Stepped care for musculoskeletal pain is ineffective: a model for utilisation of specialist physiotherapists in primary healthcare management.

ABSTRACT

Specialist physiotherapy services can fill a gap in the management of pain disorders in primary care. Fatima has persistent musculoskeletal pain, not responding to first-line guideline-based management. Despite normal radiology, specialist medical review is requested. Although waiting considerable time for the appointment (partly caused by the backlog of patients like her), Mary develops secondary mental health issues. The usual stepped-care approach is failing her. Specialist physiotherapist review is requested, providing expert-level management suggestions to address complexity in her presentation. The specialist physiotherapist works collaboratively with her treating physiotherapist to achieve positive outcomes for Fatima. Specialist physiotherapy services are an under-recognised value-added step between the GP and medical specialist. Increased utilisation of the skills and competencies of specialist physiotherapists can positively contribute to the health of Australians who suffer the burden of complex/persistent musculoskeletal pain complaints.