01 Jul BACKLOGS IN MUSCULOSKELETAL CARE DUE TO COVID-19
Musculoskeletal (MSK) conditions such as neck pain, lower back pain and arthritis are the leading causes of disability in the United Kingdom. Being a victim of this condition often means that you are unable to complete your ordinary daily activities, which has a huge societal and economic impact. These conditions are commonly treated in primary care and the specialities of trauma, orthopaedics or rheumatology.
Due to the COVID-19 pandemic, all non-emergency and elective surgeries were cancelled, in-patient admissions were minimised, and staff members were reassigned to help treat COVID-19 patients. Along with this, rheumatology and physiotherapy were also downsized to concentrate on urgent care, resulting in outpatient consultations being cancelled or being conducted virtually, either via telephonic or video calls.
Because of this restructuring of medical services, many NHS MSK patients who are on the waiting list for diagnosis, referral, treatment or surgery are struggling to complete simple daily activities or are experiencing chronic pain, depression or anxiety, because they are unable to attend face-to-face appointments.
The functional restorative services for treating arthritis, degenerative back pain and other MSK pathologies have been deferred in favour of concentrating on the immediate need to save lives during the pandemic. Due to this shift in care priorities, patients with arthritis continue to face deteriorating health circumstances, with patients only being treated when their diseases are in the advanced stages, making surgery a more complicated process. Medical professionals are urging the government to prioritise MSK patients, by establishing centres where planned elective surgery can always be delivered.
Although no national data has been analysed to show how the pandemic has affected NHS services, large volumes of rheumatology appointments or follow-ups have been cancelled due to staff redeployment, resulting in the increased backlogs and longer waiting periods for consults and treatments. This lack of access to healthcare professionals means that patients are not getting the recommended level of care on time as per the NICE guidelines. This results in unnecessary pain and disability, and ultimately the patient’s health is becoming progressively worse.
It needs to be mentioned that not all consultations or medical care was stopped due to the pandemic. General practices in the UK have provided consults during the pandemic by triaging patients for face-to-face or remote consultations based on their clinical needs. The Chair of the Royal College of General Practitioners stated that although MSK care can be provided remotely, it is necessary for face-to-face, physical examinations to be facilitated due to the nature of the condition. More patients are currently being seen in person recently due to the rollout of the vaccine.
During the pandemic, many rheumatology and MSK patients have had to manage their condition themselves. This is likely to continue as remote consultations are set to continue for all MSK care to help counteract the long waiting periods.
A musculoskeletal specialist for the Chartered Society of Physiotherapists and a Consultant at University Hospitals Sussex NSH Foundation Trust, says that there will be a high demand for physiotherapy in the upcoming months because of the surgical backlog and peripheral nerve injuries caused by Covid-19. Some patients actually prefer these remote consultations as it means they are taking less time off from work. However, neither remote nor face-to-face consultations are going to be the default, as appropriate care depends on what is crucial to the patient.
NHS’s collaboration with Best MSK Health, which launched in February this year is starting to prioritise musculoskeletal care, by emphasizing the need for appropriate care. The chief executive of ARMA advises that patients should be sent for secondary care only if necessary and that online consultations and support groups can continue to help people with chronic pain.
Oxtoby, K., 2021. Covid-19: “Life on hold” for NHS patients needing musculoskeletal care. [online] thebmj. Available at: <https://www.bmj.com/content/373/bmj.n1616> [Accessed 20 July 2021].