048 A Consensus Group Approach to Agreeing Matched Treatment Options for Musculoskeletal Pain of Patients Stratified According to Prognostic Risk

Protheroe, Joanne; Saunders, Benjamin M.; Hill, Jonathan; Bartlam, Bernadette; Dunn, Kate M.; Foster, Nadine

Abstract

Background: This paper reports on an expert consensus exercise to agree matched treatment options for subgroups of patients based on prognostic risk of persistent disabling pain. As part of the Stratified Primary Care for Musculoskeletal Pain research programme, the consensus groups focused on the five most common musculoskeletal pain presentations in primary care: back, neck, knee, shoulder and multisite pain. Agreement was sought on the most appropriate treatment options for these pain presentations for each patient risk subgroup: low, medium and high.

Methods: Three consensus meetings were conducted with multidisciplinary groups of clinical experts, including general practitioners, physiotherapists, rheumatologists, pain specialists and orthopaedic surgeons, recruited through existing clinical and research networks (group 1: n = 19 participants; group 2: n = 16; group 3: n = 12). Each meeting focused on a specific risk subgroup, with participant expertise spread across small groups for each of the five pain presentations. Participants were given a list of evidence-based treatment options appropriate for the UK National Health Service (NHS) and asked to individually identify missing treatments. Where agreed upon by the group, these were added to the list. Participants then individually rated the appropriateness of the treatment options (on a 7-point Likert scale) for patients in the risk subgroup in question. This was followed by a plenary group discussion of treatment options for each pain presentation. All participants then individually rated the options for all pain presentations for the risk subgroup in question. Following the meetings, participants were contacted via email to consider any inconsistencies.

Results: Treatment options with a mean rating score >3.5/7 were included as recommended matched treatment options. For all five pain presentations, education and advice and simple oral and topical medications were agreed for all subgroups. For patients at low risk, across all five pain presentations review by primary care practitioner if not improving after 6 weeks was also agreed. Medium-risk treatment options slightly differed across pain presentations but all included consider referral to physiotherapy and consider referral to musculoskeletal interface clinic. High-risk treatment options again varied a little by pain site, with some similarity with medium-risk options, and additional options including opioids; consider referral to expert patient/peer support groups (across all pain presentations); consider referral for lifestyle intervention, e.g. dietician (knee) and consider referral for surgical opinion (back, knee, neck, shoulder). Consider referral to rheumatology was agreed for patients with multisite pain for medium- and high-risk subgroups.

Conclusion: Multidisciplinary clinical experts achieved consensus in identifying recommended matched treatments suitable for subgroups of primary care patients at low, medium and high risk of poor prognosis. The use of the Keele STarT MSK tool (Subgrouping for Targeted Treatment in MuSculosKeletal conditions) with these matched treatment options will be tested in a future randomized controlled trial.

Citation

Protheroe, J., Saunders, B. M., Hill, J., Bartlam, B., Dunn, K. M., & Foster, N. (2016). 048 A Consensus Group Approach to Agreeing Matched Treatment Options for Musculoskeletal Pain of Patients Stratified According to Prognostic Risk. Rheumatology, 55(S1), i80–i81. https://doi.org/10.1093/rheumatology/kew140.011

• Journal Article Type: Conference Paper
• Online Publication Date: Apr 24, 2016
• Publication Date: 2016-04
• Deposit Date: Oct 5, 2023
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 55
• Issue: S1
• Pages: i80–i81
• DOI: https://doi.org/10.1093/rheumatology/kew140.011
• Publisher URL: https://academic.oup.com/rheumatology/article/55/suppl_1/i80/1794679