359: Advancing rural MSK care: Co-designing a clinical treatment pathway for improved outcomes

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Physiotherapy (e.g. exercise, rehab), Digital Health Technologies , Treatment/management

Background and Aims: People with chronic musculoskeletal (MSK) conditions in rural Australia experience approximately 25% greater disease burden than those in metropolitan areas. Geographic isolation and limited access to appropriate services contribute to inequities in care, increasing reliance on low-value, costly interventions such as unnecessary imaging, injections, opioids and surgery. Access to specialist physiotherapy remains limited outside major cities, highlighting the need for innovative service models. Telehealth offers a scalable solution by connecting rural clinicians with expert allied health (AH) support. This study co-designs implementation strategies with rural clinicians to deliver PACE-RURAL and improve equitable MSK outcomes.

Methods: Using a clinical translation framework, allied health (AH) clinicians (invited n=147; consented n=57; ineligible n=29) were engaged to co-design implementation strategies for a scalable musculoskeletal telehealth pathway across regional, rural and remote settings. Semi-structured interviews explored barriers to optimal chronic MSK care and perspectives on PACE-RURAL implementation, fostering knowledge exchange between clinicians and researchers. Emerging themes informed two co-design workshops involving clinicians, patients and organisational representatives to develop actionable strategies. This participatory approach centred rural clinician voices, strengthened professional networks across urban and non-urban regions, and supported contextually responsive implementation to improve MSK outcomes and equitable access.

Results: Using co-design principles, 41 rural clinicians (18 female, 23 male; mean age 41; 15–18 years’ experience) participated in videoconference interviews and focus groups (March–October 2025) exploring barriers to digital MSK care. Participants reviewed a risk-stratified pathway and provided feedback. Interviews were recorded, transcribed and analysed using six-phase reflexive thematic analysis. Barriers included distance, referral processes, workload, GP engagement, technology constraints and patient expectations; facilitators included improved access and clinician education. Two co-design workshops with clinicians, patients and organisational representatives developed actionable strategies, interprofessional resources and materials highlighting the value of expert AH care.

Conclusions: Education and knowledge translation emerged as central themes in strengthening MSK care pathways in rural Australia. Clinician interviews identified barriers including local culture, clinician confidence, technological limitations, time pressures, distance and complex MSK care needs. Despite these challenges, clinicians expressed strong commitment to improving rural MSK care. Co-design workshops brought together clinicians, patients and organisational representatives to develop strategies addressing identified barriers. These sessions facilitated shared learning and supported implementation of stratified care approaches that enhanced provider–patient trust. Interprofessional communication resources and collaborative practical learning opportunities strengthened rural clinician capability to support sustainable improvements in MSK service delivery (PACE-RURAL).

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Presenting Author: Jemma Mulligan
Submitting Author: Jemma Mulligan

Senior Author: Professor Trudy Rebbeck

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Professor Trudy Rebbeck - University of Sydney
• Associate Professor Kerrie Evans - University of Sydney
• Dr Tania Gardner - University of Sydney
• Dr Alla Melman - University of Sydney