A group of researchers have drawn up a list of recommendations to be considered when treating musculoskeletal disability in the paper ”What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review” in the British Journal of Sports Medicine.
Presented in bullet form, the eleven recommendations are (expanded and explained in the paper):
- Care should be patient centred. This includes care that responds to the individual context of the patient, employs effective communication and uses shared decision-making processes.
- Screen patients to identify those with a higher likelihood of serious pathology/red flag conditions.
- Assess psychosocial factors.
- Radiological imaging is discouraged unless:
- Serious pathology is suspected.
- There has been an unsatisfactory response to conservative care or unexplained progression of signs and symptoms.
- It is likely to change management.
- Undertake a physical examination, which could include neurological screening tests, assessment of mobility and/or muscle strength.
- Patient progress should be evaluated including the use of outcome measures.
- Provide patients with education/information about their condition and management options.
- Provide management addressing physical activity and/or exercise.
- Apply manual therapy only as an adjunct to other evidence-based treatments.
- Unless specifically indicated (e.g. red flag condition), offer evidence-informed non-surgical care prior to surgery.
- Facilitate continuation or resumption of work.
The researchers reached the eleven recommendations by carrying out a systematic review of current clinical guidelines in English concerning the most usual pain areas: Back pain, hip/knee pain and shoulder pain, and assess and sum up the studied guidelines.
According to the researchers, the eleven recommendations can be used to improve the treatment of musculoskeletal pain by assessing the quality of the treatment through auditing, guiding clinical decisions and outlining the need for continued education of clinicians.
The recommendations were compiled by a group of researchers consisting of Ivan Lin, Louise Wiles, Rob Waller, Roger Goucke, Yusuf Nagree, Michael Gibberd, Leon Straker, Chris g. Maher and Peter P. B. O’Sullivan from Australia (see a full list of affiliations in the paper)
Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British Journal of Sports Medicine 2019. https://bjsm.bmj.com/content/early/2019/03/02/bjsports-2018-099878