Introduction
Integrated care is a comprehensive approach to health services that aims to deliver coordinated, patient-centered care across preventive, curative, and palliative domains. Defined by the World Health Organization (WHO), this model prioritizes continuity, collaboration, and accessibility to enhance health outcomes and equity.
Integrated health care, as defined by the WHO, involves coordinating and delivering a comprehensive range of health services to address the diverse needs of individuals and communities. This approach ensures care is accessible, efficient, and patient-centered by integrating preventive, curative, and palliative services. With a focus on continuity of care and collaboration among various health sectors, integrated health care aims to improve health outcomes, enhance patient experiences, and optimize resource use. It also emphasizes the importance of community involvement and strengthening health systems to reduce health disparities and promote equity.
Chronic Musculoskeletal Pain and Coexisting Conditions
People with chronic musculoskeletal pain often live with other chronic health conditions, such as cardiovascular disease, diabetes, or mental health disorders.1 However, they face additional barriers within the health care system. Clinical practice guidelines for musculoskeletal pain rarely recommend integrated care approaches for these coexisting chronic conditions.2
The Connection Between Musculoskeletal Pain and Other Chronic Conditions
Musculoskeletal conditions can contribute to developing other chronic health conditions and vice versa. Research has identified associations between musculoskeletal pain and various chronic health conditions.3,4 For example, a meta-analysis of over 2 million people demonstrated that individuals with osteoarthritis have a 17% increased risk of developing cardiovascular disease later in life.4 Both musculoskeletal and chronic health conditions often share common causal factors, such as lifestyle choices, including tobacco use, excessive alcohol consumption, physical inactivity, and poor eating habits, which contribute to the onset and progression of these conditions.
Enhancing Clinician Expertise for Comprehensive Care
Traditionally, healthcare and professional education have focused on diagnosing and treating diseases in isolation. Without incorporating care for chronic health conditions into typical clinical scenarios, treatment for musculoskeletal pain may fall short of addressing patients' broader health issues. Training models rarely include integrated care concepts or how to communicate the complexity of healthcare needs to patients. Clinicians focused on musculoskeletal conditions may lack the skills or confidence to manage other chronic diseases and their risk factors. To address this gap, clinicians and researchers must collaborate to develop and test new ways of targeting lifestyle risk factors through behavioural changes in clinical settings. Current clinical training often emphasizes managing isolated diseases, limiting clinicians' ability to recognize and treat musculoskeletal pain alongside other conditions. Coordinated care between clinicians from different disciplines across service sectors and communities is essential to improving the patient journey.5 While integrated care can be challenging to achieve due to the complexities of the current healthcare system, it is crucial for improving patient outcomes. Clinicians and researchers should work within these constraints to enhance the patient journey and promote interprofessional collaboration and connections with other services.
Summary
Chronic musculoskeletal pain often coexists with other chronic health conditions, such as cardiovascular disease, diabetes, and mental health disorders, creating additional challenges within the healthcare system. Despite evidence linking musculoskeletal pain with other chronic conditions, integrated care approaches are seldom incorporated into clinical practice guidelines for these coexisting issues. Musculoskeletal conditions can both contribute to and be affected by other chronic diseases influenced by shared lifestyle risk factors like tobacco use, poor diet, and physical inactivity. To address these challenges, there is a need for enhanced clinician expertise and training that includes integrated care concepts. This involves promoting interprofessional collaboration and addressing lifestyle risk factors to improve patient care and outcomes.
Key Words: chronic pain, musculoskeletal, integrated care
References
- Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380:37-43. /doi:10.1016/ S0140-6736(12)60240-2
- 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. Br J Sports Med. 2020;54:79-86. doi:10.1136/bjsports-2018-099878
- Suri P, Boyko EJ, Rundell SD, Smith NL, Goldberg J. Do medical conditions predispose to the development of chronic back pain? A longitudinal co-twin control study of middle-aged males with 11-year follow-up. BMC Musculoskelet Disord. 2018;19:362. doi:/10.1186/ s12891-018-2282-5.
- Williams A, Kamper SJ, Wiggers JH, et al. Musculoskeletal conditions may increase the risk of chronic disease: a systematic review and meta-analysis of cohort studies. BMC Med. 2018;16:167. doi:10.1186/ s12916-018-1151-2
- Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2017;6:CD000072. doi:10.1002/14651858.CD000072.pub3
The authors declare no competing interests.
Author Bios
Utkarsha Kawathekar, PT, MPT is a dedicated and compassionate Musculoskeletal Physiotherapist working as an Assistant Professor with a profound commitment to helping individuals suffering from chronic pain. With a deep-rooted interest in patient well-being, she tirelessly works to improve the lives of her patients through a combination of clinical expertise, evidence-based practice, research, and holistic care. Rinkle Malani, PT, PhD is a Professor and Director of MGM School of physiotherapy. She is highly experienced with 14 years of expertise in the field of pain management. She has consistently advanced innovative approaches to alleviate chronic pain and improve patient quality of life. Her passion for research and clinical excellence has made her a respected figure in pain management, with a commitment to enhancing patient care.