Patient acceptance of care of a novel care pathway for those at risk of poor outcomes from musculoskeletal pain: A mixed methods study

Beales, Darren; Boyle, Eileen; Fary, Robyn; Mikhailov, Anton; Saunders, Benjamin; Coates, Sonia; Evans, Kerrie; Simic, Milena; Sterling, Michele; Bennell, Kim; Rebbeck, Trudy

Abstract

Objective
Investigate people's acceptance of specialist musculoskeletal care within a new care pathway for common musculoskeletal conditions (low back pain, neck pain/whiplash, knee osteoarthritis).

Design
Convergent parallel mixed methods design referencing the Theoretical Framework of Acceptability. The study included a subset of participants (n = 29) at-risk of poor outcomes from the intervention arm of the PAthway of CarE for common musculoskeletal conditions (PACE-MSK) trial. In the PACE-MSK arm, participants received specialist physiotherapist care as an adjunct to the care provided by their primary healthcare professional(s). One-to-one semi-structured interviews were conducted around 3-months after commencing in the trial. Quantitative data were collected at baseline and 3-month follow-up (health-related quality of life, pain self-efficacy, global perceived change, satisfaction).

Results
Five themes were identified (Expectations and beliefs shaped patient experience; Clinical expertise and competence influence acceptance; Person-centred care; Mechanisms facilitating beneficial responses to care; Gaps in care pathway implementation). There were positive individual changes in physical quality of life for 17/29 (59%) participants, mental health quality of life for 12/29 (41%), pain self-efficacy for 8/29 (28%) and global perceived change for 19/29 (66%). Management met expectations with the majority reporting high levels of satisfaction. Integrating the qualitative and quantitative data with the Theoretical Framework of Acceptability, there were complementary meta-inferences in the constructs of ‘ethicality’, ‘intervention coherence’, ‘self-efficacy’ and ‘affective attitude’. Divergence was identified in ‘perceived effectiveness’.

Discussion
In general, there was positive acceptance of the care pathway by participants. Specialist physiotherapists’ care was perceived as a positive addition to usual care.

Citation

Beales, D., Boyle, E., Fary, R., Mikhailov, A., Saunders, B., Coates, S., Evans, K., Simic, M., Sterling, M., Bennell, K., & Rebbeck, T. (in press). Patient acceptance of care of a novel care pathway for those at risk of poor outcomes from musculoskeletal pain: A mixed methods study. Musculoskeletal Science and Practice, 74, Article 103178. https://doi.org/10.1016/j.msksp.2024.103178

• Journal Article Type: Article
• Acceptance Date: Sep 5, 2024
• Online Publication Date: Sep 12, 2024
• Deposit Date: Sep 23, 2024
• Journal: Musculoskeletal Science and Practice
• Print ISSN: 2468-7812
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 74
• Article Number: 103178
• DOI: https://doi.org/10.1016/j.msksp.2024.103178
• Public URL: https://keele-repository.worktribe.com/output/923452
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S246878122400273X?via%3Dihub