Reducing the global burden of musculoskeletal conditions
In: Bulletin of the World Health Organization: the international journal of public health = Bulletin de l'Organisation Mondiale de la Santé, Band 96, Heft 5, S. 366-368
ISSN: 1564-0604
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In: Bulletin of the World Health Organization: the international journal of public health = Bulletin de l'Organisation Mondiale de la Santé, Band 96, Heft 5, S. 366-368
ISSN: 1564-0604
BACKGROUND: Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. We aimed to explore contemporary context, challenges and opportunities at a global level and relevant to health systems strengthening for MSK health, as identified by international key informants (KIs) to inform a global MSK health strategic response. METHODS: An in-depth qualitative study was undertaken with international KIs, purposively sampled across high-income and low and middle-income countries (LMICs). KIs identified as representatives of peak global and international organisations (clinical/professional, advocacy, national government and the World Health Organization), thought leaders, and people with lived experience in advocacy roles. Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method. Data were organised into categories describing 1) contemporary context; 2) goals; 3) guiding principles; 4) accelerators for action; and 5) strategic priority areas (pillars), to build a data-driven logic model. Here, we report on categories 1–4 of the logic model. RESULTS: Thirty-one KIs from 20 countries (40% LMICs) affiliated with 25 organisations participated. Six themes described contemporary context (category 1): 1) MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised; 2) improving MSK health is more than just healthcare; 3) global guidance for country-level system strengthening is needed; 4) impact of COVID-19 on MSK health; 5) multiple inequities associated with MSK health; and 6) complexity in health service delivery for MSK health. Five guiding principles (category 3) focussed on adaptability; inclusiveness through co-design; prevention and reducing disability; a lifecourse approach; and equity and value-based care. Goals (category 2) and seven accelerators for action ...
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In: Briggs , A M , Jordan , J E , Kopansky-Giles , D , Sharma , S , March , L , Schneider , C H , Mishrra , S , Young , J J & Slater , H 2021 , ' The need for adaptable global guidance in health systems strengthening for musculoskeletal health : a qualitative study of international key informants ' , Global Health Research and Policy , vol. 6 , 24 . https://doi.org/10.1186/s41256-021-00201-7
Background: Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. We aimed to explore contemporary context, challenges and opportunities at a global level and relevant to health systems strengthening for MSK health, as identified by international key informants (KIs) to inform a global MSK health strategic response. Methods: An in-depth qualitative study was undertaken with international KIs, purposively sampled across high-income and low and middle-income countries (LMICs). KIs identified as representatives of peak global and international organisations (clinical/professional, advocacy, national government and the World Health Organization), thought leaders, and people with lived experience in advocacy roles. Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method. Data were organised into categories describing 1) contemporary context; 2) goals; 3) guiding principles; 4) accelerators for action; and 5) strategic priority areas (pillars), to build a data-driven logic model. Here, we report on categories 1–4 of the logic model. Results: Thirty-one KIs from 20 countries (40% LMICs) affiliated with 25 organisations participated. Six themes described contemporary context (category 1): 1) MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised; 2) improving MSK health is more than just healthcare; 3) global guidance for country-level system strengthening is needed; 4) impact of COVID-19 on MSK health; 5) multiple inequities associated with MSK health; and 6) complexity in health service delivery for MSK health. Five guiding principles (category 3) focussed on adaptability; inclusiveness through co-design; prevention and reducing disability; a lifecourse approach; and equity and value-based care. Goals (category 2) and seven accelerators for action (category 4) were also derived. Conclusion: KIs strongly supported the creation of an adaptable global strategy to catalyse and steward country-level health systems strengthening responses for MSK health. The data-driven logic model provides a blueprint for global agencies and countries to initiate appropriate whole-of-health system reforms to improve population-level prevention and management of MSK health. Contextual considerations about MSK health and accelerators for action should be considered in reform activities.
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In: Haldeman , S , Nordin , M , Tavares , P , Mullerpatan , R , Kopansky-Giles , D , Setlhare , V , Chou , R , Hurwitz , E , Treanor , C , Hartvigsen , J , Schneider , M , Gay , R , Moss , J , Haldeman , J , Gryfe , D , Wilkey , A , Brown , R , Outerbridge , G , Eberspaecher , S , Carroll , L , Engelbrecht , R , Graham , K , Cashion , N , Ince , S & Moon , E 2021 , ' Distance management of spinal disorders during the COVID-19 pandemic and beyond : Evidence-based patient and clinician guides from the global spine care initiative ' , JMIR public health and surveillance , vol. 7 , no. 2 , e25484 . https://doi.org/10.2196/25484
Background: The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. Objective: The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. Methods: Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. Results: The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient's spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions. Conclusions: The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.
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In: Côté , P , Bussières , A , Cassidy , J D , Hartvigsen , J , Kawchuk , G N , Leboeuf-Yde , C , Mior , S , Schneider , M , Aillet , L , Ammendolia , C , Arnbak , B , Axen , I , Baechler , M , Barbier-Cazorla , F , Barbier , G , Bergstrøm , C , Beynon , A , Blanchette , M A , Bolton , P S , Breen , A , Brinch , J , Bronfort , G , Brown , B , Bruno , P , Konner , M B , Burrell , C , Busse , J W , Byfield , D , Campello , M , Cancelliere , C , Carroll , L , Cedraschi , C , Chéron , C , Chow , N , Christensen , H W , Claussen , S , Corso , M , Davis , M A , Demortier , M , De Carvalho , D , De Luca , K , De Zoete , A , Doktor , K , Downie , A , Du Rose , A , Eklund , A , Engel , R , Erwin , M , Eubanks , J E , Evans , R , Evans , W , Fernandez , M , Field , J , Fournier , G , French , S , Fuglkjaer , S , Gagey , O , Giuriato , R , Gliedt , J A , Goertz , C , Goncalves , G , Grondin , D , Gurden , M , Haas , M , Haldeman , S , Harsted , S , Hartvigsen , L , Hayden , J , Hincapié , C , Hébert , J J , Hesby , B , Hestbæk , L , Hogg-Johnson , S , Hondras , M A , Honoré , M , Howarth , S , Injeyan , H S , Innes , S , Irgens , P M , Jacobs , C , Jenkins , H , Jenks , A , Jensen , T S , Johhansson , M , Kongsted , A , Kopansky-Giles , D , Kryger , R , Lardon , A , Lauridsen , H H , Leininger , B , Lemeunier , N , Le Scanff , C , Lewis , E A , Linaker , K , Lothe , L , Marchand , A A , McNaughton , D , Meyer , A L , Miller , P , Mølgaard , A , Moore , C , Murphy , D R , Myburgh , C , Myhrvold , B , Newell , D , Newton , G , Nim , C , Nordin , M , Nyiro , L , O'Neill , S , Øverås , C , Pagé , I , Pasquier , M , Penza , C W , Perle , S M , Picchiottino , M , Piché , M , Poulsen , E , Quon , J , Raven , T , Rezai , M , Roseen , E J , Rubinstein , S , Salmi , L R , Schweinhardt , P , Shearer , H M , Sirucek , L , Sorondo , D , Stern , P J , Stevans , J , Stochkendahl , M J , Stuber , K , Stupar , M , Srbely , J , Swain , M , Teodorczyk-Injeyan , J , Théroux , J , Thiel , H , Uhrenholt , L , Verbeek , A , Verville , L , Vincent , K , Dan Wang , A L , Weber , K A , Whedon , J M , Wong , J , Wuytack , F , Young , J , Yu , H & Ziegler , D 2020 , ' A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity ' , Chiropractic and Manual Therapies , vol. 28 , no. 1 , 21 . https://doi.org/10.1186/s12998-020-00312-x
Background: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. Main body: We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response. Conclusion: In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory authorities and professional leaders to take robust political and regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune system.
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