked for feedback on the care they have received.

How can I get involved?

If you are an osteopath or a patient and are interested in using the app, email Carol Fawkes at:c.fawkes@qmul.ac.uk

Project background


The osteopathic profession has continued to evolve and mature since the introduction of statutory regulation. As part of this developmental process, it is critical that the profession consider the role of evidence-based practice to promote standards of patient care.

Clinical governance brings with it a range of requirements that must be met by healthcare professionals including the measurement and evaluation of patients’ experience of their care, and the outcome of that care. A way to achieve this is through the use of Patient Reported Outcome Measures (PROMs), Patient Reported Experience Measures (PREMs) and measurement of global health change.

Many such outcome measures already exist, but their measurement properties vary considerably.

The aim of this project is to consolidate the evidence base for osteopathy and develop a national data collection system to collect PROM data from osteopathic patients. These data will allow osteopaths to reflect upon their patient management, and contribute to engagement with other healthcare professionals and relevant stakeholders in patient care. The smartphone and online version of the app has been piloted by patients attending private practices, and clinics attached to osteopathic educational institutions to assess its feasibility, reliability and responsiveness.

This programme of work also includes two web-based platforms for the recording of patient experience of osteopathic care and a learning platform for the anonymous sharing of practice-based incidents in osteopathic practice. The PILARS site is accessible only to osteopaths.

Developmental stages


Since the PROM project began, a series of developmental stages have been undertaken.  The app was developed through qualitative work involving patients (n=22), and clinicians including osteopaths, physiotherapists, and chiropractors (n=46).  A systematic review to investigate the measurement properties of different PROMs was conducted also.  The findings from these research studies informed the content of the app for piloting.

Piloting of the app

Piloting of the app took place over a period of 18 months.  This process, involving osteopaths in private practice, and clinics attached to osteopathic educational institutions, was undertaken to investigate key elements of the app’s performance.   These elements included feasibility – would using the app work in private practices, reliability – how the PROMs behaved in an electronic format, and responsiveness – would the PROMs detect change in the symptoms of patients attending osteopathic practices.  At the end of the pilot process, the app underwent some small refinements and is now available for use by the osteopathic profession.

Osteopaths are naturally concerned that patients won’t want to fill out questionnaires or that older patients won’t fill out online surveys. The opposite was found to be true, with 90% of patients stating that it was very important to them to be given the opportunity to provide feedback about their experience to their osteopath.

PROM data collection in osteopathic practice

A total of 326 osteopaths are currently enrolled in the PROM data collection programme in the United Kingdoms (correct as of March 2019).  The PROM app has undergone further development: patients can now complete a questionnaire for themselves or for their children to allow adult and paediatric data to be collected.  A pilot study has been completed involving osteopaths in Europe where the app content has been translated into French, German, and Dutch (Flemish).  Further development work will be taking place throughout the next eighteen months involving osteopaths in France, Greece, Spain, Sweden, and Norway.

This pilot study is supported by the European Federation and Forum for Osteopathy.

Project team

The project team includes representatives from the National Council for Osteopathic Research(Carol Fawkes, Professor Dawn Carnes, Dr Rob Froud). Clinvivo Ltd have been commissioned to build the app.


Carol Fawkes: c.fawkes@qmul.ac.uk