Musculoskeletal pain can be debilitating. Left untreated, musculoskeletal pain leads to functional decline, independent of other health conditions, that for older adults is known to increase the risk for cognitive decline and even mortality. Common practice for addressing chronic pain?pain that is lasting more than three months?is to refer people to specialists such as rheumatologists or orthopaedic surgeons, or to obtain expensive imaging and medications. Less often are non-pharmacological interventions prescribed with a particular focus on exercise as therapy despite demonstrated effectiveness. Physical therapy-led exercise therapy holds great promise for delivering high value care for individuals with musculoskeletal pain or limitations in daily activities. The significance of the physical therapists role in caring for people with joint pain or with arthritis is heightened in low-income settings where access to specialists is limited, and greater attention to unnecessary prescribing of images and medications is needed. There is a critical need to establish new models of musculoskeletal care in low-income countries like where we will focus in Northern Tanzania because life expectancy is increasing and yet, more people are living with disability. Low back pain, for example, is the second leading cause of disability in Tanzania and the rate of disabling low back pain has increased 36% from 2007 to 2017. Research collaborations across countries can help build capacity and support translation of effective care models for improved population health. Our five year goal is to have implemented a model of care that expands access to physical therapists using text and telephone support of exercise at home in even rural and remote villages. Our proposed two-year implementation research study builds on existing partnerships to adapt and plan for scaling up an intervention we found effective with older adult Veterans in the United States. Guided by the Institute for Healthcare Improvement Framework for Going to Full Scale, we will accomplish two specific aims. (1) Explore the feasibility, reach, appropriateness, acceptability, and costs of an innovative MSK care model for Northern Tanzania compared with current practice. (2) Adapt and refine the physical therapy, text message and telephone counseling components of the model to be locally relevant and expand availability and access to care. The scalable intervention and new knowledge generated from the proposed implementation research will guide our research team to go full scale in Northern Tanzania and spread to other regions for improved population health.

Public Health Relevance

Burden from musculoskeletal disorders in Tanzania is increasing and innovative care models are needed to prevent disability and the deleterious effects of functional decline. Our implementation research will adapt and refine a non-pharmacological approach to treatment that leverages physical therapist?s expertise and mobile health strategies to increase availability and access to care. The proposed care model for Northern Tanzania and the implementation framework we will study supports full-scale implementation and future spread for improved population health from reduced disabling musculoskeletal pain.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Small Research Grants (R03)
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Special Emphasis Panel (ZAG1)
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Phillips, John
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Duke University
Schools of Medicine
United States
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