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Conference Agenda

Overview and details of the sessions of this conference. Please select a date or location to show only sessions at that day or location. Please select a single session for detailed view (with abstracts and downloads if available).

Daily Overview

Session

Import to your local calendar

GR1_1_3: Symposium: Health-Enhancing Physical Activity as a Cornerstone of Musculoskeletal Care: From Primary Prevention to Stratified Pain Management

Time:

Tuesday, 08/Sept/2026:

3:10pm - 4:20pm

Location: Glass room 1

Presentations

Health-Enhancing Physical Activity as a Cornerstone of Musculoskeletal Care: From Primary Prevention to Stratified Pain Management

Chair(s): Alan Kacin (Faculty of Health Science, Ljubljana, Slovenia)

Background and Aim of the Symposium
This symposium presents research evaluating interventions across the full continuum of musculoskeletal disorder (MSKD) care—from prevention and early management to interdisciplinary chronic pain treatment—implemented within the Slovenian primary healthcare system.

Presentation 1:
Around 22% of adults in Slovenia live with chronic pain, creating a substantial health and economic burden. The MiSkBol project introduces integrated primary care pathways based on the biopsychosocial model, promoting patient stratification, education, and health-enhancing physical activity to improve outcomes and reduce disease burden.

Presentation 2:
This presentation introduces a 150-minute multidisciplinary educational intervention for the working-age population focusing on musculoskeletal health, physical activity, ergonomics, pain self-management, and mental health. Preliminary results from 685 participants show significant improvements in health literacy and high satisfaction.

Presentation 3:
The third presentation examines the implementation of stratified care for acute low back pain using the STarT Back screening tool. Risk-based management improved pain and disability outcomes while optimizing healthcare resources by reducing unnecessary treatment sessions for low-risk patients.

Presentation 4:
This presentation reports outcomes of a 12-week multicomponent exercise program implemented across different clinical pathways. The greatest functional improvements were observed when exercise was used as a first-line intervention or as follow-up after acute physiotherapy.

Presentation 5:
The final presentation describes a 12-week interdisciplinary chronic pain management program combining physiotherapy and psychotherapy, which resulted in improved functional capacity, reduced fatigue, and lower perceived disability.

Added Value
The symposium offers a practice-focused view on MSKD care, integrating prevention, stratified treatment, exercise, and interdisciplinary chronic pain management within primary healthcare, showing how coordinated biopsychosocial approaches enhance patient outcomes and system efficiency.

Conclusion and Key Take-Home Messages
The symposium highlights the role of prevention, health-promoting physical activity, and risk-stratified care in musculoskeletal health, showing how exercise-based and interdisciplinary approaches in primary care enhance patient outcomes and reduce long-term disease burden..

Funding:
The project “Modernisation of the Management of Musculoskeletal Pain at the Primary Care Level” is being implemented within the framework of the EU Recovery and Resilience Plan, with the support of the Ministry of Health, Republic of Slovenia.

Presentations of the Symposium

Musculoskeletal disorders as a public health challenge in Europe and Slovenia: Prevalence, care pathways and opportunities for health-enhancing physical activity in healthcare

Suzana Pustivšek¹; Manica Remec²; Alan Kacin³; Matej Voglar⁴; Maja Dakskobler²; Furlan Andraž²; Maja Petrič³; Saša Bole⁵
1: National institute of public healh, Slovenia; 2: National institute of public health, Slovenia; 3: Faculty of Health Science, Ljubljana, Slovenia; 4: Faculty of Health Sciences, Izola, Slovenia; 5: University rehabilitation institute Republic of Slovenia

Introduction
Musculoskeletal disorders (MSKD) are a major global public health burden, affecting 1.71 billion people and representing the leading cause of years lived with disability worldwide. In Slovenia, chronic pain affects 22% of adults, most commonly due to back and joint pain. The economic burden of musculoskeletal and connective tissue diseases is estimated at €287 million annually, accounting approximately 0.5% of the national GDP.

Methods
This narrative review synthesizes international clinical guidelines, systematic reviews, and national Slovenian health reports to describe the burden of MSKD and current care pathways.

Discussion
The biopsychosocial model is recognized as the most effective framework for MSKD management. Evidence-based practice emphasizes individualized, supervised multidimensional exercise interventions, combined with structured patient education and self-management strategies. In Slovenia, general practitioners serve as the primary entry point to care; however, long waiting times delay treatment initiation and increase the risk of pain chronification and disability. Primary care also lacks preventive interventions, standardized clinical pathways, and patient expectations for passive treatments often conflict with evidence-based recommendations for active participation. To address these challenges and rising MSKD-related costs , Slovenia has launched the MiSkBol project, piloting integrated care pathways for acute low back pain, chronic widespread MSK pain and preventive approaches within primary healthcare centres, with a focus on Health Promotion Centres.

Conclusion
The MiSkBol project introduces patient stratification, triage, and empowerment strategies to improve access and clinical outcomes. Implementing preventive intervention and health-enhancing physical activity into MSKD care pathways is essential to reduce disease burden and optimize healthcare delivery.

EFFECTIVENESS OF PREVENTIVE INTERVENTION IN PROMOTING PHYSICAL ACTIVITY AND MUSCULOSKELETAL HEALTH AT THE PRIMARY LEVEL OF PUBLIC HEALTHCARE IN SLOVENIA

Manica Remec¹; Maja Petrič²
1: National institute of public health, Slovenia; 2: Faculty of Health Science, Ljubljana, Slovenia

Background and Aim of the Study:

Based on the biopsychosocial model of health and the 24-hour movement behaviour paradigm, a primary prevention intervention was developed. Its main objective is to raise awareness and empower adults to adopt an active lifestyle and promote musculoskeletal and mental health.

Methods:

The intervention targets the working-age population. It consists of a single 150-minute session, including three thematic modules delivered by a physiotherapist (musculoskeletal health), a kinesiologist (health-enhancing physical activity), and a psychologist (mental health). It is implemented within the Health Promotion Centre programme. Participants completed pre- and post-intervention questionnaires reporting demographic characteristics, initial knowledge, achievement of immediate cognitive and affective objectives, and overall satisfaction with the intervention. Non-parametric tests were used for statistical analysis.

Results:

A total of 685 participants were included in the pilot study. Preliminary results indicate a statistically significant (p < 0.001) improvement in most knowledge indicators, with moderate to very large effect sizes (r = 0.30–0.80). The evaluation items indicated high levels of participant satisfaction (92.3–98.0%) with the intervention.

Conclusions:

Within the Slovenian primary healthcare system, this intervention represents a novel approach that addresses the goals of health-enhancing physical activity and contributes to improved health and physical literacy among adults.

Support/Funding source:

The project “Modernisation of the Management of Musculoskeletal Pain at the Primary Care Level (MiSk-Bol)” is being implemented within the framework of the EU Recovery and Resilience Plan, with the support of the Ministry of Health of the Republic of Slovenia.

THE EFFECT OF STRATIFIED PHYSIOTHERAPY MANAGEMENT OF PATIENTS WITH ACUTE LOW BACK PAIN AT THE PRIMARY LEVEL OF PUBLIC HEALTHCARE IN SLOVENIA

Alan Kacin¹; Matej Voglar²
1: Faculty of Health Science, Ljubljana, Slovenia; 2: Faculty of Health Sciences, Izola, Slovenia

Background and Aim: Evidence indicates that early physiotherapy for low back pain (LBP) is more effective, shorter, and more cost-efficient when patients are stratified according to baseline risk for chronicity. This preliminary evaluation of the therapeutic effectiveness of implementing stratified management for acute LBP at the primary healthcare level in Slovenia.

Methods: Patients with acute LBP were stratified by general practitioner using clinical examination, pain assessment, and the STarT Back screening questionnaire into a low-risk group with low- to moderate-intensity non-specific LBP (LRC-PT; n = 126) or a higher-risk group with high-intensity non-specific or specific LBP (HRC-PT; n = 247). The LRC-PT group received physiotherapy counselling and self-management education, while the HRC-PT group underwent individual outpatient physiotherapy. Matched low- and high-risk control groups (LRC-ctrl; n = 47; HRC-ctrl; n = 47) received no physiotherapy. Pain intensity evaluated by Short Pain Inventory and Oswestry Disability Index (ODI) were assessed at baseline and follow-up. Changes were analysed using non-parametric tests.

Results: Baseline characteristics did not differ significantly between intervention and control groups. All groups showed reductions in pain intensity; however, improvements were significantly greater in both physiotherapy groups compared with controls (p ≤ 0.004). A similar pattern was observed for ODI scores (p < 0.001). The LRC-PT group required significantly fewer sessions than the HRC-PT group (3.8 ± 0.4 vs 6.3 ± 1.5; p < 0.001).

Conclusions: Stratified management of acute LBP at the primary care level significantly improves pain and disability outcomes while reducing physiotherapy utilisation.

Functional outcomes after a 12-week chronic pain management program

Saša Bole
University rehabilitation institute Republic of Slovenia

Background:

A structured 12-week chronic pain management program, combining regular physiotherapy and psychotherapy sessions was implemented in six Slovenian primary healthcare centers with the aim to update and improve the management of chronic musculoskeletal pain at the primary care level by integrating an interdisciplinary biopsychosocial approach and strengthening professional competencies.

Methods:

Functional test results were compared at baseline and after completion of the 12-week program using a paired-samples t-test. The preliminary analysis included 42 patients from five primary healthcare centers who completed the program. Outcome measures included functional performance tests (30-second chair stand test, sit and reach, handgrip strength, forward bend test, single-leg stand, 6-minute walk test) and self-reported fatigue and perceived exertion.

Results:

The findings demonstrate improvements in physical performance and overall self-assessment. Statistically significant improvements were observed in the 30-second chair stand test, 6-minute walk test and perceived fatigue levels, indicating enhanced functional capacity and reduced disability.

Conclusion:

The results support the feasibility and effectiveness of implementing an interdisciplinary biopsychosocial chronic pain program within the primary healthcare setting. The program appears to improve functional outcomes, decrease perceived disability and fatigue, and empower patients toward more active engagement in managing chronic pain. Further follow-up is needed to evaluate long-term sustainability of these improvements.

Exercise programme for people with musculoskeletal pain - a continuation of physiotherapy treatment or as a standalone intervention

Suzana Pustivšek; Maja Dakskobler; Andraž Furlan
National institute of public health, Slovenia

Introduction:
Optimizing exercise sequencing within clinical pathways for musculoskeletal pain is essential to maximize clinical and public health impact. This pragmatic study evaluated the effectiveness of a 12-week multicomponent exercise program implemented in Slovenian primary care across 3 different pathways.

Methods:
A pragmatic pre–post intervention study included 132 participants (mean age 54.32 ± 8.7 years). Participants followed three pathways: (1) exercise as a first-line intervention (n = 63), (2) exercise following a chronic pain management program (n = 12), and (3) exercise following acute low back pain physiotherapy (n = 31). Outcomes included the Oswestry Disability Index (ODI) and functional performance tests (Timed Up and Go, Sit-and-Reach, 30-second Chair Stand, 6-minute Walk Test, single-leg stand and handgrip). Within-group changes were analysed using repeated-measures and non-parametric tests.

Results:
Significant ODI improvements were observed in pathways 1 and 3, with 22.6% and 27.0% achieving the minimal clinically important difference (MCID), respectively. In pathway 2, 41.7% achieved MCID, but overall changes were not statistically significant. Participants in pathways 1 and 3 improved in most functional tests (p < 0.05), except single-leg stand and handgrip in pathway 3. No significant functional improvements were observed in pathway 2.

Conclusion:
Exercise was most effective as a primary intervention and following acute pain physiotherapy, whereas immediate continuation after chronic pain management yielded limited additional benefits. Strategic integration of exercise into clinical pathways may improve functional outcomes and optimize healthcare resource use, highlighting the need for implementation strategies to sustain long-term physical activity behaviour.