Precision-based Care for People With Musculoskeletal Conditions Seeking Primary Health Care: Enhancing Recovery and Health Outcomes

PROJECT PLAN AIM The overall aim is to strengthen the patient-centred care for people with musculoskeletal pain disorders seeking primary health care by supporting shared decision-making about treatment by investigating how a stratifying tool - the Start-Musculoskeletal - can be implemented in primary care thus enhancing precision-based primary care.

BACKGROUND Musculoskeletal (MSK) disorders are some of the most prevalent and disabling chronic pain conditions globally. The prevalence of MSK pain is high (25%-32%) and recurrences are common. Musculoskeletal disorders have a major impact on the individual, health care, and society and thus are one of the most common causes of seeking primary care.

Start-MSK is a short easy-to-use tool to stratify/classify the patient to risk for developing long-term pain. The use of Start-MSK works in two steps: first, it classifies/stratifies the patient to a low, medium/high risk of long-term pain through 10 questions on pain, functional level, and psycho-social factors (yellow flags). Second, the outcome of the tool supports the caregiver in a shared decision process to decide on an optimal level of care/management divided into: low (information/information about level of exercises); moderate (supervised exercises/management on some occasions); high risk (multimodal treatment where psychological factors are taken into consideration). The Start MSK is cross-culturally translated and validated in a Swedish primary care context. For the tool to be implemented in Swedish primary health care it needs to be further investigated in a mixed method design study including two parts: one investigating the internal and predictive validity of the tool and a second investigating how caregivers and patients experience the use of such a stratification tool. The doctoral project provides a validated prognostic tool for shared decision-making for best practice care, to be used in primary health care with established cutoff points to stratify patients with the most common MSK pain disorders into low-, medium-, and high-risk subgroups. The qualitative analysis of patient and healthcare perspectives will inform caregivers on how to embed the tool into clinical practice.

Research questions:

1. To stratify/classify patients with MSK pain disorders seeking primary care into low, medium and high risk using the tool Start MSK and to describe the risk groups regarding demographic data, pain and health-related quality of life (HRQoL) and to investigate if the tool can discriminate between the risk groups regarding these factors.
2. To investigate the predictive validity of the MSK Start tool, by following the risk groups longitudinally to investigate how the risk groups are associated with the outcome of pain and HRQoL at 3 and 6 months and to investigate whether the implemented treatment matches the stratification to the risk groups.
3. To investigate how physiotherapists experience the use of MSK Start to stratify patients to treatment level, thus how Start MSK supports shared decision-making.
4. To investigate how patients seeking primary health care experience the use of MSK-Start in the process of shared decision-making of treatment.