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RightPath: a model of community-based musculoskeletal care for children

Lookup NU author(s): Dr Nicola Smith, Vicky Mercer, Dr Sharmila Jandial, Dr Tim Rapley, Emerita Professor Helen Foster

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

Objectives: Musculoskeletal (MSK) presentations are common (reported prevalence of one in eight children) and a frequent cause of consultations (6% of 7-year-olds in a cohort study from the UK). Many causes are self-limiting or raised as concerns about normal development (so-called normal variants). We aimed to describe a new model of care to identify children who might be managed in the community by paediatric physiotherapists and/or podiatrists rather than referral to hospital specialist services.Methods: Using mixed methods, we tested the feasibility, acceptability and transferability of the model in two UK sites. Evaluation included patient flow, referral times, diagnosis and feedback (using questionnaires, focus groups and interviews).Results: All general practitioner referrals for MSK presentations (in individuals <16 years of age) were triaged by nurses or allied health professionals using a triage guide; ∼25% of all MSK referrals were triaged to be managed by community-based paediatric physiotherapists/podiatrists, and most (67%) had a diagnosis of normal variants. Families reported high satisfaction, with no complaints or requests for onward specialist referral. No children re-presented to the triage service or with serious MSK pathology to hospital specialist services in the subsequent 6 months after triage. Triagers reported paediatric experience to be important in triage decision-making and case-based learning to be the preferred training format.Conclusion: The triage model is acceptable, feasible and transferable to enable appropriate care in the community for a proportion of children with MSK complaints. This is a multi-professional model of better working together between primary community and specialist providers.


Publication metadata

Author(s): Smith N, Mercer V, Firth J, Jandial S, Kinsey K, Light H, Nye A, Rapley T, Foster HE

Publication type: Article

Publication status: Published

Journal: Rheumatology Advances in Practice

Year: 2020

Volume: 4

Issue: 2

Print publication date: 16/10/2020

Online publication date: 16/10/2020

Acceptance date: 24/09/2020

Date deposited: 02/12/2020

ISSN (electronic): 2514-1775

Publisher: Oxford University Press

URL: https://doi.org/10.1093/rap/rkaa057

DOI: 10.1093/rap/rkaa057

PubMed id: PMC7661842


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