Musculoskeletal surveillance in India using the G-MUSC survey module: a feasibility study

Musculoskeletal (MSK) disorders are the leading cause of disability globally. Global Burden of Disease studies highlight a critical lack of population-level data on the occurrence of MSK pain, particularly from low- and middle-income countries (LMICs). We evaluated the operational feasibility of implementing the Global Alliance for Musculoskeletal Health (G-MUSC) MSK survey module in a hospital-adjacent adult sample in Kerala, India, and generated preliminary standardized surveillance estimates of MSK pain and activity limitation. We conducted a cross-sectional surveillance study between November 2023 and October 2024 among adults aged ≥ 18 years recruited through hospital-adjacent convenience sampling in Kerala, India. The G-MUSC MSK survey module, a standardized instrument designed for population-level MSK health surveillance, was administered in an interviewer-assisted format by trained MD PMR residents and the research coordinator. Questions were verbally explained or translated into Malayalam when required, and responses were recorded directly into a secure REDCap form using a tablet or mobile phone. The module captured four-week occurrence of low back, neck, hip/knee, and upper limb pain and associated activity limitation. Feasibility outcomes were assessed, and descriptive estimates were calculated with 95% confidence intervals (CIs). During the study period, 1,300 people were invited to participate, of whom 1,229 were enrolled (94.5%); 1,192 datasets were included in the analysis (97.0%; missingness 3.0%). Four-week occurrence of neck pain was 16.8% (95% CI: 14.8–19.0), low back pain was 15.4% (95% CI: 13.4–17.5), hip/knee pain was 12.8% (95% CI: 11.0–14.8), and upper limb pain was 10.5% (95% CI: 8.9–12.4). Activity-limiting pain ranged from 1.6% for upper limb pain to 4.8% for neck pain. In adjusted analyses, female participants had higher odds of activity-limiting MSK pain than males (aOR 1.86, 95% CI: 1.24–2.78; p = 0.002), while participants aged ≥ 60 years had higher odds than those aged 18–29 years (aOR 2.84, 95% CI: 1.20–6.76; p = 0.018). MSK pain and activity limitation were commonly reported in this hospital-adjacent adult sample in Kerala, India. The high participation and completion rates, low missingness, and brief administration time support the operational feasibility of implementing standardized MSK surveillance in a healthcare-adjacent setting. The study also provides preliminary standardized surveillance estimates across multiple anatomical regions. Given the non-probability hospital-adjacent sampling, these findings should not be interpreted as population-representative estimates for Kerala or India. Larger community-based and nationally representative studies are needed to establish robust population estimates and inform integration of MSK surveillance into non-communicable disease monitoring systems in India.