Stratified Care for Musculoskeletal Conditions in Primary Care: A Prospective Sequential Cohort Study of the STarT MSK Tool and the eSELF-MSK Virtual Self-Management Program

Background/Objectives: To compare changes in pain intensity, musculoskeletal health and function, and psychosocial risk between usual care and implementation of a bundled STarT MSK-guided care pathway among low-risk adults. Methods: In this non-randomized sequential cohort study, the usual-care cohort was recruited before clinician training and pathway implementation, followed by recruitment of the stratified-care cohort. Both cohorts comprised adults classified as low risk by the STarT MSK Tool. The pathway combined risk classification feedback, clinician training, one in-person physiotherapy assessment, education and exercise prescription, supported self-management, and five weekly virtual consultations. NPRS and MSK-HQ, the prespecified primary outcomes, and ÖMPQ, a prespecified secondary longitudinal outcome, were assessed at baseline, 6 weeks, and 12 weeks and analyzed using linear mixed-effects models; satisfaction was a secondary outcome assessed at 12 weeks. Results: Of 750 patients screened, 136 were enrolled: 63 in usual care and 73 in stratified care. At 12 weeks, the bundled-pathway cohort showed greater improvement than usual care in NPRS (−2.12; 95% CI, −2.95 to −1.29), MSK-HQ (+7.08; 95% CI, +3.70 to +10.47), and ÖMPQ (−27.83; 95% CI, −37.90 to −17.76). Clinically important pain reduction occurred in 68.3% versus 25.9% of participants, and 88.9% versus 51.7% reported satisfaction with care. Conclusions: Implementation of the bundled STarT MSK-guided eSELF-MSK pathway was associated with greater 12-week improvements than usual care among low-risk patients. Because the pathway combined multiple components, their independent contributions cannot be separated. The non-randomized design, unblinded participants, self-reported outcomes, and possible residual confounding preclude causal conclusions and support further randomized evaluation.