The primary goal of the RETAR is to expedite the recovery of people with musculoskeletal (MSK) pain in primary healthcare by considering individualized risk profiles in their care. We will implement a new tool (Risk of Pain Spreading, ROPS) that identifies modifiable prognostic factors for pain worsening and use this tool to construct individualized care pathways targeted at identified prognostic factors for the use by primary care physiotherapists. Individualized care pathways for medium- ja high-risk patients will include available online therapies and local paths (and guidance to a more comprehensive assessment if needed) and the care strategy will be decided together with the patient. Low-risk patients will not receive any additional care. The trial will be conducted in a pragmatic, controlled, interventional Benchmarking Controlled Trial design. Adult patients who will be visiting physiotherapists in primary healthcare due to MSK pain (pain in neck/shoulder, upper limb, lower limb, and/or back, or multisite pain) and who will fulfill the inclusion criteria but none of the exclusion criteria will formulate the study population. Data will be collected from five different Wellbeing service counties of Finland (units) with primary follow-ups at 6 and 12 months. One of the units will act as a pilot. In the trial, before groups in each unit function as a control for the intervention group in each respective unit, as the groups before and after the intervention will recruit separate patients. The intervention incorporates implementation of the ROPS and risk-based care in daily practice. Control group is treated using current approaches. Both implementation and patient-level outcomes will be evaluated, with a change in functional status and adoption and fidelity of the implementation being the primary ones. Cost-effectiveness of the new care model will be assessed and the implementation procedure will be improved based on the patients' and professionals' perspectives.

2025

2032