Learning Objectives

Participants will:
• identify behavioural, psychological and healthcare system factors affecting clinicians’ and patient’s readiness for recommending and adopting evidence-based non-pharmacological management strategies.
• understand how to identify people with MSK conditions at risk of a poor prognosis and how to implement clinical pathways of ‘right’ care.
• learn lessons from studies aimed at reforming primary care services towards effective de-medicalized options for MSK pain tailored to the individual.

Description

PROBLEM – MSK CONDITIONS are a GLOBAL DISEASE BURDEN
Leaders in musculoskeletal health services research from the US, UK and Australia will share real world perspectives on outcomes from their innovative translational research that connects consumers with clinicians, services and systems, to support musculoskeletal reform. Reform is critical: musculoskeletal (MSK) conditions attribute the HIGHEST global non-communicable disease burden (Global Burden of Disease Study, 2019). Underuse of high value care practices (e.g. behavioural management and physical activity) and overuse of low value care (imaging, medicines, surgery, inappropriate manual treatments; Foster et al 2018) are key issues discussed. We will present solutions showing how collectively we can nudge helpful behavioural change at clinical interface, and leverage services and system re-design to support integrated person-centred musculoskeletal care.

SOLUTION - CHANGING CLINICAN and PATIENT BEHAVIOUR
Dr Lynn DeBar will open by summarizing broad trends in treatment practice for MSK conditions, including historical practices misaligned with optimal provision of non-pharmacotherapy evidence-based care. She will discuss behavioural, psychological, and healthcare system factors that affect the readiness of clinicians and patients to partner to optimize adoption of non-pharmacotherapeutic strategies. Examples from NIH- and PCORI-funded studies (including multi-method evaluations of US policy initiatives; Smith et al 2022; DeBar et al 2022) evaluating patients’ uptake of evidence-based behavioural interventions will be utilized. Integrative health approaches for managing chronic pain in primary care in the US will be discussed. Following, actionable strategies to scale and sustain patient-centred approaches (encouraging patients’ active partnership in a biopsychosocial function-focused means of managing MSK conditions) will be proposed. Finally, methodologies considering how to effect broader systems of care will be reviewed.

SOLUTION – IMPLEMENTING CLINICAL PATHWAYS
Professor Trudy Rebbeck will discuss implementation of risk-based clinical pathways of care utilising expert MSK physiotherapists as a promising solution. First, validated tools that assist clinicians in identifying those at risk of a poor prognosis (e.g. Orebro, WhipPredict) will be discussed. Next, different clinical pathways of care (e.g. stratified and matched care) will be introduced. Common messages across MSK conditions suitable to manage those at low risk (likely to recover) will be identified (e.g. providing exercise and advice). Integrated roles of generalist and specialist MSK physiotherapists in managing people with MSK conditions at risk of a poorer prognosis will be explored. Results and lessons learnt from large Australian implementation trials testing these models of care for people with whiplash (Rebbeck et al 2023) and MSK disorders (Rebbeck et al 2021) will be discussed.

SOLUTION – SUPPORTING DELIVERY OF CARE
Professor Jonathan Hill will introduce some cutting-edge projects that are seeking to deliver innovative guideline-based clinical decision-support systems, to improve musculoskeletal primary care decision-making. For example, the Norwegian SupportPRIM project (www.ntnu.edu/supportprim) , the UK MSK Pathways trial, and the UK STarT MSK Trial (Hill et al 2022). In addition, he will talk about the Keele MIDAS and MSK research database projects in the UK which are designed to benchmark services against key care quality indicators.

AUDIENCE DISCUSSION
Prof Helen Slater, a world leader in development, implementation and evaluation of MSK Models of Care will conclude the session by leading a discussion on the opportunities and challenges for driving whole-of-system reform to improve MSK health outcomes and how we might achieve this in a rapidly evolving health landscape (Briggs et al 2019). Critical factors at the clinical (micro), service delivery (meso) and system (macro) levels will be considered. Helen will facilitate discussion between the panel and audience and invite conversation about the future to support MSK health reforms, including through the use of digital care models, and future roles for MSK physiotherapists.

IMPLICATIONS
Participants will understand key behaviours required to change and adopt new models of care. This is critical for not only professional survival but for musculoskeletal physiotherapists to have key roles in the future of health service delivery for people with these disorders.

REFERENCES
Briggs A, Slater H et al. Pain; 2019 160:1240-1244.
DeBar L et al. Ann Intern Med. 2022 175(1): 46-55.
Foster N et al. The Lancet, 2018; 391(10137): 2368-2383.
Global Burden of Disease Study 2019. The Lancet 396(10258): 1204-1222.)
Hill et al. Lancet Rheumatology 2022; 4:9 E 591- E602.
Rebbeck T et al. Pain 2023; in press.
Rebbeck T et al. BMJ Open 2021;11e057705.
Smith DH…….. DeBar L. Medical Care 2022; 60 (6).