Abstract
Introduction/Background: In Singapore, musculoskeletal conditions have a high burden of disease contributing to 26% of the YLD. Early physiotherapy has been shown to be successful in the management of musculoskeletal conditions and avoidance of surgery. However, majority of these patients are seen in the tertiary hospitals, even though they do not require surgery and can be managed earlier in primary care and/or community-based settings.
Approach: The Ministry of Health's National One-Rehabilitation Framework introduced in 2019 provides a common coding and classification system to guide rehabilitation journeys. A cluster workgroup was convened to address the challenges faced in the unequal allocation and availability of resources for the provision of musculoskeletal physiotherapy services within the Central-North of Singapore. To increase agency for change, the workgroup members were physiotherapists from the diverse primary, tertiary and community settings.
The workgroup conducted extensive patient and clinician interviews to identify gaps within a patient journey and the network of service providers. One key finding was the training gaps of physiotherapists in the primary care and community-based settings. A systems-level change was needed to shift musculoskeletal care to the primary care and/or community-based settings so that patients can receive earlier physiotherapy. There needs to be capability building of their physiotherapy workforce, which would then build capacity.
Solution: The workgroup curated the Musculoskeletal Skill Up (MUSKUP) tiered programme which consisted of joint-specific modules delivered through virtual learning and physical workshops. Tiers 1 and 2 training were tailored to upskill fresh graduates and experienced physiotherapists respectively, to address knowledge and skills gaps so that they can manage musculoskeletal patients in their settings. Patients can then receive timely care and reduce the possibility of developing chronicity of their musculoskeletal conditions. Tier 3 training used the Train-the-Trainer concept by honing the facilitation and coaching skills of experienced physiotherapists so that they can become MUSKUP trainers. This ensures scalability and sustainability within their respective Centres and beyond.
Results: The first run of MUSKUP commenced in May 2023 and will conclude in March 2024. There was high involvement and engagement from all members as they actively participated as assistant Trainers for the workshop. On completion of the first run, all primary care institutions in the Central-North region and 5 major Day Rehabilitation Centres would have at least one MUSKUP graduand. Through word-of-mouth, MUSKUP has also garnered interest from community service providers of other healthcare clusters. This would further pave the way for new alliances and cross-settings collaborations.
Learning Points and Next Steps: A ground-up enabled approach, with partnership from stakeholders across a network of service providers, are crucial in shifting service models to address a national burden. An investment in capability building to expand capacity is one approach to shift the resources across the spectrum of care.
A harmonized tool such as the National One-Rehabilitation framework can drive the model of care and service delivery. The next steps will focus on upstream preventive care and patient empowerment through harmonized patient education materials and the adoption of digital solutions for self-triage of musculoskeletal conditions.