Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Sep;22 Suppl 2(Suppl 2):65-70.
doi: 10.1111/papr.13142.

Low-value care in musculoskeletal health care: Is there a way forward?

Jan Hartvigsen  1   2 , Steven J Kamper  3   4 , Simon D French  5
Affiliations
Review

Low-value care in musculoskeletal health care: Is there a way forward?

Jan Hartvigsen et al. Pain Pract. 2022 Sep.

Abstract

Background: Low-value care that wastes resources and harms patients is prevalent in health systems everywhere.

Methods: As part of an invited keynote presentation at the Pain in Motion IV conference held in Maastricht, Holland, in May 2022, we reviewed evidence for low-value care in musculoskeletal conditions and discussed possible solutions.

Results: Drivers of low-value care are diverse and affect patients, clinicians, and health systems everywhere. We show that low-value care for back pian, neck pain, and osteoarthritis is prevalent in all professional groups involved in caring for people who seek care for these conditions. Implementation efforts that aim to reverse low-value care seem to work better if designed using established conceptual and theoretical frameworks.

Conclusion: Low-value care is prevalent in the care of people with musculoskeletal conditions. Reducing low-value care requires behaviour change among patients and clinicians as well as in health systems. There is evidence that behaviour change can be facilitated through good conceptual and theoretical frameworks but not convincing evidence that it changes patient outcomes.

Keywords: back pain; clinical guidelines; evidence-based practice; low-value care; osteoarthritis.

PubMed Disclaimer

Conflict of interest statement

Jan Hartvigsen declares that he is co‐developer of the GLA:D Back project, which is mentioned in this paper. He has no financial outcome from the project.

References

    1. Elshaug AG, Rosenthal MB, Lavis JN, Brownlee S, Schmidt H, Nagpal S, et al. Levers for addressing medical underuse and overuse: achieving high‐value health care. Lancet. 2017;390:191–202. - PubMed
    1. Schwartz AL, Landon BE, Elshaug AG, Chernew ME, McWilliams JM. Measuring low‐value care in Medicare. JAMA Int Med. 2014;174:1067–76. - PMC - PubMed
    1. Shrank WH, Rogstad TL, Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019;322:1501–9. - PubMed
    1. Braithwaite J, Glasziou P, Westbrook J. The three numbers you need to know about healthcare: the 60‐30‐10 challenge. BMC Med. 2020;18:102. - PMC - PubMed
    1. Razmaria AA. High‐value care. Jama. 2015;314:2462. - PubMed