Integrated care for chronic musculoskeletal (MSK) disorders is promising but incomplete: a scoping review of MSK service delivery approaches across systems
This scoping review of 97 studies reveals that while integrated care for chronic musculoskeletal disorders is promising and implemented through six key themes, its current application remains fragmented with insufficient whole-system integration, limited caregiver involvement, and a need for broader evaluation frameworks.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Chronic pain in the muscles, bones, and joints is a heavy burden that affects millions of people worldwide. Conditions like persistent back pain, arthritis, and fibromyalgia do not just cause physical discomfort; they can disrupt a person's ability to work, sleep, and connect with others. For decades, the standard way to treat these long-term issues has often been fragmented. A patient might see a family doctor for a prescription, wait weeks to see a specialist, and then be referred to a physical therapist, with little communication happening between these different providers. This "siloed" approach often leaves patients feeling lost in the system, waiting too long for help, and receiving care that addresses only one piece of a much larger puzzle.
To fix this, health experts have been exploring a concept called integrated care. This approach tries to weave together the various services a patient needs into a single, coordinated experience. Instead of jumping from one disconnected office to another, the goal is to have a team of different professionals—doctors, therapists, and social workers—working together around the patient's specific needs. While this idea has shown promise for other chronic illnesses, it has been less clear how well it works for musculoskeletal disorders, or if the different ways of putting it together actually help people feel better.
A team of researchers set out to map the current landscape of this approach. They conducted a wide-ranging review of existing studies to see how integrated care is actually being built and tested for adults with chronic muscle and joint pain. They looked at nearly seven thousand research papers, eventually selecting ninety-seven that met their strict criteria. These papers came from many different countries, though the majority originated from North America and Europe, with very few from Africa, the Middle East, or Latin America. By examining these studies, the researchers wanted to understand what "integrated care" actually looks like in practice, who is involved in delivering it, and what results are being measured.
The review revealed that there is no single, universal recipe for integrated care. Instead, the researchers found six distinct ways that programs are being organized. The most common approach involves bringing together a team of different health professionals to work collaboratively. Another frequent model focuses on creating a clear, step-by-step pathway that guides a patient smoothly from one stage of treatment to the next. Some programs integrate mental health and social support directly into physical care, recognizing that pain is influenced by emotions and life circumstances. Others rely heavily on technology, using digital tools like telehealth apps to connect patients with providers. A few models focus specifically on helping people return to work, while others are driven by financial incentives designed to make care more cost-effective.
Despite this variety, the researchers noticed a pattern in who is doing the work. The teams are most often led by family doctors and physical therapists, who appear in about two-thirds of the studies. Specialists, such as orthopedic surgeons or rheumatologists, are also frequently involved. However, other crucial roles are often missing. Care coordinators, who help patients navigate the complex health system, and social workers, who address housing or financial struggles, appear in only a small fraction of the programs. Even more striking is the absence of family members and caregivers. Although these individuals play a vital role in supporting patients at home, they were mentioned in only five percent of the studies. This suggests that while the medical teams are trying to work together, the care often stops at the clinic door and does not fully extend into the patient's daily life.
The way these services are connected also varies significantly. Most of the programs reviewed focused on "horizontal" integration, meaning they coordinated care among different providers within the same level of the health system, such as various specialists in a hospital or different therapists in a community clinic. Very few studies described "vertical" or "whole-system" integration, which would link hospitals with community services, housing agencies, and employers to address the broader factors that influence health. The researchers found that while many programs successfully coordinated referrals and shared information, they rarely achieved a fully unified system where funding, governance, and delivery were completely merged.
When it came to measuring success, the studies mostly looked at how patients felt physically. Pain levels, physical function, and quality of life were the most common outcomes tracked. While these are important, the researchers noted that fewer studies looked at the broader picture, such as how much the programs cost, how well the system worked as a whole, or how satisfied the providers were with the new models. Only one study explicitly used a framework that includes provider well-being and health equity alongside patient outcomes. The review also highlighted that while digital tools are becoming more common, fully virtual care models were still rare in the literature, with only three studies describing a completely virtual approach.
The researchers identified several hurdles that make it difficult to build these integrated systems. At the organizational level, clinics often struggle with limited time, heavy workloads, and rigid administrative rules that resist change. At the policy level, different parts of the health system often operate under conflicting rules or funding structures that discourage collaboration. On the other hand, the most successful programs tended to have strong leadership, clear communication protocols, and supportive technology. When teams shared a common vision and worked together effectively, the care tended to flow more smoothly for patients.
Ultimately, the review suggests that while the idea of integrated care is powerful and widely discussed, its application for chronic muscle and joint pain remains uneven. The current models are often good at bringing medical professionals together, but they frequently fall short of connecting with the social world where patients live and work. The researchers conclude that for integrated care to truly transform the experience of chronic pain, it must move beyond just coordinating doctors and therapists. It needs to embrace a whole-system approach that includes families, communities, and social services, ensuring that the support a person receives is as comprehensive as the challenges they face.
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