Evaluation of a novel clinical pathway of care for common musculoskeletal disorders in primary care.

Summary

An opportunity exists to undertake a PhD as part of a project entitled Implementation of a novel clinical pathway of care for common musculoskeletal disorders in primary care.  People with musculoskeletal pain (low back pain, neck pain/ whiplash and knee osteoarthritis) will be stratified for risk of recovery then randomised into usual care or the clinical pathway.  Those at low risk will be referred to guideline based resources and those at high risk will be referred to an expert musculoskeletal physiotherapist who will further determine care.
Commencing in January/February 2019 and located at Cumberland Campus, the opportunity involves working with, and learning from, world leading, multi-disciplinary experts from four Australian states.  The research involves performing fundamental aspects of research work, preparing relevant materials in collaboration with team members, and helping to facilitate the efficient operation of the research project.  Funding is available to support the incumbent in a Research Assistant role whilst undertaking the PhD. 

Supervisor(s)

Dr Trudy Rebbeck, Associate Professor Paulo Ferreira, Dr Milena Simic, Dr Kerrie Evans

Research Location

Health Sciences - Generic

Program Type

PHD

Synopsis

Musculoskeletal disorders (low back pain, neck pain/whiplash and osteoarthritis) are the highest burden of disease in Australia.  The costs associated with treatment escalate when people with these disorders do not recover and are often sent for numerous investigations and referrals.  The increasing burden on the health care system, together with the overwhelming information that primary care practitioners' (such as GPs) have to cope with, means that implementing appropriate health care messages for musculoskeletal disorders effectively with GP's is difficult.

We propose a novel clinical pathway of care, stratified for risk of persistent pain and disability as a solution to providing appropriate health care resources to people with musculoskeletal disorders.  People at low risk of persistent/ disabling pain (eg simple low back pain, osteoarthritis without complications and whiplash) are known to recover or be managed well with guideline-based information and simple exercises delivered by primary health care professionals.  However, those at higher risk of persistent pain and disability will be more systematically identified and referred to an expert musculoskeletal clinician who would then decide on the care pathway.  This may either be shared care (liaison with the primary health care professional), specialist care (the expert provides care) or referred care (the expert refers for other care, e.g. psychology, surgical opinion, neurology).  To date, expert musculoskeletal clinicians (e.g. physiotherapists) have been providing such secondary referral services in other health care settings such as tertiary care centres.  Involvement of physiotherapists in these roles has resulted in satisfactory care, reduced waiting times for routine appointments of patients and less resource utilization.  Surprisingly this model of service delivery has never been tested in primary health care in Australia.

Patients with low back pain, knee osteoarthritis, or whiplash will be recruited from hospitals, primary care, advertising and social media in four participating Australian states.  They will initially undergo baseline assessment of risk of persistent disabling pain.  Participants will be randomized to usual care or the stratified clinical pathway of care. Those randomized to the clinical pathway care will be stratified to low or higher risk of poor prognosis using validated risk assessment tools.  Low risk participants will be directed to a musculoskeletal e-hub which will bring together existing guideline-based resources and websites.  Their nominated health care professional will be informed of the risk status, provided with access to and education regarding the e-resources and advised not to over treat.  At risk patients will be referred to an expert musculoskeletal clinician, who will provide a more complex assessment and decide on the care pathway.  The primary outcome will be health related quality of life (SF12), with secondary cost-effectiveness outcome in the form of cost per quality of life (QALY) gained at 12 months.

The impact of this study will be significant in the management of conditions which of 310 chronic medical conditions, have been shown to have the highest rates of years lived with a disability around the world.  It will allow a direct translation of cost-effective management for musculoskeletal disorders in the Australian population. Potentially, implementation of this clinical pathway of care will reduce disability associated with musculoskeletal disorders, be cost-effective and improve the efficiency of the current health care system, by reducing unnecessary imaging and referrals, and providing timely access to appropriate care when needed.

Additional Information

This position will be based at the Faculty of Health Sciences, The University of Sydney, and will provide the HDR student with a unique opportunity to work with world leading multi-disciplinary experts (listed below) in musculoskeletal disorders across four Australian states and will develop skills in web-based education, implementation science, research translation and research supervision. The University of Sydney Chief and Associate Investigators on this project include:

• Dr Trudy Rebbeck (Physiotherapy), Faculty of Health Sciences
• Dr Milena Simic (Physiotherapy), Faculty of Health Sciences
• A/Prof Paulo Ferreira (Physiotherapy), Faculty of Health Sciences
• Prof Ian Cameron (Rehabilitation Physician), John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School
• Prof Michael Nicholas (Psychologist), Pain Management Research Institute; Kolling Institute, Sydney Medical School
• Prof Lyndal Trevena (General Practitioner), School of Public Health
• Prof Kathryn Refshauge (Dean), Faculty of Health Sciences
• A/Prof Manuela Ferreira, Institute of Bone and Joint Research, Sydney Medial School
• Prof Tim Shaw (e-Health), Faculty of Health Sciences
• Dr Kerrie Evans (Senior Research Fellow), Faculty of Health Sciences

National and International Investigators on this project include:

• Prof Michele Sterling (Physiotherapy), University of Queensland
• Dr Darren Beales (Physiotherapy), Curtin University
• Prof Luke Connelly (Health Economist), University of Queensland
• Prof Kim Bennell (Physiotherapy), University of Melbourne
• Prof Paul Hodges (Physiotherapy), University of Queensland
• Em/Prof Gwendolen Jull (Physiotherapy), University of Queensland
• Dr Carrie Ritchie (Exercise Physiologist), University of Queensland
• Prof Nadine Foster (Musculoskeletal Health in Primary Care), Keele University, UK

Funding Available:

Funding is available to support the incumbent in a Research Assistant role whilst undertaking the Phd. The position will be fixed term (part-time, two days per week) for three years, commencing January 2019 and base salary $67K p.a pro rata plus superannuation.  Details for this role can be found on he University of Sydney's Job Search page:  Job Reference No. 1684/0818F

For further details:

Contact:  kerrie.evans@sydney.edu.au or trudy.rebbeck@sydney.edu.au

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Keywords

neck pain, low back pain, osteoarthritis, Physiotherapy, primary care, clinical pathway, patient outcomes, Pain, prevention, persistent pain, whiplash, knee osteoarthritis, website, risk stratification, Education, e-education.

Opportunity ID

The opportunity ID for this research opportunity is: 2474

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