International collaboration to improve MSK care in Thailand

From 23-25 September, 11 participants including nurses, haematologists and paediatricians came together in Bangkok for a musculoskeletal (MSK) care training session.  The training is part of the NNHF Thailand 2 project, which aims to improve MSK care in Thailand by establishing MSK training centres at the IHTC in Bangkok and the University of Chiang Mai Faculty of Medicine.

A collaborative approach to improving knowledge

The training reflected the collaborative nature of the project – bringing together project partners Prof Ampaiwan Chuansumrit and Dr Rungrote Natesirinilkul from Bangkok and Chiang Mai respectively, and international expert physiotherapists Pamela Hilliard from the Sick Kids Hospital in Canada and Sharon Funk from the University of Colorado, US.

Pamela and Sharon introduced participants to the FISH and HJHS evaluation tools.  Tay, who has severe haemophilia A, joined the group for the practical sessions so that participants could practice doing their own evaluations, under the guidance of Pamela and Sharon.

Dr Andre Doria and Dr Blanchette from the Sick Kids hospital in Toronto joined the session via video link, with Dr Doria presenting the benefits and challenges of different imaging methods in haemophilia assessment, and Dr Blanchette giving an overview of haemophilia outcome measures.

The importance of outcome measurement and adaptation

A number of common themes emerged throughout the sessions delivered by the international experts, starting firstly with the emphasis on the importance of outcome measurements in terms of early intervention, monitoring changes and demonstrating to decision makers the need for investment and resources.

Another theme was that of the importance of adaptation.  Firstly, Pamela and Sharon explained that whilst they both follow the same overall method when using an evaluation tool, they adapt the flow based on their personal preference and – most importantly – the individual needs and preferences of the patient.  Secondly was the importance of cultural adaptations.  Particularly relevant for FISH evaluations, this could include asking the patient to demonstrate eating with chopsticks, rather than a knife and fork..

Voluntary dedication leads to progress

Thanks to her extensive international experience, Pamela is accustomed to adapting her training content and style to suit the local situation and culture.  Through NNHF programmes alone, she has delivered training in Jamaica and Lithuania as well as Thailand. “Seeing the progress made over time in these projects is very rewarding” explains Pamela regarding her motivation to dedicate her time on a voluntary basis.  “For example, in Jamaica, their case is now better organised and we’re starting to see the difference in patients’ understanding of the importance of their joint health, and being able to access physiotherapy” she continues.


Dr Rungrote, who met Dr Blanchette and Pamela whilst undertaking haemophilia training in Toronto, will continue to collaborate with the international team in the next phase of the project, which includes participants of this training becoming master trainers in their regions.  The US and Canada experts will return to observe these new trainers in action, so that they can evaluate them and offer further tailored advice.  

In addition to these activities, the project also includes the translation and validation of MSK evaluation tools in Thai, education sessions for patients in Chiang Mai and Bangkok, and establishes a Thai version of the MSK registry developed through the NNHF Brazil 2 project.

With a wide range of MSK evaluation tools and scores available, the NNHF is supporting an MSK group of international experts for the development of a practical MSK guidance tool to facilitate the selection and application of the most relevant tool and scores to specific situation. The manuscript and tools are planned to be released In Q1 2017.


About this programme

For more information on this programme please contact us and we will refer you to the relevant project manager