Implementation of a clinical pathway of care for people with musculoskeletal pain at risk of poor outcomes

Abstract

Musculoskeletal (MSK) conditions place a major burden on the Australian healthcare system. Despite available guidelines, their implementation in primary care remains limited. This thesis evaluated the PACE-MSK model, a new clinical care pathway for MSK conditions, focusing on prognostic risk screening tools, an educational intervention for specialist physiotherapists, and changes in healthcare practices.

Findings showed that many patients were at medium to high risk of poor outcomes. The Keele STarT MSK Tool and SF-ÖMPSQ demonstrated strong agreement and predictive validity, supporting their use in guiding care at baseline. Compared to these tools, clinician-assigned risk status (measured after three months of treatment) showed lower accuracy and limited agreement.

An educational workshop for specialist physiotherapists improved knowledge and promoted use of the pathway, though barriers to collaboration remained. PACE-MSK participants referred fewer patients for imaging and delayed specialist referrals. However, underuse of risk tools and continued use of non-recommended treatments were observed.

The thesis concludes that validated screening tools should be used early in care to support risk stratification. While specialist physiotherapists showed strong engagement with PACE-MSK, further efforts are needed to enhance collaboration and uptake among all providers. Findings highlight the need for targeted education, system-level support, and multidisciplinary approaches to improve MSK care in Australian primary care.