600 Section - Activity-Limiting Musculoskeletal Pain in Kerala, India: Community Prevalence and Lessons for Rehabilitation in Low- and Middle-Income Settings
Clinical Assistant Professor Amrita Institute of Medical Sciences Thiruvananthapuram, Kerala, India
Objectives : Musculoskeletal (MSK) disorders are leading contributors to global disability, yet population-level data on functional limitations remain scarce in low- and middle- income countries (LMICs). Global Burden of Disease (GBD) estimates for India are model-based and do not capture activity-limiting pain or rehabilitation needs. Grounded in the International Classification of Functioning, Disability and Health (ICF) framework, this study applied the Global Alliance for Musculoskeletal Health (G-MUSC) approach to estimate the prevalence, chronicity, functional impact of MSK pain in Kerala, India.
Design: A cross-sectional survey was conducted from November 2023 to October 2024 among 1,229 adults (18–89 years) in the Kochi region. Participants were hospital companions and were interviewed using the standardized G-MUSC questionnaire assessing low-back, neck, hip/knee, and upper-limb pain in the preceding four weeks. Data on chronicity, activity limitation, formal diagnosis, and help-seeking were collected. Descriptive statistics and 95% confidence intervals were computed, with subgroup analyses by age, sex, residence, and education.
Results: Four-week prevalence was 10–17% across anatomical sites, with 1.6–4.9% reporting activity-limiting pain. Chronic pain ( >3 months) affected 7–12% of hip/knee and upper-limb cases, yet formal diagnosis was recorded in only 2–6% of cases. Pain prevalence increased with age, was higher among women and rural residents, and inversely associated with education.
Conclusion: Musculoskeletal pain imposes a substantial and under-recognized functional burden in Kerala, disproportionately affecting women, older adults, and rural residents. Low rates of formal diagnosis highlight limited engagement with healthcare and rehabilitation services. Findings underscore the value of ICF-based community surveillance of functioning and the integration of community rehabilitation within primary care systems in LMICs. As participants were hospital companions, findings may not fully represent the wider community.
