Janet Prvu Bettger, ScD MS, FAHA | Duke University; Mathew John Shayo, MS PT | Kilimanjaro Christian Medical Center; Adam P. Goode, PT, DPT, Ph.D. | Duke University; Blandina T. Mmbaga, MD, MMed, Ph.D. | Kilimanjaro Christian Medical Center/Kilimanjaro Clinical Research Institute
Competition Sponsor: National Institute on Aging, National Institutes of Health
Awardee Year: 2020
Musculoskeletal pain can be debilitating. Left untreated, musculoskeletal pain leads to functional decline, independent of other health conditions, that for older adults is known to increase the risk for cognitive decline and even mortality. Over-the-counter pain medication or seeing a physician who requests expensive imaging or prescription medicine are common for addressing chronic pain and restricted mobility. Less often prescribed are non-pharmacological interventions using exercise as therapy despite demonstrated effectiveness. Physical therapist-led exercise therapy is guideline recommended for individuals with MSK pain or limitations in daily activities. However, availability and access to physical therapists in low- and middle-income countries (LMICs) is limited. Given the rise in mobile phone ownership in LMICs, there is tremendous opportunity to leverage mobile health (mHealth) technology for MSK care delivery. The need for accessible MSK care in Tanzania is critical: low back pain is the second leading cause of disability, yet there are 0.4 physical therapists per 100,000 Tanzanians. Building from an established research and training collaboration, our five-year goal is to have implemented a model of care that expands access to physical therapists using mHealth support of exercise at home in even rural and remote villages. Our proposed two-year implementation research study will adapt and plan for scaling up an intervention we found effective with older adult Veterans in the United States. Guided by the Institute for Healthcare Improvement Framework for Going to Full Scale, we will accomplish two specific aims. (1) Explore the feasibility, reach, appropriateness, acceptability, and costs of an innovative MSK care model for Northern Tanzania compared with current practice. (2) Adapt and refine the physical therapy, text message and telephone counseling components of the model to be locally relevant and expand availability and access to care. This project is innovative as it shifts the current approach to addressing chronic MSK pain to a non-pharmacological approach leveraging mhealth to expand access to evidence-based care. The proposed research is significant because of its potential to build health system capacity and reduce the costly burden of MSK pain in Tanzania and other LMICs. The scalable intervention and new knowledge generated from the proposed R03 implementation research will guide our team to continue to work in partnership with the Ministry of Health to go full scale in Northern Tanzania and spread to other regions for improved population health.
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