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Sharma S, Pathak A, Parker R, Costa LOP, Ghai B, Igwesi-Chidobe C, Janwantanakul P, de Jesus-Moraleida FR, Chala MB, Pourahmadi M, Briggs AM, Gorgon E, Ardern CL, Khan KM, McAuley JH, Alghwiri A, Aoko OA, Badamasi HS, Calvache JA, Cardosa MS, Ganesh S, Gashaw M, Ghiringhelli J, Gigena S, Hasan ATMT, Haq SA, Jacob EN, Janse van Rensburg DC, Kossi O, Liu C, Malani R, Mason BJN, Najem C, Nava-Bringas TI, Nduwimana I, Perera R, Perveen W, Pierobon A, Pinto E, Pinto RZ, Purwanto F, Rahimi MD, Reis FJJ, Siddiq MAB, Shrestha D, Tamang M, Vasanthan T L, Viljoen C. How Low Back Pain is Managed-A Mixed-Methods Study in 32 Countries. Part 2 of Low Back Pain in Low- and Middle-Income Countries Series. J Orthop Sports Phys Ther 2024; 54:560-572. [PMID: 38602844 DOI: 10.2519/jospt.2024.12406] [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] [Indexed: 04/13/2024]
Abstract
BACKGROUND: The Lancet Low Back Pain (LBP) Series highlighted the lack of LBP data from low- and middle-income countries (LMICs). The study aimed to describe (1) what LBP care is currently delivered in LMICs and (2) how that care is delivered. DESIGN: An online mixed-methods study. METHODS: A Consortium for LBP in LMICs (n = 65) was developed with an expert panel of leading LBP researchers (>2 publications on LBP) and multidisciplinary clinicians and patient partners with 5 years of clinical/lived LBP experience in LMICs. Quantitative data were analyzed using descriptive statistics. Two researchers independently analyzed qualitative data using inductive and deductive coding and developed a thematic framework. RESULTS: Forty-seven (85%) of 55 invited panel members representing 32 LMICs completed the survey (38% women, 62% men). The panel included clinicians (34%), researchers (28%), educators (6%), and people with lived experience (4%). Pharmacotherapies and electrophysiological agents were the most used LBP treatments. The thematic framework comprised 8 themes: (1) self-management is ubiquitous, (2) medicines are the cornerstone, (3) traditional therapies have a place, (4) society plays an important role, (5) imaging use is very common, (6) reliance on passive approaches, (7) social determinants influence LBP care pathway, and (8) health systems are ill-prepared to address LBP burden. CONCLUSION: LBP care in LMICs did not consistently align with the best available evidence. Findings will help research prioritization in LMICs and guide global LBP clinical guidelines. J Orthop Sports Phys Ther 2024;54(8):560-572. Epub 11 April 2024. doi:10.2519/jospt.2024.12406.
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Nguyen AT, Aris IM, Snyder BD, Harris MB, Kang JD, Murray M, Rodriguez EK, Nazarian A. Musculoskeletal health: an ecological study assessing disease burden and research funding. LANCET REGIONAL HEALTH. AMERICAS 2024; 29:100661. [PMID: 38225979 PMCID: PMC10788788 DOI: 10.1016/j.lana.2023.100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/17/2024]
Abstract
Background Exacerbated by an aging population, musculoskeletal diseases are a chronic and growing problem in the United States that impose significant health and economic burdens. The objective of this study was to analyze the correlation between the burden of diseases and the federal funds assigned to health-related research through the National Institutes of Health (NIH). Methods An ecological study design was used to examine the relationship between NIH research funding and disease burden for 60 disease categories. We used the Global Burden of Disease (GBD) Study 2019 to measure disease burden and the NIH Research, Condition, and Disease Categories (RCDC) data to identify 60 disease categories aligned with available GBD data. NIH funding data was obtained from the RCDC system and the NIH Office of Budget. Using linear regression models, we observed that musculoskeletal diseases were among the most underfunded (i.e., negative residuals from the model) with respect to disease burden. Findings Musculoskeletal diseases were underfunded, with neck pain being the most underfunded at only 0.83% of expected funding. Low back pain, osteoarthritis, and rheumatoid arthritis were also underfunded at 13.88%, 35.08%, and 66.26%, respectively. Musculoskeletal diseases were the leading cause of years lived with disability and the third leading cause in terms of prevalence and disability-adjusted life years. Despite the increasing burden of these diseases, the allocation of NIH funding to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has remained low compared to other institutes. Interpretation Despite the increasing health burden and economic cost of $980 billion annually, the allocation of NIH funding to the NIAMS has remained low compared to other institutes. These findings suggest that the NIH may need to reassess its allocation of research funding to align with the current health challenges of our country. Furthermore, these clinically relevant observations highlight the need to increase research funding for musculoskeletal diseases and improve their prevention, diagnosis, and treatment. Funding No funding.
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Affiliation(s)
- Andrew T. Nguyen
- Harvard Medical School, Boston, MA, USA
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Izzuddin M. Aris
- Division of Chronic Disease Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Brian D. Snyder
- Harvard Medical School, Boston, MA, USA
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Mitchel B. Harris
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - James D. Kang
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Martha Murray
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Edward K. Rodriguez
- Harvard Medical School, Boston, MA, USA
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ara Nazarian
- Harvard Medical School, Boston, MA, USA
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopaedic Surgery, Yerevan State University, Yerevan, Armenia
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Briggs AM, Chua J, Cross M, Ahmad NM, Finucane L, Haq SA, Joshipura M, Kalla AA, March L, Moscogiuri F, Reis FJJ, Sarfraz S, Sharma S, Soriano ER, Slater H. ' It's about time'. Dissemination and evaluation of a global health systems strengthening roadmap for musculoskeletal health - insights and future directions. BMJ Glob Health 2023; 8:e013786. [PMID: 37918875 PMCID: PMC10626884 DOI: 10.1136/bmjgh-2023-013786] [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: 08/25/2023] [Accepted: 10/07/2023] [Indexed: 11/04/2023] Open
Abstract
Actions towards the health-related Sustainable Development Goal 3.4 typically focus on non-communicable diseases (NCDs) associated with premature mortality, with less emphasis on NCDs associated with disability, such as musculoskeletal conditions-the leading contributor to the global burden of disability. Can systems strengthening priorities for an underprioritised NCD be codesigned, disseminated and evaluated? A 'roadmap' for strengthening global health systems for improved musculoskeletal health was launched in 2021. In this practice paper, we outline dissemination efforts for this Roadmap and insights on evaluating its reach, user experience and early adoption. A global network of 22 dissemination partners was established to drive dissemination efforts, focussing on Africa, Asia and Latin America, each supported with a suite of dissemination assets. Within a 6-month evaluation window, 52 Twitter posts were distributed, 2195 visitors from 109 countries accessed the online multilingual Roadmap and 138 downloads of the Roadmap per month were recorded. Among 254 end users who answered a user-experience survey, respondents 'agreed' or 'strongly agreed' the Roadmap was valuable (88.3%), credible (91.2%), useful (90.1%) and usable (85.4%). Most (77.8%) agreed or strongly agreed they would adopt the Roadmap in some way. Collection of real-world adoption case studies allowed unique insights into adoption practices in different contexts, settings and health system levels. Diversity in adoption examples suggests that the Roadmap has value and adoption potential at multiple touchpoints within health systems globally. With resourcing, harnessing an engaged global community and establishing a global network of partners, a systems strengthening tool can be cocreated, disseminated and formatively evaluated.
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Affiliation(s)
- Andrew M Briggs
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Jason Chua
- Traumatic Brain Injury Network, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Marita Cross
- Global Alliance for Musculoskeletal Health, Institute of Bone and Joint Research, Kolling Institute, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Nighat Mir Ahmad
- Institute of Rheumatic Diseases, Central Park Medical College, Lahore, Pakistan
- Department of Rheumatology, National Hospital & Postgraduate Medical Institute, Lahore, Pakistan
- Arthritis Care Foundation, Lahore, Pakistan
| | - Laura Finucane
- International Federation of Orthopaedic Manipulative Physical Therapists Incorporated (IFOMPT) and World Physiotherapy, London, UK
- Sussex MSK Partnership, National Health Service, Brighton, UK
| | - Syed Atiqul Haq
- Asia Pacific League of Associations for Rheumatology, Singapore
- Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Asgar Ali Kalla
- Department of Medicine, University of Cape Town Faculty of Health Sciences, Observatory, South Africa
| | - Lyn March
- Global Alliance for Musculoskeletal Health, Institute of Bone and Joint Research, Kolling Institute, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Florance and Cope Professorial Department of Rheumatology, University of Sydney Faculty of Medicine and Health, Kolling Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Federico Moscogiuri
- International Federation of Musculoskeletal Research Societies, Washington DC, Washington, USA
| | - Felipe J J Reis
- Physical Therapy Department, Instituto Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Clinical Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Saurab Sharma
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- School of Health Sciences, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Enrique R Soriano
- Rheumatology Unit, Internal Medicine Services and University Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Pan-American League of Associations for Rheumatology, Atlanta, Georgia, USA
| | - Helen Slater
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Finucane LM, Stokes E, Briggs AM. Its everyone's responsibility: Responding to the global burden of musculoskeletal health impairment. Musculoskelet Sci Pract 2023; 64:102743. [PMID: 36921503 DOI: 10.1016/j.msksp.2023.102743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Laura M Finucane
- Sussex MSK Partnership, Brighton, UK; St Georges University London, Health Social Care and Education, United Kingdom.
| | - Emma Stokes
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Andrew M Briggs
- Curtin School of Allied Health and Curtin EnAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
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