Editorial Comment: The Second Annual I-MESH Symposium

David Ring MD, PhD (left) and Ana-Maria Vranceanu PhD (right)

Initiated in 2020, the International Consortium for Musculoskeletal Mental and Social Health (I-MESH) is an interdisciplinary collaboration of professionals who work together to improve whole-person care for individuals with musculoskeletal illness [8]. I-MESH has ambitious priorities, both in terms of clinical care and research [7]:

1. Develop a viable business model that supports timely access to mental and social health interventions that are billable and generate revenue for the practice;

2. Coordinate and integrate specialty and nonspecialty care;

3. Curate, develop, and integrate reliable and valuable mental and social health measures into daily care;

4. Develop, test, and implement feasible interventions to support mental and social health;

5. Ensure healthy equity in patient interactions, access to care, and interventions; and

6. Improve patient-clinician communication and relationships.

We appreciate the enthusiasm of Clinical Orthopaedics and Related Research® in forming this collaboration with I-MESH, publishing our first [4] and now our second annual proceedings from I-MESH symposia. This year’s CORR/I-MESH selected proceedings share exciting findings about how patients’ musculoskeletal symptoms may be influenced by mental and social health factors, as well as by cultural variations in the experience and expression of these factors. Articles in this section of this month’s CORR also share practical suggestions about how surgeons can build effective relationships with their patients that consider those factors, and develop communication strategies that help people gain the benefits of addressing mental and social health before undergoing surgery. We hope this helps you and your patients and inspires you to contribute to this growing body of research.

While all the papers in this month’s selected I-MESH proceedings deserve a deep dive, we’ll highlight the practical messages gleaned from just a few here. Effective patient-clinician relationships are one key to comprehensive, whole-person care. In this symposium, you will find evidence that shows how communication effectiveness during patient encounters is not correlated with patient ratings [3]. You will see how surgeons can be trained to identify unhelpful thinking and feelings of distress in their patients [2], and how noticing these aspects of illness does not, on average, harm the relationship [6]. Combined, these papers force us to rethink how we incorporate evaluation and treatment of mental health in musculoskeletal specialty care. In particular, we need to make sure we don’t anchor on the handful of encounters that don’t go well—they are the exceptions.

In the social health realm, a study of over 9000 patients receiving care for musculoskeletal trauma found that general health measures are associated with social determinants of health, including lack of transportation, trouble paying for medication, and specific types of insurance [1]. An analysis of people presenting for knee arthritis care had similar findings, including food insecurity, housing instability, utility needs, and interpersonal safety [5]. This line of evidence emphasizes how social health and mental health are two factors associated with variation in symptom intensity, and are potential targets for intervention. We hope this preview encourages you to settle back and enjoy this thought-provoking set of papers.

As we write this editorial introducing the second annual CORR/I-MESH selected proceedings, we are in the process of reviewing abstracts for the third annual I-MESH Virtual Symposium. We are excited to have received about 50 submissions from eight countries, and look forward to even broader participation in the selected proceedings of I-MESH 3 in CORR next year. With efforts like these, we can achieve our mission of implementing equitable, timely access to whole-person care through diagnoses and treatments that account for mental and social determinants of health. In combination with effective palliative and disease-modifying treatments of musculoskeletal pathophysiology, these efforts can help promote both good treatment and thoughtful accommodation of musculoskeletal symptoms and impairment.

If you are interested in joining our group, please inquire about our next bimonthly meeting at www.I-MESH.org. All are welcome. We welcome abstracts for potential presentation at the symposium at the beginning of each year, with the symposium occurring virtually in March. The call for submissions for the selected proceedings in CORR comes out immediately after the annual symposium meeting at www.I-MESH.org.