The Evolving Landscape of Musculoskeletal Physiotherapy: Preparing for a Complex Future
It was during a recent MSc lecture that a moment of realisation swept through my mind. Our shoulder specialist lecturer, with over two decades of clinical experience mentioned, "I've noticed a significant change in my practice," she shared. "My patients aren't just presenting with isolated shoulder conditions anymore—they're coming in with concurrent mental health conditions, ADHD, and increasingly complex health backgrounds."
Her observation resonated with my own clinical experiences. Reflecting back on my patient caseload from the past year in the public system, I noticed a clear pattern emerging. The once "straightforward" musculoskeletal cases have become increasingly rare, replaced by complex presentations intertwined with multiple health conditions, varying levels of health literacy, and diverse sociocultural backgrounds. Piqued by curiosity, I went and researched a little bit further. What I found was surprising but worrying.
The numbers paint a compelling picture. According to the Global Burden of Disease Study, musculoskeletal conditions remain the leading contributor to years lived with disability in the UK, affecting around 18.8 million people. However, what's particularly noteworthy is that approximately 40% of these individuals live with at least one other long-term condition.
This complexity is further emphasised by recent research from the Health Foundation (2023), which indicates that one in four adults in England now lives with two or more chronic conditions—a figure projected to rise to one in three by 2035. These aren't just statistics; they represent a fundamental shift in the patient population we serve.
Understanding the Multi-Dimensional Challenge
The evolution of our patient demographic can be attributed to several factors:
Ageing Population
The Office for National Statistics projects that by 2042, one in four people in the UK will be aged 65 or over. This demographic shift brings unique challenges, as research by Barnett et al. (2021) shows that 65% of people aged 65-84 have at least two chronic conditions, rising to 82% in those aged 85 and over.
Mental Health Crisis
The relationship between musculoskeletal conditions and mental health is particularly striking. The Arthritis and Musculoskeletal Alliance's report reveals that individuals with chronic musculoskeletal conditions are:
Systemic Lifestyle Challenges
We're witnessing unprecedented rates of lifestyle-related conditions:
The Access Paradox: A Growing Concern
Perhaps the most concerning aspect of this evolution is those with the greatest health needs often have the least access to healthcare services. Recent studies by the King's Fund highlight several barriers:
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Adapting to Change
Research by Foster et al. (2023) suggests that traditional biomechanical approaches alone may be insufficient for our evolving patient population. The biopsychosocial model offers a more comprehensive framework, considering psychological and social factors (more on that in the next episode). However, recognising the need for change is merely the first step.
Our traditional service models require significant modernisation, including (but not limited to):
I can see that the need for musculoskeletal physiotherapy is transforming. Our patients are more complex, their needs more diverse, and their challenges more multifaceted than ever before. As healthcare professionals, I think we should adapt our practices, expand our skills, and advocate for systemic changes that better serve our evolving patient population.
I also don’t think it’s just about adding new techniques to our clinical toolbox – it's about fundamentally rethinking how we deliver care in an increasingly complex healthcare landscape.
See you next time
Justin
References
Arthritis and Musculoskeletal Alliance (ARMA) (2023) 'Musculoskeletal Conditions and Mental Health Report'
Barnett, K., et al. (2021) 'Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study', The Lancet, 380(9836), pp. 37-43.
Diabetes UK (2023) 'Facts & Figures', https://www.diabetes.org.uk/professionals/position-statements-reports/statistics
Foster, N.E., et al. (2023) 'Stratified approaches to the management of musculoskeletal pain', Best Practice & Research Clinical Rheumatology, 37(2), pp. 101-115.
Global Burden of Disease Study (2023) 'Global, regional, and national burden of musculoskeletal disorders, 1990–2022: a systematic analysis for the Global Burden of Disease Study 2022', The Lancet, 396(10258), pp. 1312-1336.
Health Foundation (2023) 'Health and care for an ageing population', Available at: https://www.health.org.uk/publications/reports/health-and-care-for-an-ageing-population
Health Survey for England (2022) 'Health Survey for England 2022', NHS Digital. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2022
King's Fund (2023) 'Understanding pressures in general practice', Available at: https://www.kingsfund.org.uk/publications/pressures-in-general-practice
Office for National Statistics (2023) 'National population projections: 2022-based interim', Available at: https://www.ons.gov.uk/releases/nationalpopulationprojections2022basedinterim
BSc (Hons) Physiotherapy, MCSP, HCPC.
1 个月Completely agree. My only question is how to change this for the better? Especially when the factors seem to be external e.g. political, social, economical. Health & wellbeing for all is a topic close to my heart. Partly due to my own struggles when needing help. Larger part due to the suffering I've witnessed others go through; from family & friends, to patients & the general public. It can be especially painful thinking about friends who've committed suicide, overdosed on drugs or the homeless that I've worked with in the past as a volunteer. Also heartbreaking working with NHS patients who had little to nothing to fall back on socially or economically. It also seems to be getting worse in our increasingly individualistic, fast-paced, productivity & consumer obsessed societies. While this maybe disheartening, it's nice to know it's becoming more of a topic of discussion. It definitely needs attention. It's particularly cool to see this discussed by a fellow MSK physiotherapist I follow on LinkedIn, so thank you for sharing. I hope things get better for all of us, sooner rather than later ??