Feasibility of an intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions in the setting of lifestyle‐related chronic disease

Abstract

Background: Lifestyle factors are associated with musculoskeletal pain and metabolic chronic diseases. To date, intensive lifestyle medicine programs have predominantly targeted metabolic rather than musculoskeletal conditions. Objective: To assess the feasibility of an intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions. Design: Prospective observational feasibility study. Setting: Tertiary academic medical center. Patients: Adults diagnosed with musculoskeletal condition(s) and lifestylerelated chronic disease(s) who previously completed standard-of-care musculoskeletal treatments, enrolled from 2018 to 2020. Interventions: Patients enrolled in an intensive interprofessional lifestyle medicine program led by a physiatrist, with options to interface with an acupuncturist, dietician, massage therapist, psychologist, physical therapist, and smoking cessation specialist. The physiatrist engaged in shared decision making with patients to establish program goals related to function, overall health, and required lifestyle changes. Bimonthly interprofessional team conferences facilitated communication between treatment team and patients. Main Outcome Measures: Feasibility was measured by patient participation and goal attainment. Secondary outcomes included changes from program enrollment to discharge in patient anthropometric, metabolic lab, sleep apnea risk, and Patient-Reported Outcomes Measurement Information System (PROMIS) function, pain, and behavioral health measures. Results: Twenty-six patients enrolled in the program (18 [69%] female, mean age 59 [SD 14.5] years, baseline hemoglobin A1c 6.0% [0.8%], high-sensitivity C-reactive protein 7.7 [12.1] mg/dL, 25-hydroxy vitamin D 32.0 [14.2] ng/mL). Of 21 (81%) patients who completed the program, 13/21 (62%) met their goal. On average, program completers presented for 26.2 (10.6) total visits over 191 (88) days. By discharge, program completers achieved clinically meaningful improvement in PROMIS Anxiety (mean difference À3.5 points, 95% confidence interval [À6.5 to 0.5], p = .035), whereas noncompleters did not (p > .05). Conclusions: An intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions is feasible. With training in lifestyle intervention, physiatrists are well suited to lead interprofessional teams aimed at assisting patients in making lifestyle changes to achieve personalized function-and health-related goals.

Unique characteristics of patients who choose an intensive lifestyle medicine program to address chronic musculoskeletal pain

“…These programs are also a feasible, albeit currently uncommon, care pathway for patients seeking treatment for a musculoskeletal condition. 11 In this study, we sought to identify unique characteristics of musculoskeletal patients who chose an intensive lifestyle medicine program to address their chronic musculoskeletal pain, as opposed to continuing with a more traditional care pathway. Overall, patients who chose the intensive lifestyle medicine program were more racially diverse and had a higher prevalence of obesity and diabetes.…”

“…The full program has been described previously. 11 In brief, patients are referred to the program by a nonoperative musculoskeletal specialist, orthopedic surgeon, primary care provider, other medical provider, or via self-referral. All patients who enter the program have previously undergone standard musculoskeletal evaluation and treatment, as appropriate.…”

“…8 In addition, musculoskeletal patients who have participated in an intensive program that focuses on lifestyle and psychosocial interventions have reported relatively low overall health care resource use despite high satisfaction regarding access to care. 10,11 Because of their effectiveness, intensive care models are becoming widely available for management of metabolic conditions such as cardiovascular disease and diabetes. 12,13 Yet, even though psychosocial risk factors such as a sedentary lifestyle, poor diet, tobacco use, and anxiety are known to exacerbate pain and physical dysfunction, [14][15][16][17][18][19] intensive lifestyle medicine-based care programs are not currently a standard care pathway for musculoskeletal conditions.…”

“…In a Cochrane Review of patients with chronic low back pain, compared with patients who received traditional musculoskeletal care, patients who participated in an intensive rehabilitation program achieved greater pain relief and twice the likelihood of returning to work within 6 to 12 months 8 . In addition, musculoskeletal patients who have participated in an intensive program that focuses on lifestyle and psychosocial interventions have reported relatively low overall health care resource use despite high satisfaction regarding access to care 10,11 . Because of their effectiveness, intensive care models are becoming widely available for management of metabolic conditions such as cardiovascular disease and diabetes 12,13 .…”

Digital Mental Health Intervention Plus Usual Care Compared With Usual Care Only and Usual Care Plus In-Person Psychological Counseling for Orthopedic Patients With Symptoms of Depression or Anxiety: Cohort Study

“…The psychologist delivered cognitive behavioral therapy, motivational interviewing, and mindfulness and deep breathing training, as indicated, during treatment sessions. This unique service was available through a lifestyle medicine–based center within the study institution’s orthopedic department [ 31 ]. The center’s purpose is to help patients manage musculoskeletal conditions by addressing underlying lifestyle habits and biopsychosocial comorbidities that contribute to musculoskeletal pain.…”