Despite these efforts, the global burden of MSK disorders has increased by 123% over the last four decades. In the United States, low back pain affects 30% of adults, knee pain affects 25%, and people with anxiety, depression, and cardiovascular disease also report a high prevalence of MSK pain.
Sadly, due to the complex and chronic nature of many MSK conditions, patients frequently experience fragmented care, leading to inconsistent treatment plans and poorer health outcomes. This has led to high recurrence rates, increases in medication and surgical-based approaches, and significantly higher costs of care – approaching $600 billion annually in the United States. This amount surpasses the annual costs of heart disease, cancer, and diabetes combined.
These findings suggest two possibilities:
- Our patient-level focus, although noble, should not be used in isolation, and
- We need a broader, systems-level approach to managing MSK pain disorders.
Systems-Level Focus for Musculoskeletal Provides Better Patient Care
Systems-level management addresses which specialist should provide care, when patients receive care, and how it’s managed. System-level approaches are population-based and use large-scale data collection and research to inform decisions for specific groups.
These systems-based approaches are better for patients and systems because they assure that the patient receives the right care at the right time.
Several different approaches to systems-level management exist:
- Stepped care involves a structured approach to treatment that starts with the least intensive, most cost-effective interventions and steps up to more intensive treatments as needed.
- Stratified care approaches involve categorizing patients based on their risk of developing chronic pain or their data-driven expected treatment response and tailoring interventions accordingly.
- Integrated care pathways are structured multidisciplinary care plans that outline the essential steps in the care of patients with a specific clinical problem.
As a Duke University School of Medicine researcher, I have investigated stepped care and stratified care models for MSK disorders for many years. My research team and I have found that using stepped care models in the military (for 60,000 servicepersons with knee pain) led to cost savings, fewer knee-related visits, fewer episodes of knee pain, fewer knee surgeries, and decreased opioid prescriptions.
Currently, we are studying a stepped care model for 1,800 veterans with low back pain in the VA (the AIM-Back trial). In this study, we place patients in selected groups based on their initial severity screen. Our emerging findings suggest that placing individuals with lower severity into less intensive care plans may lead to improved outcomes, a reduction in unnecessary care, and reduced costs.
TailorCare Integrates both Patient-Level and Systems-Level Management Models
The future is systems-level care, which is why I joined the TailorCare Clinical Advisory Board. The TailorCare model is a holistic navigation solution that provides personalized guidance throughout a patient’s MSK care journey. The model uses both patient-level and systems-level tools to guide the patient and recommend treatments to address their preferences and needs.
TailorCare clinical navigators, who are licensed physical therapists, triage patients using stratified care management methods, help patient’s choose a care pathway, and refer to care management resources based on stepped-care principles. They schedule appointments and reduce the risk of fragmented care. In some cases, “self-management” techniques are assigned, which offer a low-cost approach to MSK treatment. Clinical navigators serve as the patient’s case manager and as a liaison with the patient’s primary care provider and specialists, reflecting the best of both patient-level and systems-level approaches.
By Dr. Chad Cook PT, PhD, MBA, FAPTA – Clinical Advisory Board Member at TailorCare
Dr. Cook is a renowned clinical researcher, physical therapist, and professional advocate with a clinical care excellence and service history. He currently serves as a professor for the Department of Orthopaedics at Duke University and has secondary appointments within the Department of Population Health Sciences and the Duke Clinical Research Institute.
Dr. Cook has authored or co-authored four textbooks, published over 380 peer-reviewed manuscripts, and internationally lectured on orthopedic examination and treatment. His passions include refining the patient examination process and validating tools used in day-to-day physical therapist practice.