Risk-based identification of patients with musculoskeletal pain and individualized care pathway in primary healthcare - A Benchmarking Controlled Trial
Improving outcomes in patients with musculoskeletal pain
The intervention of the trial is the implementation of a new tool, risk of pain spreading (ROPS), including individualized care pathways based on the ROPS. Patients in the intervention group are divided into risk groups defined according to the ROPS (low, moderate, and high risk) and the content of the care is determined accordingly. Intervention groups are contrasted to control groups which are collected before the intervention in each participating units. Control group's patients are treated according to current practices, i.e. they are receiving usual care. Risk-based care is tailored according to ROPS: • Low-risk patients: physiotherapists are encouraged to keep the number of possible clinical follow-ups to a minimum and provide an information booklet for the patients (suitable booklets will be gathered during the pilot). • Moderate-risk patients: "Identify and React" method. No recommendations are given for physiotherapists about the number of follow-ups. • High-risk patients: "Identify and React" method. A control appointment for physiotherapist at 6 months. During the control visit, the "Identify and Act" method. No recommendations are given for physiotherapists about the number of clinical follow-ups. "Identify and React" method 1. The physiotherapist discusses with the patient the prognostic factors identified using the ROPS and asks the patient whether the identified ROPS factors are already being taken care of or whether the patient needs treatment for them. 2. If the patient wishes for care, the physiotherapist presents the patient with a care pathway menu, which includes self-care support methods targeted at identified prognostic factors. 3. If the patient wishes for care, but does not want to implement self-care support methods, has gone through these in the past or finds them insufficient, the physiotherapist refers the patient to a healthcare professional that will evaluate further measures according to local procedures.
1. Patients who will be visiting physiotherapists in primary healthcare due to MSK pain. MSK pain is referred to pain in the following anatomical areas: neck/shoulder, upper limb, lower limb, and/or back, or multisite pain (pain in many of these locations). 2. At least 18 years of age 3. Possibility and ability to use a smart device (phone, computer, or tablet) 4. Consent to take part in the trial.
1. Red-flag symptoms/findings (acute urinary retention, faecal incontinence, perianal anesthesia, symptoms of paralysis or major numbness of the limbs, fever or unexplainable weight loss related to pain) 2. Trauma as a reason for pain in the past six months 3. Memory disorder 4. Cancer 5. Serious mental health disorder, such as schizophrenia or psychotic depression 6. Pregnancy 7. Operation on the area where musculoskeletal pain occurs within the past year 8. Insufficient Finnish language skills for participating in the interviews and answering the surveys