Interprofessional Lifestyle Medicine Program Recommended for Musculoskeletal Conditions

Abby L. Cheng, MD

Investigators reported on the feasibility of an intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions and concluded that physiatrists were well-suited to lead interprofessional teamed aimed at assistant patients in making significant lifestyle changes.

Such changes would lead to the achievements of personalized function- and health-related goals, investigators suggested.

Abby L. Cheng, MD, Departments of Orthopedic Surgery and Neurology, Division of Physical Medicine and Rehabilitation Washington University in St. Louis School of Medicine, and fellow investigators assessed the feasibility of this proposed program to treat patients with chronic painful musculoskeletal conditions and coexisting lifestyle-related chronic diseases.

The Methods

The prospective, observational feasibility study was conducted at 1 single tertiary care university setting, where an enrollment process occurred between November 6, 2018, to January 13, 2020. Data extraction was updated through January 2021.

Patients were recruited via email, printed bulletins, and direct patient referrals. A total of 26 patients were enrolled in the program, with a majority (69%) being female patients with a mean age of 59 years.

Eligible musculoskeletal conditions included peripheral joint osteoarthritis and spine conditions such as radiculopathy, spondylosis, spinal stenosis, and/or myofascial pain.

Lifestyle-related chronic medical conditions such as obesity, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, and history of stroke were also eligible.

Diagnostic evaluations and standard-of-care treatment for musculoskeletal and lifestyle-related chronic medical conditions were completed by all eligible patients prior to program enrollment.

Investigators defined the overall goal of the intensive lifestyle medicine program was to improve patients’ chronic, medical, psychiatric, and/or physical conditions that would result in better management of spine/joint conditions.

The initial examination period involved a comprehensive history of each patient’s condition. Program utilization metrics included the number of days a patient spent in the program, the number of services received, visits completed, and whether the patient’s intake goal was achieved.

Bi-monthly interprofessional team conferences were held to discuss patients successes and barriers to change, as well as ensuring providers facilitated lifestyle changes utilizing consistent communication with the patient, and decisions to advance or alter the patient’s care pathway through the program and education across disciplines.

The Findings

The investigators reported that the common lifestyle related comorbidities of program patients were obesity (24/26, 92%), cardiovascular disease (21/26, 80%), and diabetes (7/26, 26%).

Out of the 26 eligible patients, 21 (81%) completed the program. Those who completed the program used an average of 26.2 visits over an average of 191 days.

In addition to their visits with the program physiatrist, 24/26 (92%) worked with the psychologist, 24/26 (92%) of the patients participated in nutrition counseling, 24/26 (92%) engaged in physical therapy, 24/26 (92%) received acupuncture, and 19/26 (73%) received massage therapy.

Of the 21 patients completing the program, 13 (62%) met their personal end-of-program goal (10/16, 62%), and 6/8 (75%) patients who entered the program to optimize their health in order to qualify for an elective joint replacement surgery or spine surgery met their goal and qualified for surgery by the end of the program.

To the knowledge of Cheng and colleagues, their study was the first description of an intensive lifestyle medicine program developed specifically for patients with painful musculoskeletal disorders and comorbid lifestyle-related chronic illnesses.

They added that further research was warranted, but that the proposed changes that could develop from this program were feasible.

“With additional lifestyle medicine training, physiatrists are in a unique position to lead interprofessional lifestyle medicine teams to coordinate patient-specific, goal-directed care,” the team wrote. “More research is needed to determine the efficacy and synergistic benefit of a lifestyle medicine approach for management of both musculoskeletal conditions and lifestyle- related chronic disease”

The study, “Feasibility of an intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions in the setting of lifestyle-related chronic disease,” was published online in