£1.9 million grant for musculoskeletal research

Posted on 04 June 2014

Researchers at Keele University have been awarded a £1.93 million National Institute of Health Research (NIHR) Programme Grant for a new five year programme of research to develop a new treatment model for people with musculoskeletal problems in primary care, in which treatment will be tailored to patients' risk of persistent pain and disability.

The Chief Investigator, NIHR Professor Nadine Foster in the Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences at Keele, said: "Musculoskeletal problems represent the single largest group of chronic conditions for which patients consult their GPs. How to manage this enormous workload poses huge challenges for primary care services. Whilst many patients have mild complaints which could be self-managed with appropriate support, some have more serious or persistent problems that research has shown would benefit from treatments such as exercise programmes or pain management."

"The problem is that the traditional “medical model”, where treatment decisions are guided by the doctor making a specific diagnosis, has not helped identify who could be supported to self-manage and who needs other more expensive treatments. There is wide variation in care – some patients are offered unnecessary treatments whilst others do not get access to effective treatments. This makes primary care inefficient and does not get the right patient to the right treatment at the right time."

"We previously have shown it is possible to use a simple set of questions to separate people who consult their GP about back pain into three groups: those likely to get better who can be given simple advice (low risk); those with more troublesome problems who can be referred for physiotherapy (medium risk); those with more complex problems (eg significant worries about the impact of pain) who can be referred to a specially trained physiotherapist (high risk). When people’s back pain is treated according to the group they are in (stratified care), this leads to better pain relief and physical function, and is cheaper to deliver than usual care."

In the new programme, starting in June 2104, the research team will test if stratified care can be extended to a larger group of patients with common musculoskeletal problems including back pain, neck pain, shoulder pain, knee pain and pain in multiple body sites. If so, there is the real potential to improve patients’ experiences and outcomes, and increase the efficiency of primary care, in a major way.

In a series of four linked research workpackages the researchers will use a variety of research methods to test a new set of questions to help group people with musculoskeletal pain; identify the treatment options which can be targeted to each group; test how this helps GPs and patients to agree treatment options; how it helps improve patients’ outcomes and experiences; and test whether it is cost-effective for the NHS.

They aim to develop a much more patient centred model for patients with musculoskeletal problems, where treatment is tailored to reduce the future risk of pain and disability.