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Digitising isn’t Enough to Drive Clinical Transformation in Musculoskeletal Care

Matthew Driver
Digitising isn’t Enough to Drive Clinical Transformation in Musculoskeletal Care

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Musculoskeletal (MSK) injuries and conditions impact approximately 20 million people in the UK, making them the leading cause of disability. They affect peoples’ daily lives, the NHS, the workplace and the economy (1). In fact, musculoskeletal problems and care costs the NHS £5 billion ever year (2), account for 14-18% of all GP appointments in England, and result in 24 million lost working days annually (3).  Despite this already hefty burden, the prevalence of MSK conditions is rising due to an ageing population and lifestyle factors (15).

The case for self-management

The value in supporting people to self-manage MSK conditions as early as possible is well researched (4-8), and recommended within national guidelines and policy (4-6, 9–12). However, it is not delivered consistently or at scale. A recent report by The Arthritis and Musculoskeletal Alliance (ARMA) highlighted the variation in strategy, leadership and prioritisation of MSK conditions across integrated care boards (ICBs) despite it being one of six priorities in NHSEs major conditions strategy.

The NHSE ‘Best MSK Health Collaborative’ and Getting It Right First Time’s (GIRFT) community MSK workstream have both highlighted the absolute need to adopt evidence based digital technology to support people with MSK injuries and conditions (13). At the same time there is a growing emphasis on the link between health and economic inactivity and a new government focused on improving both (14).

Early intervention holds the key, but people are waiting too long

GIRFT has highlighted the need for early intervention in the musculoskeletal care pathway to reduce the primary impact and longer-term consequences. Additionally, not enough is being done to minimise the time on or effectively support people on waiting lists. The BMA estimates that 8 million patients are currently waiting for consultant-led elective care (16).  However, the number does not include the ‘hidden backlog’ – those who have not yet presented for care or are waiting for other services (e.g., physiotherapy or investigations). There are up to six waiting stages before an orthopaedic procedure, each offering a chance to reduce deconditioning, encourage self-management, support a person’s return to work, and possibly avoid costly surgical intervention. Extended waiting times for MSK treatment at any point on this journey takes a toll on patients’ physical and mental health, leading to deconditioning, increased pain, lesser quality of life, difficulty to work and, in some cases, irreversible deterioration (17).

Enabling people with musculoskeletal conditions to self-manage their care and recovery

Digitally supported self-management tools help integrated care systems (ICSs) to support musculoskeletal patients across their entire care pathway. They help people to trust their recovery, utilise less healthcare resource and return to work more quickly and safely.

For maximum impact, digital self-management pathways should be made available to people at the earliest possible opportunity wherever they connect with the health system or seek help – in the community (pharmacies, libraries, leisure centres), primary (GP, FCP), urgent care or secondary care (elective care). Self-management support is suitable for 80% of all new, recurrent, or long-term MSK conditions, including people on waiting lists (18).

Tools like getUBetter enable people to self-manage their recovery by following a recovery and prevention pathway defined by their local healthcare system.  And, because it’s digitally enabled, it supports people to manage their condition 24 hours a day, 365 days a year, taking them through their recovery day-by-day, and providing them with the knowledge, skills, and confidence to help themselves.  Support is provided through triage, advice and guidance, exercises, outcome measures, dynamic safety netting and referral when necessary.

getUBetter also supports people by connecting them to treatment, local support and public health services (e.g., smoking cessation, weight reduction and return to work).

Behaviour change model 

For a digital platform to have a positive impact on people and the NHS, it must be trusted, and help people change their behaviour. That’s why, getUBetter was designed with an underpinning COM-B behaviour change model as its foundation (22). The COM-B model is a theoretical framework that incorporates key components (capability, opportunity, and motivation) considered to affect behaviour.

For example, all content has been created with behaviour change at its core and tailored depending on the individual’s stage of their recovery and how they are feeling. Content includes support to mitigate against negative behaviours and promote positive behaviour; it is personalised, targeted, and localised to clinical pathways, health services and community support.  getUBetter include support for safety netting as well as other factors such as psychological elements of MSK recovery, the relationship between work, home, and health and system obstacles to work.  All can influence someone’s ability to recover, live and work well.

Digitising isn’t enough to drive clinical transformation and positive impact

The NHS Is littered with examples of poorly designed patient-facing applications that have not been co-designed with their users. This leads to a frustrating experience and short-lived engagement.

An iterative design process ensures content is accessible, intuitive, inclusive, and easy to follow, while barriers to adoption such as digital exclusion are minimised (21). Working in Partnership with ICB clinicians, champions and transformation stakeholders is essential. Their local expertise is crucial for ensuring that any digital tool integrates seamlessly into routine care. This ensures the best approach for deployment and adoption, and creates a blueprint for NHSE scale and adoption

The impact of digital self-management on musculoskeletal care

The Independent Investigation of the NHS in England (23) confirms that it must move care to the community, enable patients to take active involvement in their own care, digitise, and help tackle economic inactivity.  MSK digital self-management tools are ideally placed to play a central role.

Earlier this year NICE published an Early Value Assessment approving the use of five digital tools for use in the NHS for non-specific low back pain – the biggest cause of days taken off work.

An economic evaluation conducted by Health Innovation Network (HIN) South London highlighted the scale of the burden of back pain, and the possible return on investment that can be achieved by deploying digital self-management tools. The independent report demonstrated that a cost saving of over £1.9 million for back pain alone could be achieved per area (place) of an ICS with a population of 330,000 (19) through deploying digital self-management.  Further research conducted by the HIN demonstrated that when using getUBetter, an ICS can expect a 13% reduction in GP follow-up appointments, a 50% reduction in MSK related prescribed medication, a 20% reduction in physiotherapy referrals, and 24-66% less urgent care attendances. An Somerset NHS Foundation Trust evaluation found that 50% of patients on a MSK physiotherapy waiting list no longer needed their appointment and NHS South East London ICS found that when they got there, they required 40% less appointments (24). NHS Frimley ICS reported 11% fewer sick notes, helping people back to work.

The musculoskeletal care problem in the UK is a complex one to solve and requires close collaboration with patients, clinicians, ICB leads, transformation experts, health systems, and the government to ensure the solution reflects local needs. While technology has a role as an enabler in digitising ICS-wide MSK pathways, it is not achievable without clearly defined methodologies of co-design, behaviour change and clinical transformation.

If you’d like to hear more about this approach and blueprint, please sign-up for the forthcoming webinar ‘Transforming MSK care across complex health systems with digital self-management support: Technology vs methodology’ on 26 September 2024.

By Dr Carey McCLellan, Founder and CEO of getUBetter

 

References

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