Primary care centre wins new funding to develop a stratified treatment model for people with musculoskeletal conditions

The Arthritis Research UK Primary Care Centre at Keele University has been awarded a £1.93 million from the Department of Health to further develop a stratified treatment model for patients with musculoskeletal problems.

The five-year National Institute for Health Research (NIHR) programme aims to create a new template for treating patients with musculoskeletal conditions in primary care, with therapy to be tailored to an individual's risk of persistent pain and disability.

Researchers at the centre  have already developed a successful model for stratifying people with low back pain, which is now being rolled out to GP surgeries across the UK.

They will now test if stratified care can be extended to a larger group of patients with common musculoskeletal problems including back pain, neck pain, shoulder pain, knee pain and pain in multiple body sites.

A variety of research methods will be used to test a set of questions that will assist in the categorisation of pain patients, identify treatment options that can be targeted to each group and test how this helps GPs and patients to agree treatment options.

The researchers will also look at how it might improve patients' outcomes and experiences and whether it is cost-effective for the NHS.

Currently, treatment decisions are generally guided by doctors making a specific diagnosis, meaning little is done to identify those patients who could be supported to self-manage and those who needs other more intensive or expensive treatments. This creates inefficiencies and variations in care quality.

NIHR Professor Nadine Foster of the primary care centre said: "Musculoskeletal problems represent the single largest group of chronic conditions for which patients consult their GPs. How to manage this enormous workload poses huge challenges for primary care services.

"Whilst many patients have mild complaints which could be self-managed with appropriate support, some have more serious or persistent problems that research has shown would benefit from treatments such as exercise programmes or pain management."

"We previously have shown it is possible to use a simple set of questions to separate people who consult their GP about back pain into three groups: those likely to get better who can be given simple advice (low risk); those with more troublesome problems who can be referred for physiotherapy (medium risk); those with more complex problems (eg significant worries about the impact of pain) who can be referred to a specially trained physiotherapist (high risk). Keele's STarT Back and IMPaCT Back studies showed that when people's back pain is treated according to the group they are in (stratified care), this leads to better pain relief and physical function, and is cheaper to deliver than usual care."

A spokesman for Arthritis Research UK said: "Our primary care centre is doing great work and is leading the way in stratifying patients into different treatment groups according to their specific needs, rather than relying on a one-size fits-all approach to treatment. We're delighted that they have been awarded NIHR funding to take this work a stage further."