Summary of quantitative outcomes from eDelphi rounds 1 and 2. The component descriptions reflect the revisions applied after free-text data analysis from Round 1 and additions from the Phase 2 policy scoping review. Bolded scores reflect those components identified as essential by at least 80% of the panel.
| Component | Pooled panel | High-income countries panel | Low/middle-income countries panel | ||||||||||||
| Round 1 | Round 2 | Round 1 | Round 2 | Round 1 | Round 2 | ||||||||||
| Median in 1–9 NRS (IQR) | n (%) in median band 7–9 | N | N (%) ranked essential | N | Median in 1–9 NRS (IQR) | n (%) in median band 7–9 | N | N (%) ranked essential | N | Median in 1–9 NRS (IQR) | n (%) in median band 7–9 | N | N (%) ranked essential | N | |
| Pillar 1: engaging, empowering and educating citizens, communities, organisations and governments to act on MSK health | |||||||||||||||
| 1.1a: improving prevention and management of MSK health requires engagement and partnerships with citizens, patients and civil society organisations. | 9 (1) | 610 (90.6) | 674 | 391 (90.1)* | 434 | 9 (1) | 444 (89.9) | 494 | 293 (90.4)* | 324 | 9 (1) | 166 (92.2) | 180 | 98 (89.1)* | 110 |
| 1.1b: improving prevention and management of MSK health requires engagement and partnerships with industry, workplaces and employers. | 8 (2) | 582 (86.4) | 674 | 351 (80.9)* | 434 | 8 (2) | 427 (86.4) | 494 | 264 (81.5)* | 324 | 8 (2) | 155 (86.1) | 180 | 87 (79.1) | 110 |
| 1.1c: improving prevention and management of MSK health requires engagement and partnerships with third-party payers/insurers. | 7 (2) | 522 (77.4) | 674 | 281 (64.7) | 434 | 8 (2) | 393 (79.6) | 494 | 212 (65.4) | 324 | 8 (3) | 129 (71.7) | 180 | 69 (62.7) | 110 |
| 1.1d: improving prevention and management of MSK health requires engagement and partnerships with the built environment sector. | 8 (2) | 421 (62.5) | 674 | n/r | n/r | 7 (2) | 295 (59.7) | 494 | n/r | n/r | 8 (3) | 126 (70.0) | 180 | n/r | n/r |
| 1.1e: improving prevention and management of MSK health requires engagement and partnerships with schools and education facilities. | 9 (1) | 545 (80.9) | 674 | 308 (71.0) | 434 | 8 (2) | 394 (79.8) | 494 | 222 (68.5) | 324 | 8 (2) | 151 (83.9) | 180 | 86 (78.2) | 110 |
| 1.1f: improving prevention and management of MSK health requires engagement and partnerships with national and subnational governments. | 9 (1) | 592 (87.8) | 674 | 363 (83.6)* | 434 | 9 (1) | 432 (87.4) | 494 | 274 (84.6)* | 324 | 9 (1) | 160 (88.9) | 180 | 89 (80.9)* | 110 |
| 1.2: improving prevention and management of MSK health requires education across the following sectors: schools and higher education facilities; workplaces; health professionals and the community. | 9 (1) | 643 (96.4) | 667 | 398 (91.7)* | 434 | 9 (1) | 471 (96.1) | 490 | 293 (90.4)* | 324 | 9 (1) | 172 (97.2) | 177 | 105 (95.5)* | 110 |
| 1.3: improving prevention and management of MSK health requires globally relevant educational messages contextualised to local settings. | 9 (1) | 624 (93.6) | 667 | 310 (71.4) | 434 | 9 (1) | 458 (93.5) | 490 | 228 (70.4) | 324 | 9 (1) | 166 (93.8) | 177 | 82 (74.5) | 110 |
| 1.4: Use mechanisms to drive public education, including empowering people with lived experience to share stories and co-design messages; mass and social media; peer support models and engaging civil society and professional organisations. | 8 (1) | 606 (91.7) | 661 | 279 (64.3) | 434 | 8 (2) | 446 (91.8) | 486 | 213 (65.7) | 324 | 9 (1) | 160 (91.4) | 175 | 66 (60.0) | 110 |
| Pillar 2: leadership, governance and shared accountability | |||||||||||||||
| 2.1: MSK health should be explicitly integrated with broader reform efforts for non-communicable diseases (NCDs). | 9 (1) | 587 (90.9) | 646 | 297 (68.9) | 431 | 9 (1) | 435 (92.2) | 472 | 212 (66.0) | 321 | 8 (1.25) | 152 (87.4) | 174 | 85 (77.3) | 110 |
| 2.2: Universal Health Coverage essential care packages and/or insurance schemes should include prevention and management of MSK health impairment. | 9 (1) | 589 (90.3) | 652 | 314 (72.9) | 431 | 9 (1) | 430 (89.6) | 480 | 232 (72.3) | 321 | 9 (1) | 159 (92.4) | 172 | 82 (74.5) | 110 |
| 2.3: strategic global responses for MSK health should explicitly link with and support implementation of existing global and national health systems strengthening efforts. | 9 (1) | 609 (94.1) | 647 | 289 (67.1) | 431 | 9 (1) | 449 (94.1) | 477 | 212 (66.0) | 321 | 9 (1) | 160 (94.1) | 170 | 77 (70.0) | 110 |
| 2.4: global leadership from the WHO in prioritising MSK health is essential to drive a global response to the burden of MSK health impairment. | 8 (2) | 559 (88.0) | 635 | 320 (74.2) | 431 | 8 (2) | 411 (88.0) | 467 | 232 (72.3) | 321 | 9 (1.75) | 148 (88.1) | 168 | 88 (80.0)* | 110 |
| 2.5: country-level leadership is needed to prioritise MSK health impairment by national governments. | 9 (1) | 610 (95.9) | 636 | 366 (84.9)* | 431 | 9 (1) | 450 (95.7) | 470 | 275 (85.7)* | 321 | 9 (1) | 160 (96.4) | 166 | 91 (82.7)* | 110 |
| 2.6: leadership is needed from professional and civil societies and citizens that extends beyond just MSK health. | 8 (2) | 531 (83.2) | 638 | 256 (59.4) | 431 | 8 (2) | 393 (83.3) | 472 | 186 (57.9) | 321 | 8 (2) | 138 (83.1) | 166 | 70 (63.6) | 110 |
| 2.7: global and national multi-sectoral and inter-ministerial leadership is needed to prioritise action on policy and financing for MSK health. | 8 (2) | 550 (88.9) | 619 | 264 (61.3) | 431 | 8 (2) | 408 (89.9) | 454 | 198 (61.7) | 321 | 8 (2) | 142 (86.1) | 165 | 66 (60.0) | 110 |
| 2.8: global and national health and performance indicators must extend beyond mortality reduction to consider function and participation. | 9 (1) | 610 (96.2) | 634 | 368 (85.4)* | 431 | 9 (1) | 452 (96.6) | 468 | 274 (85.4)* | 321 | 9 (1) | 158 (95.2) | 166 | 94 (85.5)* | 110 |
| 2.9: a meaningful, acceptable and internationally comparable classification system is needed for MSK health. | 8 (2) | 557 (89.4) | 623 | 268 (62.2) | 431 | 8 (2) | 401 (87.6) | 458 | 193 (60.1) | 321 | 9 (1) | 156 (94.5) | 165 | 75 (68.2) | 110 |
| 2.10: legislation and regulation are needed to sustain reform efforts in health systems strengthening for NCDs, including MSK health. | 8 (2) | 535 (87.2) | 614 | 274 (63.6) | 431 | 8 (2) | 383 (85.3) | 449 | 199 (62.0) | 321 | 8 (1) | 152 (92.1) | 165 | 75 (68.2) | 110 |
| Pillar 3: financing | |||||||||||||||
| 3.1: existing healthcare financing models need to integrate health promotion and healthcare delivery for MSK health. | 8 (1) | 574 (92.7) | 619 | 344 (80.2)* | 429 | 9 (1) | 420 (92.1) | 456 | 253 (79.1) | 320 | 8 (1) | 154 (94.5) | 163 | 91 (83.5)* | 109 |
| 3.2: financing models for MSK health should accommodate flexibility for public–private partnerships, partnerships with civil society, international aid, tagged donorships and revenue-raising strategies. | 8 (2) | 480 (76.7) | 626 | 214 (49.9) | 429 | 8 (1) | 343 (74.4) | 461 | 146 (45.6) | 320 | 8 (2) | 137 (83.0) | 165 | 68 (62.4) | 109 |
| 3.3: support multinational foreign aid for MSK care in low-resource settings. | 8 (2) | 474 (75.7) | 626 | 215 (50.1) | 429 | 8 (2) | 334 (72.4) | 461 | 143 (44.7) | 320 | 9 (1) | 140 (84.8) | 165 | 72 (66.1) | 109 |
| 3.4: allocated funding, essential medicines funding and donor funding for MSK health and injury care need to be quarantined. | 8 (2) | 465 (74.6) | 623 | 178 (41.5) | 429 | 8 (2) | 323 (70.5) | 458 | 117 (36.6) | 320 | 8 (2) | 142 (86.1) | 165 | 61 (56.0) | 109 |
| 3.5: financing for MSK healthcare should cover well-defined, high-value (effective, safe, affordable) packages of care for prevention, diagnosis and management, particularly for community-based interventions. | 8 (1) | 554 (89.8) | 617 | 340 (79.3) | 429 | 9 (1) | 408 (89.5) | 456 | 262 (81.9)* | 320 | 8 (2) | 146 (90.7) | 161 | 78 (71.6) | 109 |
| 3.6: financing models should incentivise prevention and integrated interdisciplinary care for MSK health conditions. | 9 (1) | 554 (89.8) | 617 | 318 (74.1) | 429 | 9 (1) | 414 (90.8) | 456 | 243 (75.9) | 320 | 8 (2) | 140 (87.0) | 161 | 75 (68.8) | 109 |
| Pillar 4: service delivery | |||||||||||||||
| 4.1: service models for MSK conditions need to support early diagnosis and triage and management through local care pathways. | 9 (1) | 574 (93.0) | 617 | 354 (82.7)* | 428 | 9 (1) | 421 (92.3) | 456 | 261 (81.8)* | 319 | 9 (1) | 153 (95.0) | 161 | 93 (85.3)* | 109 |
| 4.2: local care pathways should support essential packages of affordable, effective and safe care for MSK health impairment, while de-adopting care that is not supported by evidence, is costly and potentially harmful. | 9 (1) | 564 (91.7) | 615 | 335 (78.3) | 428 | 9 (1) | 416 (91.6) | 454 | 247 (77.4) | 319 | 9 (1) | 148 (91.9) | 161 | 88 (80.7)* | 109 |
| 4.3: services for MSK healthcare should be integrated with service models for NCDs and services that target the broader social determinants of health. | 8 (2) | 541 (88.5) | 611 | 260 (60.7) | 428 | 8 (2) | 395 (87.8) | 450 | 188 (58.9) | 319 | 8 (1) | 146 (90.7) | 161 | 72 (66.1) | 109 |
| 4.4: evidence-based diagnostic and therapeutic practices should be prioritised in service models over approaches that are not supported by evidence, are costly and potentially harmful (low-value). | 9 (1) | 560 (92.1) | 608 | 351 (82.0)* | 428 | 9 (1) | 411 (91.9) | 447 | 256 (80.3)* | 319 | 9 (1) | 149 (92.6) | 161 | 95 (87.2)* | 109 |
| 4.5: service models for MSK conditions should support integrated, person-centred care that targets functional ability through a biopsychosocial approach. | 9 (1) | 574 (94.4) | 608 | 334 (78.0) | 428 | 9 (1) | 422 (94.4) | 447 | 249 (78.1) | 319 | 9 (1) | 152 (94.4) | 161 | 85 (78.0) | 109 |
| 4.6: service models for MSK healthcare should promote community-based interdisciplinary care. | 8 (1) | 565 (93.2) | 606 | 280 (65.4) | 428 | 9 (1) | 416 (93.3) | 446 | 204 (63.9) | 319 | 8 (1) | 149 (93.1) | 160 | 76 (69.7) | 109 |
| 4.7: MSK care should be integrated into existing community-based or regionally based service models for NCD care. | 8 (1) | 541 (89.9) | 602 | 248 (57.9) | 428 | 8 (2) | 394 (88.7) | 444 | 182 (57.1) | 319 | 9 (1) | 147 (93.0) | 158 | 66 (60.6) | 109 |
| 4.8: community-led service models for MSK healthcare should be co-designed by the community. | 8 (2) | 520 (86.5) | 601 | 189 (44.2) | 428 | 8 (2) | 379 (85.4) | 444 | 141 (44.2) | 319 | 9 (1.5) | 141 (89.8) | 157 | 48 (44.0) | 109 |
| 4.9: service models should prioritise access to health information and care to vulnerable groups. | 8 (1) | 544 (90.5) | 601 | 267 (62.4) | 428 | 8 (2) | 399 (89.9) | 444 | 190 (59.6) | 319 | 9 (1) | 145 (92.4) | 157 | 77 (70.6) | 109 |
| 4.10: primary and secondary prevention initiatives for NCDs should include MSK health. | 8 (2) | 541 (90.5) | 598 | 330 (77.1) | 428 | 8 (2) | 397 (90.0) | 441 | 242 (75.9) | 319 | 8 (2) | 144 (91.7) | 157 | 88 (80.7)* | 109 |
| 4.11: MSK-specific primary prevention initiatives should be delivered where evidence of clinical and cost-effectiveness exists. | 9 (1) | 562 (94.0) | 598 | 317 (74.1) | 428 | 9 (1) | 415 (94.1) | 441 | 235 (73.7) | 319 | 9 (1) | 147 (93.6) | 157 | 82 (75.2) | 109 |
| 4.12: national injury (sport, workplace, falls) and trauma prevention strategies and campaigns are needed. | 8 (2) | 499 (83.4) | 598 | 237 (55.4) | 428 | 8 (2) | 359 (81.4) | 441 | 164 (51.4) | 319 | 9 (2) | 140 (89.2) | 157 | 73 (67.0) | 109 |
| Pillar 5: equitable access to medicines and technologies | |||||||||||||||
| 5.1: countries need to identify, resource and provide access to essential therapeutics for priority MSK conditions. | 8 (2) | 516 (86.4) | 597 | 345 (80.8)* | 427 | 8 (2) | 371 (84.3) | 440 | 256 (80.3)* | 319 | 9 (1) | 145 (92.4) | 157 | 89 (82.4)* | 108 |
| 5.2: global and national prioritisation and management are needed in innovation of, and access to, low-cost assistive devices, technologies and interventions that support function and participation. | 8 (2) | 493 (82.6) | 597 | 288 (67.4) | 427 | 8 (2) | 353 (80.2) | 440 | 201 (63.0) | 319 | 9 (1) | 140 (89.2) | 157 | 87 (80.6)* | 108 |
| Pillar 6: workforce (building workforce capacity, systems and tools) | |||||||||||||||
| 6.1: increase the number of medical specialists and allied health practitioners for MSK healthcare in LMICs. | 8 (2) | 470 (78.9) | 596 | 275 (64.4) | 427 | 8 (2) | 337 (76.8) | 439 | 193 (60.5) | 319 | 8 (2) | 133 (84.7) | 157 | 82 (75.9) | 108 |
| 6.2: build capacity in the local existing community-based workforce to contribute to basic MSK health and injury care. | 8 (1) | 535 (89.8) | 596 | 294 (68.9) | 427 | 8 (2) | 389 (88.6) | 439 | 206 (64.6) | 319 | 9 (1) | 146 (93.0) | 157 | 88 (81.5)* | 108 |
| 6.3: establish flexible service models to enable the non-medical workforce (eg, nurses, pharmacists, allied health practitioners) to adopt advanced practice/extended scope roles that improve access to evidence-based triage, assessment and management of MSK conditions and injuries. | 9 (1) | 538 (90.4) | 595 | 289 (67.7) | 427 | 9 (1) | 396 (90.4) | 438 | 220 (69.0) | 319 | 9 (1) | 142 (90.4) | 157 | 69 (63.9) | 108 |
| 6.4: integrate MSK health into curricula across medical disciplines and increase the number of MSK medical specialist training positions in LMICs. | 8 (2) | 503 (84.7) | 594 | 317 (74.2) | 427 | 8 (2) | 360 (82.4) | 437 | 233 (73.0) | 319 | 9 (1) | 143 (91.1) | 157 | 84 (77.8) | 108 |
| 6.5: build skills-based competencies across medical, nursing and allied health disciplines (and non-clinical roles in LMICs) in the identification of MSK health problems and basic prevention and management practices. | 9 (1) | 561 (94.4) | 594 | 317 (74.2) | 427 | 9 (1) | 409 (93.6) | 437 | 236 (74.0) | 319 | 9 (1) | 152 (96.8) | 157 | 81 (75.0) | 108 |
| 6.6: extend training curricula for prelicensure medical, nursing, pharmacy and allied health clinicians in MSK health, persistent pain and injury care within a person-centred, biopsychosocial model. | 8 (2) | 525 (88.4) | 594 | 286 (67.0) | 427 | 8 (2) | 388 (88.8) | 437 | 213 (66.8) | 319 | 8 (2) | 137 (87.3) | 157 | 73 (67.6) | 108 |
| 6.7: educate healthcare workers and health planners to deliver information and care aligned to positive health behaviours for MSK health and other NCDs. | 8 (1) | 544 (91.6) | 594 | 318 (74.5) | 427 | 8 (1) | 398 (91.1) | 437 | 232 (72.7) | 319 | 9 (1) | 146 (93.0) | 157 | 86 (79.6)* | 108 |
| 6.8: increase remuneration for the health workforce in LMICs to maintain workforce volumes. | 8 (2) | 465 (78.3) | 594 | 241 (56.4) | 427 | 8 (2) | 326 (74.6) | 437 | 157 (49.2) | 319 | 9 (1) | 139 (88.5) | 157 | 84 (77.8) | 108 |
| Pillar 7: surveillance (monitoring population health) | |||||||||||||||
| 7.1: build country-level population health surveillance capacity to monitor incidence, prevalence and impact of MSK conditions. | 8 (2) | 304 (84.8) | 594 | 282 (66.0) | 427 | 8 (2) | 363 (83.1) | 437 | 206 (64.6) | 319 | 8 (2) | 141 (89.8) | 157 | 76 (70.4) | 108 |
| 7.2: include metrics on function, participation, quality of life and care experience in national health surveillance systems. | 8 (2) | 531 (89.4) | 594 | 329 (77.0) | 427 | 8 (2) | 386 (88.3) | 437 | 244 (76.5) | 319 | 9 (1) | 145 (92.4) | 157 | 85 (78.7) | 108 |
| 7.3: surveillance outcomes should be disaggregated by age, sex and gender, geography, socioeconomic status and by the International Classification of Diseases and International Classification of Functioning, Disability and Health systems. | 8 (2) | 457 (77.1) | 593 | 245 (57.4) | 427 | 8 (2) | 327 (75.0) | 436 | 178 (55.8) | 319 | 8 (2) | 130 (82.8) | 157 | 67 (62.0) | 108 |
| Pillar 8: research and innovation | |||||||||||||||
| 8.1: research priority area 1 - epidemiological and population health research: lifecourse risk factors; risk assessment tools; core outcomes for population health research. | 8 (2) | 513 (86.5) | 593 | 287 (67.4) | 426 | 8 (2) | 368 (84.4) | 436 | 203 (63.8) | 318 | 9 (1) | 145 (92.4) | 157 | 84 (77.8) | 108 |
| 8.2: research priority area 2 - public health research: public health interventions to shift health behaviours; impact of MSK health on other conditions; dynamic systems modelling to inform public health policy. | 8 (2) | 526 (88.7) | 593 | 288 (67.6) | 426 | 8 (2) | 386 (88.5) | 436 | 210 (66.0) | 318 | 9 (2) | 140 (89.2) | 157 | 78 (72.2) | 108 |
| 8.3: research priority area 3 - health policy and systems research: implementation of MSK service models across contexts; strategies to reduce health inequalities and access inequities; development of a MSK health classification system; effectiveness and acceptability of digital technologies to support MSK care and surveillance. | 8 (2) | 519 (87.5) | 593 | 272 (63.8) | 426 | 8 (2) | 379 (86.9) | 436 | 196 (61.6) | 318 | 8 (1.25) | 140 (89.2) | 157 | 76 (70.4) | 108 |
| 8.4: research priority area 4 - clinical and basic science research: mechanisms associated with MSK conditions, including persistent pain; curative therapies for MSK conditions; biomarkers, assays and diagnostic applications; and extend evidence for non-surgical and non-pharmacological interventions. | 9 (1) | 533 (89.9) | 593 | 325 (76.3) | 426 | 9 (1) | 386 (88.5) | 436 | 240 (75.5) | 318 | 9 (1) | 147 (93.6) | 157 | 85 (78.7) | 108 |
| 8.5: research priority area 5 - health economics research: cost of MSK health conditions and injuries to communities and governments; cost-effectiveness of treatments; cost-effectiveness of integrating MSK health prevention and management within broader NCD care; and return on MSK health investment for other sectors such as workforce participation. | 9 (1) | 549 (92.7) | 592 | 304 (71.4) | 426 | 9 (1) | 404 (92.7) | 436 | 226 (71.1) | 318 | 9 (1) | 145 (92.9) | 156 | 78 (72.2) | 108 |
| 8.6: research capacity priority 1- support national-level MSK health research; multinational and interdisciplinary research collaborations and lower-resource settings to undertake critical local research. | 8 (1) | 527 (89.2) | 591 | 292 (68.5) | 426 | 8 (1) | 385 (88.3) | 436 | 216 (67.9) | 318 | 9 (1) | 142 (91.6) | 155 | 76 (70.4) | 108 |
| 8.7: research capacity priority 2 - support co-design of research by people with lived experience of various MSK health conditions and clinicians. | 8 (2) | 502 (84.9) | 591 | 236 (55.4) | 426 | 8 (2) | 368 (84.4) | 436 | 177 (55.7) | 318 | 8 (2) | 134 (86.5) | 155 | 59 (54.6) | 108 |
| 8.8: increase the proportion of research funding allocated to MSK research and allocate additional funding leveraged through public–private partnerships. | 8 (1) | 523 (88.6) | 590 | 270 (63.4) | 426 | 8 (1) | 376 (86.4) | 435 | 194 (61.0) | 318 | 8 (1) | 147 (94.8) | 155 | 76 (70.4) | 108 |
| 8.9: support innovation sharing between countries and between researchers and clinicians. | 8 (2) | 524 (89.0) | 589 | 290 (68.1) | 426 | 8 (2) | 381 (87.8) | 434 | 205 (64.5) | 318 | 9 (1) | 143 (92.3) | 155 | 85 (78.7) | 108 |
| 8.10: support research that harnesses the emerging potential of digital technologies and the collection and use of 'big data' and machine learning. | 8 (2) | 500 (84.9) | 589 | 236 (55.4) | 426 | 8 (2) | 359 (82.7) | 434 | 168 (52.8) | 318 | 9 (1) | 141 (91.0) | 155 | 68 (63.0) | 108 |
*Components identified as essential by at least 80% of the panel.
IQR, inter-quartile range; LMIC(s), low- and middle-income country(ies); MSK, musculoskeletal; NCD(s), non-communicable disease(s); n/r, not rated; NRS, Numerical Rating Scale; WHO, World Health Organization.