Risk-stratified and stepped models of care for back pain and osteoarthritis: are we heading towards a common model?

Abstract

Supplemental Digital Content is Available in the Text. Substantial overlap between interventions and models of care for osteoarthritis and low back pain suggests potential for one common model, which may facilitate implementation.

Back and neck pain: in support of routine delivery of non-pharmacologic treatments as a way to improve individual and population health

“…level of care determined by risk of prolonged disability). 72 The purpose of this particular framework is also to provide initial care options that are personalized to individual needs (in contrast to traditional stepped care models where all individuals receive the same initial care), while escalating care to interventional treatments only when it is likely to result in more effective care for the management of back pain. 72 This new hybrid model has not yet undergone widespread implementation and testing but the proposed framework has the potential provide personalized care that is guideline adherent, includes robust exposure to non-pharmacologic treatments, and minimizes the risk of unwarranted escalation of care.…”

Global, regional, and national burdens of hip osteoarthritis from 1990 to 2019: estimates from the 2019 Global Burden of Disease Study

“…Thus, it is essential that prevention measures, management and treatment of OA are given priority [ 13 , 14 ]. As excess weight is a risk factor for hip osteoarthritis, maintaining a healthy weight and performing regular exercise are crucial to prevent the development of hip osteoarthritis [ 15 , 16 ]. Exercise not only helps to manage weight but also strengthens muscles surrounding the joints, which prevents wear and tear of the cartilage [ 16 , 17 ].…”

How to sustain and improve client centred (matched) care in chronic musculoskeletal pain? Start by changing the way policy makers select and judge the large amount of available data, and get rid of the dogma of stepped care

“…We do have high levels of evidence for the prognostic value of modifiable, mostly psychosocial factors in musculoskeletal pain [8], so why not implement the appropriate screening and early treatment? In my opinion, matched care is the way forward as in this model, next to the risk factors, information on social factors, comorbidity, previous and personal experiences with other treatments can be taken into account [9], and real client centred care in which shared decision making is also integrated can be delivered. For us as clinicians there is the obligation to collect data and to start using promising techniques like machine learning to build up clinically based evidence and to improve the effectiveness of this type of care.…”