The development of a model of care to reduce waiting times in outpatient musculoskeletal clinics: a multi-methods study.

AIM: Develop a model of care aiming to reduce waiting times for adults with musculoskeletal conditions referred to outpatient musculoskeletal clinics in Australian public hospitals.

METHODS

Multi-methods development. Stage 1: Designing a preliminary model based on existing research and input from a multidisciplinary steering group; Stage 2: Refining and finalising the model following findings from our feasibility and pilot randomised controlled trial (RCT) and qualitative interviews.

RESULTS

Stage 1: Existing research and our steering group suggested managing patients at low-risk of poor outcomes with less resources (e.g., a brief phone call, App-based physiotherapy) could free-up clinic-based resources for those with more complex presentations. The Keele STarT MSK tool was chosen to match the mode and type of care to patients' risk of persistent disabling pain, while potential radiculopathy was seen as an indicator warranting in-person assessment and treatment. Stage 2: Our feasibility and pilot RCT led to modifying key aspects of the model (e.g., providing telehealth to patients requiring postoperative rehabilitation and clinic-based care for those at high risk of persistent disabling pain). Qualitative interviews (11 patients with musculoskeletal conditions, 13 health professionals and key stakeholders) identified 7 key themes related to model acceptability, barriers and facilitators to telehealth, communication, access, and implementation which helped finalise the model.

CONCLUSION

We developed a model of care for musculoskeletal conditions allowing physiotherapists to identify patients who can be managed with less resources (e.g. brief telephone call, App-based exercises) and those who require clinic-based care. An adequately-powered RCT evaluating our model is underway.