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March MK, Roberts KE. Same patient but different worlds: A state-of-the-art review translating best practice psychosocial care from musculoskeletal care to the orthopaedic context. BMC Musculoskelet Disord 2024; 25:998. [PMID: 39639261 PMCID: PMC11619146 DOI: 10.1186/s12891-024-08107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/22/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Individuals with chronic musculoskeletal conditions experience persistent pain and disability that has deleterious impacts on physical function, psychological health, social engagement, relationships, and work participation. This impact is greater in people with psychosocial risk factors, and best practice musculoskeletal care recommends a biopsychosocial approach to management. Orthopaedic surgery is often an effective management approach for chronic musculoskeletal conditions, but research has only recently explored the links between differing patient outcomes after orthopaedic surgery and psychosocial risk factors. Implementing biopsychosocial approaches to musculoskeletal care has taken great strides in the primary care setting however, implementation of the biopsychosocial approach in orthopaedic surgery brings complexity as the context changes from primary care to hospital based secondary care. The aim of this review therefore is to explore implementation of psychosocial care in the elective orthopaedic surgery context, informed by evidence in musculoskeletal care. ASSESSMENT AND MANAGEMENT OF PSYCHOSOCIAL FACTORS Several composite screening tools for psychosocial factors or 'yellow flags' are recommended for use in primary care for musculoskeletal conditions alongside a comprehensive patient interview. However, in the orthopaedic surgery context, composite measures have focused on discharge destination, and there is not a universal approach to comprehensive patient interview incorporating a biopsychosocial approach. A range of biopsychosocial approaches to musculoskeletal conditions have been developed for the primary care setting, yet few have been explored in the context of orthopaedic surgery. IMPLEMENTATION OF PSYCHOSOCIAL CARE Implementing best practice psychosocial care into the orthopaedic context has enormous potential for all stakeholders, but several barriers exist at the level of the individual patient and practitioner, workforce, health service and society. We have discussed key considerations for implementation including workforce composition, patient-centred care and shared decision making, health literacy, continuity of care, and consideration of preferences for women and culturally diverse communities. CONCLUSION This review considers current literature exploring implementation of psychosocial care into the orthopaedic surgery context, informed by current research in musculoskeletal care. This presents a critical opportunity for orthopaedic surgery to provide optimised, equitable, high-value, patient-centred care.
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Affiliation(s)
- Marie K March
- Physiotherapy Department, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Marcel Cres, Blacktown, NSW, 2148, Australia.
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Katharine E Roberts
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
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Sánchez Medina CM, Gutiérrez Camacho C, Moseley AM, Tejeda Castellanos X, Chen Q, Denova-Gutiérrez E, Cashin AG, Valderrama Godínez V, Fuentes Gómez A, Olivares Hernández AE, Ferreira GE. The methodological quality of clinical trials of physical therapy for low back pain varies between countries with different income levels. A meta-epidemiological study. Braz J Phys Ther 2024; 28:101139. [PMID: 39566201 DOI: 10.1016/j.bjpt.2024.101139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 03/09/2024] [Accepted: 10/28/2024] [Indexed: 11/22/2024] Open
Abstract
BACKGROUND Low back pain is a severe global health problem. To face this issue, testing interventions using rigorously performed randomized controlled trials is essential. However, it is unclear if a country's income level is related to the quality of trials conducted. OBJECTIVE To compare the frequency and methodological quality of randomized controlled trials of physical therapy interventions for low back pain conducted in countries with different income levels. METHODS This meta-epidemiological study retrieved trials from the Physiotherapy Evidence Database (PEDro), Literatura Latino Americana em Ciências da Saúde (LILACS), and Scientific Electronic Library Online (SciELO). The methodological quality was evaluated using the 0-10 PEDro scale. Then we calculated the mean differences with a 95% confidence interval and performed an ANOVA test with Bonferroni correction to compare the PEDro scores between income groups. RESULTS We included 2552 trials; 70.4% were conducted in high-income countries. The mean (standard deviation) PEDro score of all trials was 5.5 (0.03) out of 10. Trials from low- or lower-middle-income countries had lower methodological quality than those from upper-middle- and high-income countries, but the mean difference was small (-0.6 points (95% CI -0.9, -0.3), and -0.7 points (95% CI -1.1, -0.5) respectively). CONCLUSION Income level influences the methodological quality of trials of physical therapy intervention but is not the only factor. Implementing strategies to improve the methodological rigor of trials in patients with low back pain is necessary in all countries, regardless of income level.
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Affiliation(s)
| | - Claudia Gutiérrez Camacho
- Directorate of Teaching and Academic Development, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico
| | - Anne M Moseley
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District Sydney, New South Wales, Australia
| | | | - Qiuzhe Chen
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District Sydney, New South Wales, Australia
| | - Edgar Denova-Gutiérrez
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Australia; School of Health Sciences, University of New South Wales, Australia
| | - Viridiana Valderrama Godínez
- Physical Therapy Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Akari Fuentes Gómez
- Physical Therapy Research Unit, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District Sydney, New South Wales, Australia
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N. Bulto L. Voices unheard: Bridging language gaps, ensuring equity and inclusion of non-native speakers in health research and clinical trials. Nurs Open 2024; 11:e70048. [PMID: 39308320 PMCID: PMC11417425 DOI: 10.1002/nop2.70048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 09/12/2024] [Indexed: 09/26/2024] Open
Affiliation(s)
- Lemma N. Bulto
- Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
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Gilbert S, Jordan A, Ding D, Tiedemann A, Sherrington C, Pinheiro MDB. Cultural, Linguistic, and Geographical Diversity of Participants in Australian Physical Activity Research Studies: A Systematic Review. J Phys Act Health 2024; 21:554-559. [PMID: 38479379 DOI: 10.1123/jpah.2023-0608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/18/2024] [Accepted: 02/05/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The Australian population is highly diverse in terms of cultural heritage, languages spoken, and geographical dispersion. Health outcomes are often worse among these culturally, linguistically, and geographically diverse populations, and this is reflected in rates of physical activity participation, with people from these groups often engaging in insufficient physical activity for health benefits. This research aimed to investigate if physical activity intervention studies conducted in Australia were (1) designed to recruit culturally, linguistically, and geographically diverse participants and (2) recruiting culturally, linguistically, and geographically diverse participants. METHODS We conducted a systematic review of physical activity intervention studies conducted in adults in Australia between 2015 and November 2022. Information relevant to inclusivity in study recruitment methods and diversity of recruited participants was extracted. RESULTS We identified and extracted data from 371 studies, of which 98 were protocol papers for which no follow-up data was available. Only 26 studies (7%) included methods to recruit culturally or linguistically diverse participants. Most studies (189, 51%) recruited participants from major city locations, with few studies recruiting from more remote locations. No studies included recruitment from very remote regions. Information on cultural, linguistic, or geographic diversity of participants recruited to physical activity studies was provided by 109 studies (40% of studies including results) with the majority recruiting White, English-speakers from major cities. CONCLUSIONS Few Australian physical activity studies are designed to recruit culturally, linguistically, and geographically diverse participants. Due to limited reporting of the diversity of participants, comparisons with population-representative data are unreliable.
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Affiliation(s)
- Stephen Gilbert
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health,Sydney Local Health District,The University of Sydney, Gadigal Country, NSW, Australia
| | - Alastair Jordan
- School of Science, Technology, and Health, York St John University, York, United Kingdom
| | - Ding Ding
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Gadigal Country, NSW, Australia
- The Charles Perkins Center, The University of Sydney, Gadigal Country, NSW, Australia
| | - Anne Tiedemann
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health,Sydney Local Health District,The University of Sydney, Gadigal Country, NSW, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health,Sydney Local Health District,The University of Sydney, Gadigal Country, NSW, Australia
| | - Marina De Barros Pinheiro
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health,Sydney Local Health District,The University of Sydney, Gadigal Country, NSW, Australia
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Santos JD, Dawson S, Conefrey C, Isaacs T, Khanum M, Faisal S, Paramasivan S. Most UK cardiovascular disease trial protocols feature criteria that exclude ethnic minority participants: a systematic review. J Clin Epidemiol 2024; 167:111259. [PMID: 38215800 DOI: 10.1016/j.jclinepi.2024.111259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVES We systematically reviewed UK cardiovascular disease (CVD) randomized controlled trial (RCT) protocols to identify the proportion featuring eligibility criteria that may disproportionately exclude ethnic minority (EM) participants. METHODS We searched MEDLINE, Embase, and Cochrane Library databases, January 2014-June 2022, to identify UK CVD RCT protocols. We extracted nonclinical eligibility criteria from trial protocols and inductively categorized the trials by their language, consent, and broad (ambiguous) criteria. Findings are narratively reported. RESULTS Of the seventy included RCT protocols, most (87.1%; 61/70) mentioned consent within the eligibility criteria, with more than two-thirds (68.9%; 42/61) indicating a requirement for 'written' consent. Alternative consent pathways that can aid EM participation were absent. English language requirement was present in 22.9% (16/70) of the studies and 37.1% (26/70) featured broad criteria that are open to interpretation and subject to recruiter bias. Only 4.3% (3/70) protocols mentioned the provision of translation services. CONCLUSION Most UK CVD trial protocols feature eligibility criteria that potentially exclude EM groups. Trial eligibility criteria must be situated within a larger inclusive recruitment framework, where ethnicity is considered alongside other intersecting and disadvantaging identities.
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Affiliation(s)
- Jhulia Dos Santos
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Carmel Conefrey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Talia Isaacs
- UCL Centre for Applied Linguistics, IOE, UCL's Faculty of Education and Society, University College London, London, UK
| | - Mahwar Khanum
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Saba Faisal
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sangeetha Paramasivan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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Puljak L. Caution is needed when describing a study design as meta-epidemiological. J Clin Epidemiol 2022; 152:326-327. [PMID: 36309145 DOI: 10.1016/j.jclinepi.2022.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Croatia.
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