Table 3 Guiding principles for a global MSK strategy

Adaptability: global guidance and recommendations must be adaptable to local cultural, political and economic contexts.

A strategy for implementation in every country is neither possible nor appropriate. Goals or actions within a global MSK strategy need to be broad and adaptable to the local context to take account of beliefs, cultural sensitivities and economic contexts that are unique to each country.

“… but different countries are going to have unique issues that are going to be really hard to address with a global strategy, but the global strategy I think can encompass enough that there’s flexibility for each of those individual regions or countries, or regions within countries.” (ID7)

“You can’t have a “global” education program. It has to be context-specific. In the USA we might be busy saying to people, “Look, from an education point of view, this is what we need to do to allow you to be able to go to the tennis club” but from a low income point of view, “This is what we need to be able to do so that you can walk to go and get your water” and in the middle income to walk and go and get your shopping, get your necessities for the day or to be able to work and earn money for your family. So, it’s those kinds of context-specific things that we need to think about.” (ID25)

Inclusiveness through co-design: global guidance and recommendations must be co-designed through consultation across economies, intentionally including people with lived experience of MSK health impairment and vulnerable populations.

Components of a strategy should be underpinned by robust consultation and co-design approaches to ensure representation and meaningful engagement and inclusiveness across economies (in particular, not dominated by perspectives of high-income settings) and intentionally include people with lived experience and vulnerbale or marginalised groups.

This approach should also and enable local implementation strategies to be devised to suit the local context and population needs.

“I think that really being intentional about who creates that, because things tend to be very Western dominated, very wealthy country, kind of, dominated, very white dominated, all of those things, and patients and community members can be excluded from the creation of those things. I think it misses a lot when those groups aren’t involved in the creation of it because they’re the ones that are then supposed to live it out, but they didn’t have any say in the process.” (ID8)

“... so there needs to be an enormous amount of consultation to ensure that whatever is developed is going to be useful in local settings.” (ID12)

Reduce disability to improve function, quality of life and overall health.

A key focus should be on enabling participation and function of people and communities across the lifecourse by preventing and reducing the disability burden associated with MSK health impairment(s), thereby improving quality of life and overall health.

For older people in particular, this means improving locomotor capacity (mobility) as a component of intrinsic capacity to improve functional ability.

“I think our ultimate goal should be reduced burden of musculoskeletal disorders in the global community in terms of incidence and prevalence, disability reduction, achievement of remission and relative freedom from adverse effects of drugs, improved quality of life and, ultimately, abolition of the disease.” (ID5)

“People want to stay at home, they don’t want to be in residential care facilities, so what how can we create an environment that an older person’s mobility is the key goal? Because if mobility was a key goal then pain would be addressed, as would impairment.” (ID23)

Adopt a lifecourse approach to prevention and management.

Improve MSK health outcomes across the lifecourse, with an emphasis on prevention. This is critical in acknowledgement of the impact of MSK health impairment on children’s development and function and the importance of MSK health in intrinsic capacity in older people.

“I think the goals for prevention would be to maximise musculoskeletal health and the goals for management would be to minimise the burden and maximise function and participation as much as is reasonably possible. I also think it really does need to have a lifecourse approach, because we know that a lot of these problems track from the second decade of life into adult life and that the exposures are often cumulative over a long period of time, as I think is the burden over time.” (ID21)

“… educate people that actually play [for children] is important for your long-term health. People kind of know that but they’re not thinking about musculoskeletal, they’re thinking about heart disease and diabetes.” (ID6)

Equity and value-based care: prioritise equitable and early access to the right MSK health care and de-adopt low-value care.

Prioritise equitable and early access to the right MSK and pain care (i.e. care that is safe, effective, affordable and acceptable to patients) and de-adopt low-value care options. For LMICs and some high-income countries, this will require improving access to vulnerable groups to reduce equity gaps. Here, low-value care refers to care that is not supported by evidence, is not cost effective and has the potential for harm, or the risk of harm exceeds probable benefit [50].

“I think the priority has to be equitable access to care and is critical in management strategies and, again, I understand that in low- and middle-income countries health equity is a massive, massive issue. With so many parts of the world that don’t have any access to health services at all, musculoskeletal will come even further down the list probably than it would have been before, but we need to prioritise equitable access to care.” (ID7)

“So, I think for the global community and particularly at a high level, there is a need to better reinforce evidence-based treatments that are culturally adapted....” (ID4)