Low‐value care in musculoskeletal health care: Is there a way forward?

Abstract

Background Low‐value care that wastes resources and harms patients is prevalent in health systems everywhere. Methods As part of an invited keynote presentation at the Pain in Motion IV conference held in Maastricht, Holland, in May 2022, we reviewed evidence for low‐value care in musculoskeletal conditions and discussed possible solutions. Results Drivers of low‐value care are diverse and affect patients, clinicians, and health systems everywhere. We show that low‐value care for back pian, neck pain, and osteoarthritis is prevalent in all professional groups involved in caring for people who seek care for these conditions. Implementation efforts that aim to reverse low‐value care seem to work better if designed using established conceptual and theoretical frameworks. Conclusion Low‐value care is prevalent in the care of people with musculoskeletal conditions. Reducing low‐value care requires behaviour change among patients and clinicians as well as in health systems. There is evidence that behaviour change can be facilitated through good conceptual and theoretical frameworks but not convincing evidence that it changes patient outcomes.

Physiotherapists Using the Biopsychosocial Model for Chronic Pain: Barriers and Facilitators—A Scoping Review

“…The identified theme of environmental context and resources also draws attention to the organization of the health-care system. Time, reimbursement, incentives and being part of a network have been described as factors influencing the implementation of BPS care [ 3 , 55 ]. It might be expected that being trained in a system where physiotherapists have first line practitioner status as opposed to having to work technically under medical referral, or a national health system versus an insurance center health care system, or private practice versus government hospital practice will influence the use and implementation of a BPS approach.…”

“…Psychosocial factors, such as cognitive, emotional, behavioral and social factors, are broadly recognized to influence chronic musculoskeletal pain [ 2 ]. Clinical practice guidelines recommend a biopsychosocial (BPS) approach to musculoskeletal conditions [ 3 , 4 ]. Patients with chronic pain are not a homogeneous group and different interventions may be indicated for different subgroups of patients.…”

“…The acknowledgment that physiotherapists are well positioned to provide BPS treatment as primary care clinicians in various health care settings has facilitated the proliferation of physiotherapy-led biopsychosocial-oriented treatments [ 10 ]. A recent systematic review highlighted that physiotherapists appreciate the importance of using a BPS approach but there is overwhelming evidence that many patients receive care that does not reflect guideline recommendations [ 3 , 10 , 11 , 12 ]. To bring care into line with best available guideline recommended evidence, more insight is needed on the barriers and facilitators that physiotherapists experience when adopting this approach in clinical practice.…”

Optimising the process of knowledge mobilisation in Communities of Practice: recommendations from a (multi-method) qualitative study

“…The overall quality of care for MSKDs is suboptimal, partly due to the inconsistent clinical uptake of guidelines and evidence-based recommendations [ 4 – 7 ]. Bridging the evidence-to-practice gap to reduce clinical variation and improve the management of MSKDs is a major challenge[ 8 ]. There is a need to explore knowledge mobilisation (KM) strategies to help clinicians and other musculoskeletal stakeholders address the complexity of implementation.…”

Prognosis and bio-psycho-social prognostic factors in children and adolescents with musculoskeletal pain consulting general practice

“…The management of MSK pain conditions in general practice is important. Low-value care, defined as health services that inflict little or no benefit to patients or where risk of harm exceeds probable benefit, according to best available evidence 53 is common across health systems globally, provided by all health professions and prevalent in the care of MSK conditions 54 .…”