Addressing musculoskeletal rehabilitation

Key points
Countries are being asked by WHO to include rehabilitation as a core health service, which should be available to individuals of all ages with disabilities. Rehabilitation matters to older people, but its role to reduce dependency and reliance on societies’ long-term care systems is under-recognized. For clinicians and policy makers who are considering approaches to increasing the provision of rehabilitation for people with musculoskeletal (MSK) disability, a key issue is how to provide scalable effective interventions, which adhere to the International Classification of Functioning, Disability and Health(ICF) International framework within constrained resources. Approaches include: encouraging primary care to intervene early on problems such as mobility disability and frailty, promoting integrated care approaches to provide multidisciplinary care after fragility fractures, leveraging off technology to deliver rehabilitation for a lower price (e.g. following joint replacements) and paying for outcomes rather than individual treatments. Improving the access of people with MSK disability to rehabilitation involves countries redirecting health system resources beyond acute care and monitoring the quality of life and functional independence outcomes.