Collaborative solutions in rehabilitation: Tackling MSK and brain injury comorbidities

Approximately 2.41 billion individuals globally are affected by conditions requiring rehabilitation (Cieza et al., 2020), with musculoskeletal (MSK) rehabilitation constituting for nearly two-thirds of this.

MSK disorders are notably widespread, impacting approximately 14.9 million individuals in the UK (Vos et al., 2015).

Also, MSK patients represent one of the largest groups waiting for outpatient appointments within the National Health Service (NHS) (Joesph et al., 2014).

The need for MSK rehabilitation is not a new problem, with the World Health Organization (WHO) having coined the period from 2000 to 2010 as the “bone and joint decade,” reflecting the critical need to research and invest in this area (Woolf & Pfleger, 2003).

In individuals with brain injuries, the prevalence of MSK disorders is notably higher (Cieza et al., 2020), with 79 per cent of traumatic brain injury (TBI) patients having reported MSK complaints (Brown et al., 2011).

As 10 per cent of the NHS budget is devoted to acquired brain injury (Menon et al., 2018), this is a major consideration.

In response to these challenges, FLX Health developed an at-home solution, designed to reduce reliance on physiotherapy appointments, where patients may experience wait times of up to 132 days (Equipsme, 2019).

This initiative is expected to alleviate pressure on healthcare systems by decreasing the prevalence of MSK disorders and their associated impacts on disability (Ma et al., 2014).

This illustrates the potential of the FLX application to address the longstanding challenges in the healthcare sector and how rehabilitation needs innovative advancements to address public need.

MSK disorders can significantly diminish an affected individuals’ quality of life through experienced pain, limiting social engagement, and hindering their earning potential (Liseth Hansen et al., 2023; Hancock et al., 2024; Li et al., 2024).

Among various MSK disorders, lower back pain stands out as the most common, reported as the leading health condition necessitating rehabilitation in 134 of 204 countries (Cieza et al., 2020).

Due to often ambiguous underlying causes, diagnosing lower back pain can be complicated, making it harder to treat (Hartvigsen et al., 2018).

This health condition is only likely to rise due to an ageing population, where lower back pain remains a common reason for early retirement, resulting in further economic implications.

This at-home solution for MSK health issues restores natural movement patterns that may be affected by modern lifestyles.

With 31.3 per cent of the global population not meeting the advised physical activity guidelines, promoting movement through applications like FLX could mitigate the associated risks, such as non-communicable diseases, poor physical and cognitive function, mental ill health and weight gain (Strain et al., 2024).

Moreover, evidence suggests that increased exercise frequency correlates with reduced recurrence of back pain, reinforcing the importance of physical activity in managing MSK disorders and the need for applications like FLX to facilitate healthy ageing (Hancock et al., 2024).

The co-morbidity of MSK injury and brain injury presents unique challenges, as those with brain injuries experience more bodily pain and diminished health status compared to the general population (Galea et al., 2019; Brown et al., 2011).

Various hypotheses explore the neurological mechanisms linking brain injury to MSK disorders, including unresolved neuromuscular impairments (McCann et al., 2022), sensorimotor deficits (Edwards et al., 2022) and changes in motor cortex function (Dubose et al., 2017), all of which necessitate the need for additional investigation.

Therefore, FLX Heath and Kompass launched a project, supported by an NIHR FAST i4i grant to investigate the use of the FLX app within a brain injury population.

It sought to explore the feasibility of enhancing movement within this population, leveraging the combined expertise of the two companies.

This project demonstrated the benefit of technological interventions, with the FLX app providing an at-home solution for MSK issues, and Kompass developing an Outcome Measures Wizard to track the range of metrics that were tracked over the course of the study.

MSK disorders represent a heterogeneous group of disorders, necessitating the use of various outcome measures (OMs) to assess the efficacy of treatment (Woolf et al., 2010).

Also, when assessing the varying extents of a Traumatic Brain Injury (TBI), various OMs have been identified for use (Shulka et al., 2011).

In addition to this, the level of disability due to brain injury can be assessed in numerous ways such as physical measures, mood measures, social measures, and many more.

However, quantitative analysis of MSK and brain injury has lacked significantly (Zhuang et al., 2022), the need for a technological intervention to track the range of quantitative outcome measures is apparent.

The Outcome Measures Wizard fulfilled this perfectly and within the trial of the FLX application within a brain injury population, a range of outcome measures including EQ5D scores and mood measures were successfully tracked.

This demonstrates the utility of technology, firstly in providing the intervention and also in measuring its impact.

Conclusion

Technological development in MSK and brain injury is necessary to improve rehabilitative interventions and to track quantitative outcome measures.

This is pertinent considering the need and effect of rehabilitation in these two areas.

The collaboration between FLX Health and Kompass is testament to the success of interdisciplinary collaboration, demonstrating technological progress through the outcomes of their partnership.

Article Credit

Charlotte Naylor, Research Assistant- Kompass

Sarah Lake, Research Assistant- Kompass

FLX Health- Rob Lewis and Martin Haines

Kompass- Dr Penny Trayner

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