The Cochrane Library – Special collections

NEW: Exercise for musculoskeletal conditions

Musculoskeletal conditions frequently have an adverse influence on health and quality of life, and cause more functional limitations than any other group of disorders within the adult population in most developed countries. Estimates from global data indicate that one in four people will experience chronic musculoskeletal pain at some time, and that musculoskeletal conditions are the most commonly reported cause of chronic impairments in the United States. Thus, musculoskeletal conditions are considered to be an international public health issue. Exercise therapy is considered an important component of the treatment of musculoskeletal conditions with the aims of: reducing pain; improving joint stability, functional ability, quality of life and aerobic capacity; and preventing bone loss and fractures.

This special collection brings together a selection of Cochrane Reviews assessing exercise for musculoskeletal conditions including: osteoarthritis, osteoporosis and rheumatoid arthritis, ankylosing spondylitis, fibromyalgia, juvenile idiopathic arthritis; regional musculoskeletal conditions in the knee, low back, neck and shoulder; and chronic musculoskeletal pain.

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Improving access to NICE approved drugs

The lack of integrated services to improve health and well-being across the NHS and local government is a missed opportunity to create long-term savings and make a real impact on patients and local communities. As demands on the NHS increase and reforms get underway, the service will need to embrace well-being to improve health and drive savings.

That is the message from a joint report produced by the NHS Confederation and the Faculty of Public Health on wellness services and the way they are integrated across health and social care.

Wellness services take a whole-person and community approach to improving physical and mental health to improve people’s overall health and wellbeing. They include services like weight management, smoking cessation and support in accessing physical activity services. 

The joint report, From Illness to Wellness, has been published with the aim of sharing learning among health and local government commissioners and providers and encouraging new ways of shifting organisational approaches towards wellness rather than just focusing on illness.

Commenting on the report NHS Confederation deputy director of policy Jo Webber, said: “It makes sense for health and local government to look at people’s health in the round, rather than splitting the population up into people who are or are not under clinical care. We need to take this opportunity to have a good look at how we can improve the health and well-being outcomes of our communities, provide more responsive and cost-effective care, whilst reducing pressure on the NHS.”

The report says locally developed approaches which embrace innovation will provide more responsive, cost effective care. It says taking a more holistic approach to health will help organisations align care and reduce the duplication of services. However, the way services are currently planned and provided means they have not yet fully embraced the idea of integrating physical and mental health and well-being.  

Jo Webber continued: “It is increasingly irrelevant to see good health as simply the absence of disease. The evidence says we need a different concept of good health or wellness that looks at things much more holistically.

“There are some big challenges for staff in the NHS and local government in making this change and our report sets out some key thinking about how to get on and implement solutions that are key to improving health and wellbeing.”

Professor Sarah Stewart-Brown, Chair of the Faculty of Public Health’s Mental Health Committee, said: “We fully support wellness services that take a whole-person, whole community approach to improving health. Our own reports on both children’s mental health and green spaces show how wellness plays an important part in tackling a range of health and social problems like obesity, mental illness and antisocial behaviour.

“At this time of major change in public health, it is critical that local authorities, health professionals and policymakers work together to promote wellbeing and tackle health inequalities.”

As the NHS and other parts of the public sector face an unprecedented financial challenge, the report is clear that the big opportunity for new structures such as health and well-being boards is to tackle the causes of ill health at source. Wellness services can help coordinate services such as occupational health, housing, smoking cessation and mental health provision.

The report summarises the growing body of evidence to support a shift in how the NHS should view health services and provides examples of where integrated approaches are being put in place.  It also provides answers to the questions posed by the Government’s Future Forum about what the NHS can do to keep the public’s health at the heart of the NHS.

Access the report here.