abstract: 'IntroductionMusculoskeletal (MSK) disorders such as low back pain and

  osteoarthritis are a leading cause of disability and the leading

  contributor to the need for rehabilitation services globally. This need

  has surpassed the availability of trained clinicians; even in urban

  areas where services and providers are thought to be more abundant,

  access can be challenged by transportation options and financial costs

  associated with travel, care and lost time from work. However,

  continuing standard of fully in-person rehabilitation care for

  MSK-associated pain and disability may no longer be necessary. With

  increased ownership or access to even a basic mobile phone device, and

  evidence for remote management by trained clinicians, some individuals

  with MSK disorders may be able to continue their rehabilitation regimen

  predominantly from home after initial evaluation in primary care or an

  outpatient clinic. MethodsThis manuscript describes application of a

  framework we used to culturally and contextually adapt an evidence-based

  approach for leveraging digital health technology using a mobile phone

  (mHealth) to expand access to rehabilitation services for MSK-associated

  pain and disability. We then conducted a multi-level analysis of

  policies related to the adapted approach for rehabilitation service

  delivery to identify opportunities to support sustainability. ResultsOur

  study was conducted in Tanzania, a lower-middle income country with

  their first National Rehabilitation Strategic Plan released in 2021.

  Lessons learned can be applied even to countries with greater

  infrastructure or fewer barriers. The seven-step adaptation framework

  used can be applied in other regions to improve the likelihood of local

  mHealth adoption and implementation. Our practice and policy assessment

  for Tanzania can be applied in other regions and used collaboratively

  with government officials in support of building or implementing a

  national rehabilitation strategic plan. ConclusionThe work described,

  lessons learned and components of the plan are generalizable globally

  and can improve access to rehabilitation services using mHealth to

  address the significant and increasing burden of disability.'
affiliation: 'Bettger, JP (Corresponding Author), Duke Univ, Sch Med, Dept Orthopaed
  Surg, Durham, NC 27710 USA.

  Bettger, JP (Corresponding Author), Temple Univ, Coll Publ Hlth, Dept Hlth \& Rehabil
  Sci, Philadelphia, PA 19122 USA.

  Shayo, Mathew J.; Shayo, Pendo; Haukila, Kelvin F.; Mmbaga, Blandina T., Kilimanjaro
  Christian Med Univ Coll, Kilimanjaro Christian Med Ctr, Moshi, Tanzania.

  Norman, Katherine; Burke, Colleen, Duke Univ, Sch Med, Dept Populat Hlth Sci, Durham,
  NC USA.

  Burke, Colleen; Allen, Kelli D., Dept Vet Affairs Hlth Serv Res \& Dev Serv, Durham,
  NC USA.

  Ngowi, Kennedy; Mmbaga, Blandina T., Kilimanjaro Clin Res Inst, Moshi, Tanzania.

  Goode, Adam P.; Bettger, Janet Prvu, Duke Univ, Sch Med, Dept Orthopaed Surg, Durham,
  NC 27710 USA.

  Allen, Kelli D., Univ North Carolina Chapel Hill, Thurston Arthrit Res Ctr, Chapel
  Hill, NC USA.

  Wonanji, Vivian Timothy, Minist Hlth Community Dev Gender Elderly \& Childr, Dodoma,
  Tanzania.

  Bettger, Janet Prvu, Temple Univ, Coll Publ Hlth, Dept Hlth \& Rehabil Sci, Philadelphia,
  PA 19122 USA.'
article-number: '982175'
author: Shayo, Mathew J. and Shayo, Pendo and Haukila, Kelvin F. and Norman, Katherine
  and Burke, Colleen and Ngowi, Kennedy and Goode, Adam P. and Allen, Kelli D. and
  Wonanji, Vivian Timothy and Mmbaga, Blandina T. and Bettger, Janet Prvu
author-email: janet.bettger@temple.edu
author_list:
- family: Shayo
  given: Mathew J.
- family: Shayo
  given: Pendo
- family: Haukila
  given: Kelvin F.
- family: Norman
  given: Katherine
- family: Burke
  given: Colleen
- family: Ngowi
  given: Kennedy
- family: Goode
  given: Adam P.
- family: Allen
  given: Kelli D.
- family: Wonanji
  given: Vivian Timothy
- family: Mmbaga
  given: Blandina T.
- family: Bettger
  given: Janet Prvu
da: '2023-09-28'
doi: 10.3389/fresc.2022.982175
eissn: 2673-6861
files: []
journal: FRONTIERS IN REHABILITATION SCIENCES
keywords: 'rehabilitation; access; mobile health; musculoskeletal disease;

  disability'
keywords-plus: HOME EXERCISE PROGRAMS; ADHERENCE; PEOPLE
language: English
month: JAN 6
number-of-cited-references: '39'
orcid-numbers: Haukila, Kelvin/0000-0002-6140-8566
papis_id: 957246f415b9f75b959cca30e5b75861
ref: Shayo2023expandingaccess
times-cited: '0'
title: Expanding access to rehabilitation using mobile health to address musculoskeletal
  pain and disability
type: Article
unique-id: WOS:001008692700001
usage-count-last-180-days: '1'
usage-count-since-2013: '1'
volume: '3'
web-of-science-categories: Rehabilitation
year: '2023'