Improving Musculoskeletal Care for Active-Duty Service Members through Primary Care Provider Education and Holistic Self-Guided Rehabilitative Care

Addressing musculoskeletal injuries (MSKI) early in primary care settings is essential; however, many DoD primary care clinicians receive limited education and training on how to properly assess and treat MSKI. Currently, these gaps in primary care provider training can lead to an overutilization of advanced imaging and specialist referral that do not improve MSKI clinical outcomes and come at significant cost to DoD. Addressing this knowledge gap through targeted evidence-based musculoskeletal education for primary care providers can not only reduce costs associated with over imaging and unnecessary referral, but also has the potential to improve access to specialty care by preserving referrals for patients with complex cases.

Evidence-based courses of treatment for common MSKI typically include prescribed physical therapy, but many military treatment facilities are not adequately staffed to handle the volume of referrals. This can lead to long delays before care commences, or significant increases in costs for care that is referred out into the community. Additionally, existing barriers, such as geography, time/employment responsibilities, or other health-related concerns, may further act as deterrents to ADSM seeking in-person care for MSKI. Review of civilian models of MSKI care show that many of these conditions can be effectively self-managed through structured home exercise programs that use targeted exercises to improve mobility, strength, and endurance of surrounding musculature. Additionally, evidence from Veterans Health Administration’s Whole Health System, a model of care that integrates peer support, complementary and integrative health modalities, well-being activities, and whole heath clinical care, indicates that patients benefit from working one-on-one with dedicated health coaches, and may also be of benefit to ADSM. Health coaches who assist patients with incorporating holistic and complementary treatment strategies into their typical course of traditional care, and are performed at home, could accelerate and enhance treatment of MSKI, alleviate some of the burden currently placed on specialists, and free up appointment time for complex cases. Effective solutions are needed both for patients and providers to address the burden of MSKI across the spectrum of ADSM care.

The proposed project aims to 1) improve the ADSM and Veteran patient experience by providing them with MSK-trained primary care providers who will have enhanced MSKI knowledge, assessment techniques, skills, and abilities; and 2) through the delivery of a convenient virtual self-care rehabilitation management program coordinated through dedicated health coaches. Additionally, this project aims to improve ADSM access to health care by delivering a virtually accessible self-care rehabilitation management program coordinated through dedicated health coaches. The Platform will allow ADSM to perform their prescribed self-care rehabilitation from the comfort of their own home or on the go, with limited exercise equipment, at a time that best fits their work and home-life schedules.