Reflections from Therapy Expo Musculoskeletal Conference – Opening Speech

Back Clinical Insight - - 2 minute read.
Sports Rehabilitator with Female Patient

The challenge for all of us is to look at a number of uncomfortable truths and leave egos at the door.

We wanted to share insight from the recent MSK conference “Working Together” from our teams who were there.

We include extracts and questions from the opening speech, which looked to challenge some assumptions and biases within MSK rehabilitation.

Let’s start with some facts:

  1. In 2017, MSK disorders ranked fifth amongst all diseases in disability-adjusted life years.
  2. People with MSK disorders are twice as likely to have other systemic diseases.
  3. Smoking and obesity are strongly linked to ongoing MSK pain.
  4. National and global inequalities occur and these negatively affect outcome for MSK pain.
  5. The highest prevalence is lower back pain and neck pain. The highest risk factors are stress, lack of social support such as loneliness and depression, psychosocial factors, catastrophising, and anxiety disorders.

Adapting our MSK Service

As MSK clinicians, do our services or clinical provision effectively cater for this?

The highest risk factors for ongoing pain and disability are social behaviours and psychological factors. However, when MSK services are commissioned, do they really consider these factors within the service provision?

If they did, would they not widen the workforce to include vocational support, mental health, or occupational therapy perhaps?

Why do we continue to recruit the same staff when the evidence suggests we should widen? Is this due to professional silos, poor commissioning, cognitive professional change apathy/fatigue, or just acceptance of the status quo?

The Challenge

The challenge for all of us is to look at a number of uncomfortable truths and leave egos at the door.

Is it time to deconstruct some of the assumptions that we have about effective interventions? Multi-modal, multi-agency, bespoke, psychologically and socially-informed with some lovely ways to move better may present a different way forward?

Do some clinicians who rehabilitate think that knowledge on the advances in knee replacement would beat knowledge in how to arrange respite care or a raised toilet seat?

Which would be more useful to a struggling patient?

The Future of MSK

We need to ask ourselves the following: what does the MSK rehab practitioner of tomorrow look like, what does the service look like, what does education look like, and what does the patient experience look like?

Rehab practitioners of the future are perhaps not held by a single disease process, they address functional needs across all areas of rehab, they manage psychological distress as expertly as they prescribe exercise, they allow the patient to lead and they never handover a patient. They are the case manager and the patient never feels d/c.

The service is prevention, public health minded, it welcomes complexity by addressing the fundamentals of function, and social challenges together; it is integrated in all forms of communication and the patient remains the holder of that passport.

The Future of Education

Education perhaps needs to reflect the multi-morbidity issues that patients face, within an integrated model that links systems together and does not teach things separately.

Let’s start with psychological determinants before we think about physical factors; they link, but perhaps we should understand our patient before we think about “diagnosis”.

If MSK services/clinicians accept that the impact of delivery is not meeting a demand, and that the wider workforce coming together and not working in separate systems is the next step, then really what is holding the process back?

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