Hutting N1, Johnston V2, Staal JB3, Heerkens YF1
1HAN University of Applied Sciences, Research Group Occupation & Health, Nijmegen, Netherlands, 2The University of Queensland, RECOVER Injury Research Centre, Brisbane, Australia, 3HAN University of Applied Sciences, Research Group Musculoskeletal Rehabilitation, Nijmegen, Netherlands

Background: Persistent musculoskeletal pain is a worldwide health problem resulting in negative effects on individuals' wellbeing and substantial costs to society. The most common musculoskeletal problems include osteoarthritis, rheumatoid arthritis, and spine-related neck and back problems. These conditions often have a multifactorial origin and are influenced by multifactorial risk factors including biomechanical, psychosocial, and individual factors. Recently, there has been discussion about effective treatment approaches to persistent musculoskeletal disorders(MSDs). Evidence demonstrates that many of these musculoskeletal pain conditions are often resistant to current treatments and are associated with long-term disability. A person-centered approach focusing on self-management and a healthy lifestyle as a means of restoring and maintaining functioning and optimizing participation is considered important.

Purpose: To argue that self-management strategies are essential to the management of persistent MSDs and that self-management should be the main approach to the treatment of patients with persistent MSDs.

Methods: This is a narrative review and viewpoint of the authors.

Results: There are two common sequelae for people with persistent MSDs after treatment and/or as a natural course of the disorder: 1) symptoms stabilize with some fluctuation over time, or 2) symptoms reduce and possibly even disappear. In both cases, self-management is a valuable addition to routine care, to enable people to better manage their condition. Self-management interventions aim to equip patients with skills to actively participate in and take responsibility for the management of their persistent condition in order to function optimally. With their expertise in MSDs and the duration of patient contact, physical therapists(PTs) are ideally placed to support people with persistent MSDs in their self-management. There is evidence that self-management integrated in routine healthcare with individual sessions in a clinical setting can be effective and might improve adherence. Therefore, a self-management approach can be used by one-on-one providers, including PTs, for individual patients.
PTs can provide self-management support aimed at a behavioral change, which can lead to self-management behavior and the long-term management of the disorder. Within a self-management approach, PTs can use a behavior change framework such as the ASE model (with attitude, self-efficacy, social influence, knowledge, and skills as determinants of self-management behavior) and include topics based on the patient's needs and goals. Specific methods (self-management strategies) such as goal setting, modelling, feedback, discussion, self-monitoring, guided practice and skill training, can be utilized to obtain a behavior change and to equip patients with the skills needed to actively participate in and take responsibility for the management of their condition. Practical examples and possible self-management topics that can be included in a self-management approach based on the patient's needs and goals will be provided during this session.

Conclusion(s): The authors believe that PTs should use a self-management approach to individual (physical therapy) treatment for patients with persistent MSDs whenever possible.

Implications: Within a self-management approach PTs should focus on a behavioral change and an active lifestyle. Building self-efficacy, problem-solving and decision-making are important components of this approach. PTs should use customized self-management support, targeting biomechanical, psychosocial, and individual factors in their treatment of people with persistent MSDs.

Keywords: Musculoskeletal disorders, Self-management, Pain management

Funding acknowledgements: No funding was received.

Topic: Musculoskeletal; Pain & pain management; Professional issues

Ethics approval required: No
Institution: HAN University of Applied Sciences
Ethics committee: Ethics Committee
Reason not required: This is a narrative review and expert opinion

All authors, affiliations and abstracts have been published as submitted.

Back to the listing