Stratified Care for Musculoskeletal Conditions in Primary Care: A Prospective Sequential Cohort Study of the STarT MSK Tool and the eSELF-MSK Virtual Self-Management Program
- 1Department of Physiotherapy, Prince Sultan Military Medical City (PSMMC), Ministry of Defense Health Services, Riyadh 11159, Saudi Arabia
- 2Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
- 3Department of Family and Community Medicine, Prince Sultan Military Medical City (PSMMC), Ministry of Defense Health Services, Riyadh 11159, Saudi Arabia
Abstract
Background/Objectives: To compare changes in pain intensity, musculoskeletal health and function, and psychosocial risk between usual care and implementation of a bundled STarT MSK-guided care pathway among low-risk adults. Methods: In this non-randomized sequential cohort study, the usual-care cohort was recruited before clinician training and pathway implementation, followed by recruitment of the stratified-care cohort. Both cohorts comprised adults classified as low risk by the STarT MSK Tool. The pathway combined risk classification feedback, clinician training, one in-person physiotherapy assessment, education and exercise prescription, supported self-management, and five weekly virtual consultations. NPRS and MSK-HQ, the prespecified primary outcomes, and ÖMPQ, a prespecified secondary longitudinal outcome, were assessed at baseline, 6 weeks, and 12 weeks and analyzed using linear mixed-effects models; satisfaction was a secondary outcome assessed at 12 weeks. Results: Of 750 patients screened, 136 were enrolled: 63 in usual care and 73 in stratified care. At 12 weeks, the bundled-pathway cohort showed greater improvement than usual care in NPRS (−2.12; 95% CI, −2.95 to −1.29), MSK-HQ (+7.08; 95% CI, +3.70 to +10.47), and ÖMPQ (−27.83; 95% CI, −37.90 to −17.76). Clinically important pain reduction occurred in 68.3% versus 25.9% of participants, and 88.9% versus 51.7% reported satisfaction with care. Conclusions: Implementation of the bundled STarT MSK-guided eSELF-MSK pathway was associated with greater 12-week improvements than usual care among low-risk patients. Because the pathway combined multiple components, their independent contributions cannot be separated. The non-randomized design, unblinded participants, self-reported outcomes, and possible residual confounding preclude causal conclusions and support further randomized evaluation.
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BibTeX
@article{almuhana2026stratified,
title = {{Stratified Care for Musculoskeletal Conditions in Primary Care: A Prospective Sequential Cohort Study of the STarT MSK Tool and the eSELF-MSK Virtual Self-Management Program}},
author = {Norah AlMuhana and Dalia Alimam and Walaa Moslem and Ibraheem Alsmari and Fahad Alfarraj and Ameerah S. Alharthi and Muteb Aldosari and Abdullah Alassaf and Hamad M. Aloraini and Hana Alsobayel},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208105},
url = {https://www.mdpi.com/2077-0383/15/20/8105},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Stratified Care for Musculoskeletal Conditions in Primary Care: A Prospective Sequential Cohort Study of the STarT MSK Tool and the eSELF-MSK Virtual Self-Management Program
AU - Norah AlMuhana
AU - Dalia Alimam
AU - Walaa Moslem
AU - Ibraheem Alsmari
AU - Fahad Alfarraj
AU - Ameerah S. Alharthi
AU - Muteb Aldosari
AU - Abdullah Alassaf
AU - Hamad M. Aloraini
AU - Hana Alsobayel
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208105
UR - https://www.mdpi.com/2077-0383/15/20/8105
AB - Background/Objectives: To compare changes in pain intensity, musculoskeletal health and function, and psychosocial risk between usual care and implementation of a bundled STarT MSK-guided care pathway among low-risk adults. Methods: In this non-randomized sequential cohort study, the usual-care cohort was recruited before clinician training and pathway implementation, followed by recruitment of the stratified-care cohort. Both cohorts comprised adults classified as low risk by the STarT MSK Tool. The pathway combined risk classification feedback, clinician training, one in-person physiotherapy assessment, education and exercise prescription, supported self-management, and five weekly virtual consultations. NPRS and MSK-HQ, the prespecified primary outcomes, and ÖMPQ, a prespecified secondary longitudinal outcome, were assessed at baseline, 6 weeks, and 12 weeks and analyzed using linear mixed-effects models; satisfaction was a secondary outcome assessed at 12 weeks. Results: Of 750 patients screened, 136 were enrolled: 63 in usual care and 73 in stratified care. At 12 weeks, the bundled-pathway cohort showed greater improvement than usual care in NPRS (−2.12; 95% CI, −2.95 to −1.29), MSK-HQ (+7.08; 95% CI, +3.70 to +10.47), and ÖMPQ (−27.83; 95% CI, −37.90 to −17.76). Clinically important pain reduction occurred in 68.3% versus 25.9% of participants, and 88.9% versus 51.7% reported satisfaction with care. Conclusions: Implementation of the bundled STarT MSK-guided eSELF-MSK pathway was associated with greater 12-week improvements than usual care among low-risk patients. Because the pathway combined multiple components, their independent contributions cannot be separated. The non-randomized design, unblinded participants, self-reported outcomes, and possible residual confounding preclude causal conclusions and support further randomized evaluation.
SN - 2077-0383
ER -