Return on Investment Interventions to Manage Musculoskeletal Conditions

For many people with musculoskeletal conditions, becoming physically active may be challenging due to the nature of this condition. Activity can take many forms, a ‘one-size fits all’ approach is not appropriate for people with differing levels of mobility and activity.

PHE’s return on investment The tool recommends the following 7 interventions:

1. Cognitive Behavioural Therapy (CBT), approach including exercise and education using CBT. The intervention is delivered as group sessions by physiotherapists specifically trained in CBT. Eight two-hour sessions delivered over a five-week period in groups of four to 10 led by two physiotherapists. For further information please see: https://www.ncbi.nlm.nih.gov/pubmed/17621203
2. STarT Back (stratified risk assessment and care) uses a validated, simple-to-use prognostic screening method (the Keele STarT Back Screening Tool) to allocate patients into one of three risk-defined groups – low, medium, and high. Three treatment pathways were matched to these risk groups. For further information please see: http://www.wmahsn.org/programmes/view/start-back-
3. PhysioDirect involves a telephone assessment and advice followed by face-to-face care if required (as opposed to being placed on a waiting list for routine face-to-face treatment). The interview was conducted by a specially trained senior physiotherapist and assisted by computerised templates. Patients were sent leaflets and advice on self-management, with and invitation to call again or make a face-to-face appointment. For further information please see: http://www.csp.org.uk/frontline/article/hanging-telephone
4. Self-referral to physiotherapy By patients with or without the suggestion of their GP. For further information please see: http://www.csp.org.uk/professional-union/practice/selfreferral-key-improving-access-physiotherapy
5. YOGA for Healthy Lower Backs (this is the name of the specific intervention) Participants received a 12-week educational course of specialised gentle yoga (75-minute weekly classes). This mind-body long-term self-management course is designed to help attendees gain improvements in pain reduction, strength, flexibility, mobility, postural awareness, confidence in movement, spinal and back-care education, mental focus, relaxation and breathing techniques, ‘psychosocial’ / positive mental mood. For further information please see: http://www.yogaforbacks.co.uk/
6. ESCAPE-pain is an exercise-based rehabilitation program designed to improve function by integrating exercise, education, and self-management strategies to dispel inappropriate health beliefs, alter behaviour, and encourage regular physical activity. Participants were invited to attend 12 supervised sessions, twice weekly for six weeks. For 15 to 20 minutes of each session, the supervising physiotherapist facilitated a discussion on a specific topic, advising and suggesting simple coping strategies. For 35 to 40 minutes of the session, each participant performed a simple individualised exercise regimen to address their disabilities and progressed this as they improved. After completion, participants were discharged with encouragement to perform home exercises and physical activity, especially walking, but did not receive any additional intervention as part of the program. For further information please see: http://www.escape-pain.org/ Please see Escape pain video: https://www.bing.com/videos/search?q=Versus+Arthritis+physical+activity+cartoon&docid=608040135094641754&mid=CEB85D68BF54BEA2F31ECEB85D68BF54BEA2F31E&view=detail&FORM=VIRE
7. Vocational advice in primary care, to provide a structured approach to managing work related issues for all MSK conditions. During the initial clinical trial individuals with a musculoskeletal problem who require help and support in remaining at or returning to work were referred to the ‘vocational advice service’ by their GP or nurse practitioner. The patient was contacted by a vocational advisor, seven days after receipt of the referral to identify and overcome obstacles assisting with remaining at or returning to work. A stepped care model was used, with initial telephone contact and follow up face-to-face appointments for approximately 20% of patients. The Flags model of management of the health and work interface was used to structure the vocational advice service, including identification of obstacles to working with health conditions. A plan was produced to manage their health condition, specific actions to address the issues each individual patient was facing with respect to managing their musculoskeletal condition in the workplace. The plan included goal approach with an evaluation to monitor the progress being made to support the individual’s sustained return-to-work.

For further information please see: https://www.keele.ac.uk/kctu/ourresearch/swap/