Preventing Disability from MSK Pain in Northern Tanzania

摘要 肌肉骨骼疼痛可能会使人虚弱。如果不治疗，肌肉骨骼疼痛会导致功能衰退， 与其他健康状况无关，已知对老年人来说，这会增加认知能力下降的风险 甚至死亡。治疗慢性疼痛的常见做法-持续三年以上的疼痛 几个月-是将人们推荐给风湿科医生或整形外科医生等专家，或获得 昂贵的成像和药物治疗。较少使用非药物干预药物 尽管已证明有效，但仍特别重视将运动作为治疗方法。理疗为主导的运动 治疗有望为患有肌肉骨骼疼痛的个人提供高价值的护理 日常活动的限制。理疗师在护理关节疼痛患者中的作用 或关节炎在低收入环境中加重，那里找专家的机会有限，而且更多 需要注意不必要的图像和药物处方。迫切需要建立 低收入国家肌肉骨骼护理的新模式，比如我们将重点放在坦桑尼亚北部 因为预期寿命在增加，然而，越来越多的人生活在残疾之中。腰背痛，对于 例如，腰痛是坦桑尼亚第二大致残原因，致残下腰痛的比率 从2007年到2017年增长了36%。跨国家的研究合作可以帮助建设能力和 支持转化有效的护理模式，以改善人口健康。我们的五年目标是 实施了一种护理模式，通过短信和电话支持扩大与物理治疗师的联系 即使是在农村和偏远的村庄，也要在家里锻炼身体。我们建议的为期两年的实施研究 建立在现有合作伙伴关系的基础上，以适应和计划扩大我们发现对老年人有效的干预措施 美国的成年退伍军人。由卫生保健研究所指导的GOO改进框架 我们将全面实现两个具体目标。(一)探索可行性、可达性、适当性、 与当前相比，坦桑尼亚北部创新的MSK护理模式的可接受性和成本 练习一下。(2)调整和完善物理治疗、短信和电话咨询组件 模式要与当地相关，并扩大护理的可得性和可及性。可扩展的干预和新功能 建议的实施研究产生的知识将指导我们的研究团队全面展开 在坦桑尼亚北部，并传播到其他地区，以改善人口健康。

Abstract 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.