Clinical recommendations for chronic musculoskeletal pain in South African primary health care

Background: Chronic musculoskeletal pain (CMSP) is prevalent globally and places a significant burden on individuals, healthcare systems and economies. Contextually appropriate clinical practice guidelines (CPGs) on CMSP are advocated to translate evidence into practice. Aim: This study aimed to investigate the applicability and feasibility of evidence-based CPG recommendations for adults with CMSP in the primary health care (PHC) sector of South Africa (SA). Setting: The PHC sector in South Africa (SA). Methods: Consensus methodology was used, comprising two online Delphi rounds and a consensus meeting. A multidisciplinary panel of local healthcare professionals involved in CMSP management was purposefully sampled and invited to participate. The first Delphi survey considered 43 recommendations. In the consensus meeting, the results of the first Delphi round were discussed. The second Delphi round reconsidered the recommendations with no consensus. Results: Seventeen experts participated in the first Delphi round, 13 in the consensus meeting and 14 in the second Delphi round. In Delphi round two, 40 recommendations were endorsed, three were not endorsed and an additional recommendation was added. Conclusion: A multidisciplinary panel endorsed 41 multimodal clinical recommendations as applicable and feasible for the PHC of adults with CMSP, in SA. Although certain recommendations were endorsed, they may not be readily implementable in SA because of context factors. Contribution: The study forms the basis of a model of care for contextually relevant PHC of CMSP. Future research should explore factors that could influence the uptake of the recommendations into practice to optimise chronic pain care in SA.