None listed
Conditions
Brief summary
PACE-RURAL introduces a novel, risk-based pathway designed to ensure that people with musculoskeletal conditions receive appropriate care which matches their needs. PACE-RURAL is about getting the right care to people at the right time. For example, people with reasonably straightforward presentations who should recover well are supported through a musculoskeletal e-hub featuring guideline-based resources and simple exercise programs, enabling effective self-management. Those at greater risk of persistent pain or disability will be referred to expert musculoskeletal clinicians (e.g., specialist physiotherapists) for a comprehensive assessment. Depending on their needs, care may involve shared management with primary healthcare providers (using telehealth when appropriate), specialist-led care, or referrals for services such as psychology or surgical opinions.
Interventions
The PACE-RURAL pathway comprises 3 steps.
1. Prognostic risk stratification. The patient’s score from the Short-Form Örebro Musculoskeletal Pain Screening Questionnaire (SF-ÖMPQ) will be used to stratify the patient into low risk (good outcome, scores <50/100) and high risk (poor outcome, =50/100). This will be completed online via REDCap as part of the baseline questionnaire.
2. Low risk pathway. Participants at low risk will be reassured by their treating primary clinician that they have a g
The PACE-RURAL pathway comprises 3 steps. 1. Prognostic risk stratification. The patient’s score from the Short-Form Örebro Musculoskeletal Pain Screening Questionnaire (SF-ÖMPQ) will be used to stratify the patient into low risk (good outcome, scores <50/100) and high risk (poor outcome, =50/100). This will be completed online via REDCap as part of the baseline questionnaire. 2. Low risk pathway. Participants at low risk will be reassured by their treating primary clinician that they have a good prognosis and are likely to do well with minimal management supported by their clinician and a high-quality e-resource www.mypainhub.com). 3. High risk pathway. Participants at high risk of poor outcome will be referred to an allied health specialist by their treating primary clinician, who will undertake a telehealth (or in-person if preferred) consultation with the participant and their rural clinician in attendance (whenever possible). The examination will be tailored to the individual’s presentation and may include assessment of physical impairments, co-morbidities, pain features, cognitive and affective factors, social and lifestyle considerations, and patients’ values and preferences. Following this, the clinician team will collaboratively determine further care pathways with the patient. Further care will depend on the individual’s risk factors and impairments and may involve further consultations with the specialist or interdisciplinary virtual care when required (e.g., 1-3 sessions with psychologists, dieticians or medical specialists as indicated). Specialist consultations will be approximately 1 hour duration. Each participant will be followed up for 12 months. Duration of clinical care will be determined collaboratively with the patient participant and their primary clinician. Adherence to the intervention will be evaluated by clinical audit at 6 months post implementation. Clusters are eligible to participate if considered regional, rural, or remote (Modified Monash Model). Accordingly, our eight participating clusters are determined according to Australian regions and are: Cluster 1: Far North Queensland and Cluster 2: Central Queensland will transition to implementation phase in July 2026. Cluster 3: Far North NSW and Cluster 4: Mid North Coast NSW will transition to implementation phase in September 2025. Cluster 5: South East Victoria and Cluster 6: South West Victoria will transition to implementation phase in April 2026. Cluster 7: South West WA and Cluster 8: Midwest WA will transition to implementation phase in January 2026.
Sponsors
University of Sydney
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patient participants are eligible to be included in the study if they have one of the musculoskeletal conditions listed below and present for care to a primary HCP working within the cluster. Patient participants are required to have been experiencing symptoms for >3 months and receiving care for no longer than 4 weeks for the current episode of symptoms. 1) International Classification of Diseases-Version 11 classifications for spinal musculoskeletal pain (low back pain and cervical spine pain; ME84), pain arising from the lower limb joints and soft tissue (ME82, FB 56.4), or chronic primary MSK pain (MG30). 2) Grade I-III whiplash associated disorder (WAD) as classified by the Quebec Task Force Classification of Grades of WAD. 3) Knee or hip joint pain: activity-related joint pain, with either no morning joint-related stiffness or morning stiffness lasting 18 years, and proficient in written and spoken English. Clinician participants: Rural clinicians in clusters will be eligible to participate if they are clinicians who regularly manage people with chronic MSK conditions (e.g., physiotherapists, GPs, chiropractors, osteopaths), work within the participating public health services or primary clinics in the cluster and are registered with the Australian Health Practitioner Regulation Agency (Ahpra). Allied Health Specialist participants are defined in this study as “a health care professional with expertise in the management of complex MSK conditions”. Allied health specialists will be most commonly physiotherapists, but can also include psychologists, chiropractors and medical practitioners. Specialist physiotherapists are those that fulfil one of the following: i) completed fellowship with a professional college in MSK, pain or sports sub-speciality (e.g., Fellow of the Australian College of Physiotherapists); ii) have been independently appointed to a government regulator or insurer to perform peer reviews for people with complex MSK conditions; iii) have a higher degree (PhD) in the field and still practise clinically; or iv) appointed as a clinical specialist in a public hospital (e.g., Level 6 physiotherapist).
Exclusion criteria
Exclusion criteria for patient participants: known or suspected serious spinal pathology (e.g., metastatic disease of the spine), confirmed fracture or dislocation at time of injury (WAD IV), or extreme depression defined as at risk of self-harm. Patients with osteoarthritis will be excluded if they have undergone or are scheduled for joint replacement surgery for the joint for which they are seeking care.
Outcome results
None listed