Quality Indicators for the Primary and Community Care of Musculoskeletal Conditions: A Systematic Review

OBJECTIVES

To identify, appraise, and synthesize common themes from quality indicator (QI) sets designed for the assessment, management, and rehabilitation of musculoskeletal (MSK) conditions in primary and community care contexts.

DATA SOURCES

A systematic search was performed on six databases (MEDLINE, EMBASE, AMED, Web of Sciences Core Collection, The Cochrane Library, and The Health Management Information Consortium), public repositories, and the websites of organizations involved in the reporting of MSK QIs.

STUDY SELECTION

Potential QI sources were screened for relevance using an a priori criteria. After the screening of 1493 titles, abstracts, 71 articles were reviewed independently by two authors, of which 25 met our criteria and were therefore included within the review.

DATA EXTRACTION

The development of the QI sets was appraised using the AIRE instrument. Key characteristics of QI sets were extracted and tabulated. Nine out of 25 QI sets had "high" developmental methodology quality. A total of 410 QIs were identified from 25 QI sets.

DATA SYNTHESIS

A narrative synthesis was undertaken to identify common themes among QIs. Themes were mapped against improvement drivers mentioned in recent British primary/community MSK care policy directives. Finally, "Draft Indicators" were synthesized from common themes identified. Eleven overarching themes were synthesized: policy and governance; optimizing access and provision of care; staffing and spending; optimizing assessment and diagnosis; optimizing patient education and self-management; pharmacology and injection guideline adherence; optimizing personalized care; optimizing imaging, investigations, and referral; public health management relevant to MSK conditions; optimizing patient experience; and optimizing patient outcomes.

CONCLUSIONS

This review has identified common themes among QIs that focus on optimizing assessment, investigations, and treatment decisions for the primary/community care of MSK conditions. This work represents a valuable resource to commissioners, service managers, and clinicians internationally who resource, monitor, manage, assess, and rehabilitate individuals with MSK conditions.

Patient lived experiences of functioning and disability following lumbar discectomy: a secondary analysis of qualitative data

BACKGROUND

Knowledge of patient lived experiences of functioning and disability is limited. This study aims to address the gap in the literature by exploring patient lived experiences of functioning and disability following lumbar discectomy.

METHOD

A secondary analysis, reported in line with the Standards for Reporting Qualitative Research, was conducted of qualitative data exploring patient journeys following lumbar discectomy surgery (DiscJourn). Adult patients (≥ 16 years) undergoing elective or emergency primary lumbar discectomy were recruited from one National Health Service secondary care centre in the UK. Semi-structured interviews were conducted at 1-3 weeks and 1-year post surgery. Participants who completed both semi-structured interviews were eligible for the secondary analysis. Transcripts from the semi-structured interviews were analysed using interpretative phenomenological analysis (IPA). IPA involved two independent reviewers identifying themes for individual data sets followed by an iterative process involving the wider research team to identify overarching themes that represented the whole date set. Subthemes generated from the IPA were mapped against the International Classification of Functioning, Disability and Health (ICF) framework at the level of chapters, in order to ascertain the ICF's utility in capturing experiences of functioning and disability. Strategies to enhance trustworthiness of data analysis included blind coding, peer examination and debrief, declaration of pre-conceived beliefs and active reflexivity throughout the study.

RESULTS

Nine participants met the eligibility criteria and their interview transcripts were analysed. Patient lived experiences of functioning and disability were captured by three overarching themes: Immediate impact following surgery, Multiple roads to recovery over 1 year, and Functioning influenced by personal loci of control. Each theme consisted of three subthemes which were subsequently mapped onto the ICF. Three subthemes mapped to the ICF's body component, 1 to activity and participation and 3 to environment. Two subthemes themes did not map onto the ICF.

CONCLUSION

Findings provide valuable insights into patient experiences of functioning and disability following lumbar discectomy. Convergence in experiences of functioning and disability were identified immediately following surgery. Divergence in such experiences were identified with regards to the roads to recovery over 1 year and the individuals' locus of control. Findings build on the body of literature exploring patients functioning and disability following discectomy and make recommendations for future research and clinical practice.