Improving access to evidence-based information and care for people with musculoskeletal conditions: ‘The right care at the right time’

Abstract

Musculoskeletal conditions such as neck or back pain or sporting injuries affect almost 1.7 billion people worldwide and are the leading contributor to years lived with disability globally. The onset of musculoskeletal conditions can be sudden or occur gradually which can impact the timing of a diagnosis, management and subsequent patient outcomes. Anterior cruciate ligament (ACL) rupture is an example of a condition which often occurs suddenly due to a clear mechanism of injury (e.g. pivoting during sport) which can prompt early diagnosis and management. In contrast, other conditions such as degenerative cervical myelopathy, a slowly evolving degenerative spinal cord injury, may progress slowly over time which can make a timely diagnosis and management challenging.

There is an increasing number of people living with musculoskeletal conditions which impact their quality of life and global healthcare systems cannot cope with the associated health care costs. Unfortunately, many patients with musculoskeletal conditions do not receive guideline recommended care due to unnecessary surgery and long waiting times to access care. There is potential for simple and innovative ways to help patients receive recommended care, such as better online information, patient decision aids and development of a new model of care.

Together the findings reported in this thesis show online information on the management of ACL rupture may be misleading patients to have unnecessary surgery. This thesis also shows patient decision aids for children and adolescents with ACL rupture and adults with degenerative cervical myelopathy can align patients’ management decisions to their values and potentially reduce unnecessary surgery. The innovative triage and treatment model of care described for people with musculoskeletal conditions utilises early assessment and telehealth in outpatient public hospitals. This model could reduce waiting times and improve access to care for millions of Australians.