{"id":9831,"date":"2021-07-02T07:00:09","date_gmt":"2021-07-02T06:00:09","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=9831"},"modified":"2021-07-02T07:02:57","modified_gmt":"2021-07-02T06:02:57","slug":"proposing-a-dream-approach-to-musculoskeletal-medicine","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2021\/07\/02\/proposing-a-dream-approach-to-musculoskeletal-medicine\/","title":{"rendered":"Proposing a #DREAM approach to musculoskeletal medicine"},"content":{"rendered":"

A proposed holistic and interdisciplinary model of care<\/i><\/strong><\/p>\n

When it comes to musculoskeletal (MSK) injuries, most clinicians will be familiar with the acronyms <\/span>\u2018RICE<\/span><\/a>, <\/span>POLICE<\/span><\/a> and even <\/span>PEACE & LOVE(1)<\/span><\/a>\u2019, but how does knowing that help in the grander rehabilitation process? Whilst they may provide a structure for the acute management of MSK injuries, they are extremely limited in providing a blueprint that considers the broader and more holistic elements that affect patients\u2019 recovery<\/span>. From our own clinical and educational experiences, and in revising for various formal MSK qualifications from a range of sources, we found that each book\/website\/clinician has a different approach to MSK medicine, and they are often specific to the background and training of the author\/practitioner. As a result, these approaches can often overlook potentially key factors that influence patients\u2019 outcomes(<\/span>2,4)<\/span>. Whilst each of us have our own specialist skills and scope-of-practice, we propose a holistic an<\/span>d multi-disciplinary model that all clinicians can use to guide their approach to MSK complaints, one that can be tailored to anyone, from sedentary patients to elite athletes.<\/span><\/p>\n

What is the #DREAM approach?<\/b><\/p>\n

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Figure 1: Summary Infographic<\/figcaption><\/figure>\n

As outlined in Figure 1, #DREAM refers to an acronym that encapsulates some of the key domains that clinicians should consider when seeing a patient with an MSK injury. Each injury will \u2018have\u2019 its own specific \u2018#DREAM\u2019, which in practice would be informed by scientific evidence, the experience of the practitioner and a multitude of patient-specific factors. The purpose of this blog is not to delve into the evidence behind individual components (<\/span>e.g. the evidence supporting certain<\/span><\/i> rehabilitation protocols<\/span><\/i>) or to provide a guide to a certain pathology, but to provide a practical blueprint and a list of factors for practitioners to consider.\u00a0<\/span><\/p>\n

D: Diagnosis<\/b><\/span><\/p>\n

In all cases, a thorough history and clinical examination should take place, cognisant of red-flags or significant pathology. Other factors that should be routinely considered include:<\/span><\/p>\n