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Original research
Health systems strengthening to arrest the global disability burden: empirical development of prioritised components for a global strategy for improving musculoskeletal health
  1. Andrew M Briggs1,
  2. Carmen Huckel Schneider2,
  3. Helen Slater1,
  4. Joanne E Jordan3,
  5. Sarika Parambath2,
  6. James J Young4,5,
  7. Saurab Sharma6,
  8. Deborah Kopansky-Giles4,7,
  9. Swatee Mishrra8,
  10. Kristina E Akesson9,10,
  11. Nuzhat Ali11,
  12. Joletta Belton12,
  13. Neil Betteridge13,
  14. Fiona M Blyth2,
  15. Richard Brown14,
  16. Demelash Debere15,
  17. Karsten E Dreinhöfer16,17,18,
  18. Laura Finucane19,20,
  19. Helen E Foster21,
  20. Francesca Gimigliano22,
  21. Scott Haldeman23,24,25,26,
  22. Syed A Haq27,
  23. Ben Horgan28,
  24. Anil Jain29,
  25. Manjul Joshipura30,
  26. Asgar A Kalla31,
  27. Jakob Lothe32,
  28. Shuichi Matsuda33,
  29. Ali Mobasheri34,35,36,37,
  30. Lillian Mwaniki38,
  31. Margareta C Nordin39,40,
  32. Marilyn Pattison41,42,
  33. Felipe J J Reis43,44,45,
  34. Enrique R Soriano46,47,
  35. Heather Tick48,49,
  36. James Waddell50,
  37. Dieter Wiek51,
  38. Anthony D Woolf52,
  39. Lyn March8,53
  1. 1Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
  2. 2Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  3. 3HealthSense (Aust) Pty, Ltd, Melbourne, Victoria, Australia
  4. 4Department of Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
  5. 5Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  6. 6Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
  7. 7Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  8. 8Sydney Musculoskeletal, Bone and Joint Health Alliance. Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  9. 9Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden
  10. 10Department of Orthopedics, Skane University Hospital, Malmö, Sweden
  11. 11Health Improvement, Public Health England, London, UK
  12. 12Global Alliance of Partners for Pain Advocacy, International Association for the Study of Pain, Washington, DC, USA
  13. 13Neil Betteridge Associates, London, UK
  14. 14World Federation of Chiropractic, Toronto, Ontario, Canada
  15. 15Rehabilitation International (Africa Region), Addis Ababa, Ethiopia
  16. 16Medical Park Berlin Humboldtmühle, Berlin, Germany
  17. 17Center for Musculoskeletal Surgery, Charité Universitätsmedizin, Berlin, Germany
  18. 18Global Alliance for Musculoskeletal Health, Berlin, Germany
  19. 19International Federation of Orthopaedic Manipulative Physical Therapists Incorporated (IFOMPT), World Physiotherapy, London, UK
  20. 20Sussex MSK Partnership, Physiotherapy Department, National Health Service, Brighton, UK
  21. 21Population Health Institute, Newcastle University, Newcastle upon Tyne, UK
  22. 22Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
  23. 23Department of Neurology, University of California, Irvine, California, USA
  24. 24Southern California University of Health Sciences, Whittier, California, USA
  25. 25Faculty of Health Sciences, University of Ontario Institute of Technology, Toronto, Ontario, Canada
  26. 26World Spine Care, Santa Ana, California, USA
  27. 27Rheumatology Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  28. 28Consumer and Community Involvement Program, West Australian Health Translation Network, Perth, Western Australia, Australia
  29. 29Department of Physical Medicine and Rehabilitation, Santokba Durlabhji Memorial Hospital, Jaipur, India
  30. 30AO Alliance Foundation, Davos, Switzerland
  31. 31Department of Medicine, University of Cape Town, Cape Town, South Africa
  32. 32Norwegian Council for Musculoskeletal Health, Oslo, Norway
  33. 33Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
  34. 34Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
  35. 35Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
  36. 36Departments of Orthopedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  37. 37Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University Guangzhou, Guangdong, People's Republic of China
  38. 38Global Alliance for Musculoskeletal Health, Kenya
  39. 39Department of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York City, NY, USA
  40. 40Department of Occupational and Industrial Orthopedic Center, NYU Grossman School of Medicine, New York University, New York City, NY, USA
  41. 41World Federation of Occupational Therapists (WFOT), London, UK
  42. 42MPOT/Access Fitness and Talking Matters, Adelaide, South Australia, Australia
  43. 43Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
  44. 44Clinical Medicine Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
  45. 45Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
  46. 46Rheumatology Unit, Internal Medicine Services and University Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  47. 47Pan-American League of Associations for Rheumatology, Miami, Florida, USA
  48. 48Department of Family Medicine and Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
  49. 49Academic Consortium for Integrative Medicine and Health, New Buffalo, Michigan, USA
  50. 50Saint Michael's Hospital Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  51. 51People with Arthritis and Rheumatism, European Alliance for Associations for Rheumatology (EULAR), Kilchberg, Switzerland
  52. 52Bone and Joint Research Group, Royal Cornwall Hospitals Trust, Truro, UK
  53. 53Department of Rheumatology, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Professor Andrew M Briggs; a.briggs{at}curtin.edu.au

Abstract

Introduction Despite the profound burden of disease, a strategic global response to optimise musculoskeletal (MSK) health and guide national-level health systems strengthening priorities remains absent. Auspiced by the Global Alliance for Musculoskeletal Health (G-MUSC), we aimed to empirically derive requisite priorities and components of a strategic response to guide global and national-level action on MSK health.

Methods Design: mixed-methods, three-phase design.

Phase 1: qualitative study with international key informants (KIs), including patient representatives and people with lived experience. KIs characterised the contemporary landscape for MSK health and priorities for a global strategic response.

Phase 2: scoping review of national health policies to identify contemporary MSK policy trends and foci.

Phase 3: informed by phases 1–2, was a global eDelphi where multisectoral panellists rated and iterated a framework of priorities and detailed components/actions.

Results Phase 1: 31 KIs representing 25 organisations were sampled from 20 countries (40% low and middle income (LMIC)). Inductively derived themes were used to construct a logic model to underpin latter phases, consisting of five guiding principles, eight strategic priority areas and seven accelerators for action.

Phase 2: of the 165 documents identified, 41 (24.8%) from 22 countries (88% high-income countries) and 2 regions met the inclusion criteria. Eight overarching policy themes, supported by 47 subthemes, were derived, aligning closely with the logic model.

Phase 3: 674 panellists from 72 countries (46% LMICs) participated in round 1 and 439 (65%) in round 2 of the eDelphi. Fifty-nine components were retained with 10 (17%) identified as essential for health systems. 97.6% and 94.8% agreed or strongly agreed the framework was valuable and credible, respectively, for health systems strengthening.

Conclusion An empirically derived framework, co-designed and strongly supported by multisectoral stakeholders, can now be used as a blueprint for global and country-level responses to improve MSK health and prioritise system strengthening initiatives.

  • health policy
  • health services research
  • health systems
  • cross-sectional survey
  • qualitative study

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2021-006045

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplemental information.

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    Footnotes

    • Handling editor Seye Abimbola

    • Twitter @AndrewMBriggs, @hels_slater, @James_J_Young, @link_physio, @lynmarch1

    • Contributors Design of the study—AMB, CHS, HS, SS, DK-G and LMarch. Data collection—AMB, CHS, HS, JEJ, SP, JJY, SS, DK-G and SMishrra. Data analysis and interpretation—AMB, CHS, HS, JEJ, SP, JJY, SS, DK-G and LMarch. Preparation of the initial manuscript—AMB and CHS. Revision of the manuscript and approval for publication—AMB, CHS, HS, JEJ, SP, JJY, SS, DK-G, SMishrra, KEA, NA, JB, NB, FMB, RB, DD, KED, LF, HEF, FG, SH, SAH, BH, AJ, MJ, AAK, JL, SMatsuda, AM, LMwaniki, MCN, MP, FJJR, ERS, HT, JW, DW, ADW and LMarch.

    • Funding This research was funded by a grant awarded by the Bone and Joint Decade Foundation. Additional funding was provided by Curtin University and The University of Sydney.

    • Map disclaimer The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

    • Competing interests AMB reports grants from the Bone and Joint Decade Foundation during the conduct of the study. CHS reports grants from Curtin University during the conduct of the study. HS reports grants from the Bone and Joint Decade Foundation during the conduct of the study; personal fees from AbbVie outside the submitted work. JEJ reports personal fees from Curtin University during the conduct of the study. SP has nothing to disclose. JJY reports grants from the Danish Foundation for Chiropractic Research and Post-graduate Education, grants from Canadian Memorial Chiropractic College, grants from Ontario Chiropractic Association, grants from National Chiropractic Mutual Insurance Company Foundation, grants from the University of Southern Denmark Faculty Scholarship outside the submitted work. SS has nothing to disclose. DK-G has nothing to disclose. SMishrra reports grants from Curtin University during the conduct of the study. KEA reports personal fees from Amgen, personal fees from UCB, personal fees from FAN, personal fees from Astellas pharma, personal fees from Chugai pharma outside the submitted work. NA has nothing to disclose. JB has nothing to disclose. NB reports personal fees from Amgen, personal fees from Grunenthal, personal fees from Lilly, personal fees from Pfizer, personal fees from Sanofi, personal fees from Global Alliance for Patient Access outside the submitted work. FMB has nothing to disclose. RB reports personal fees from World Federation of Chiropractic outside the submitted work. DD has nothing to disclose. KED has nothing to disclose. LF has nothing to disclose. HEF has nothing to disclose. FG has nothing to disclose. SH has nothing to disclose. SAH has nothing to disclose. BH has nothing to disclose. AJ has nothing to disclose. MJ has nothing to disclose. AAK has nothing to disclose. JL has nothing to disclose. SMatsuda has nothing to disclose. AM reports grants, non-financial support and other from Merck KGaA; grants, non-financial support and other from Kolon TissueGene; grants, non-financial support and other from Merck KGaA; grants from Pfizer; grants from European Commission-Innovative Medicines Initiative (IMI); grants from European Union Structural Funds administered by the Research Council of Lithuania (Lietuvos mokslo taryba); grants from European Union Structural Funds administered by the Research Council of Lithuania (Lietuvos mokslo taryba); grants from European Commission-Framework 7 (FP7-HEALTH); grants from European Commission-Framework 7 (FP7-PEOPLE) Marie Skłodowska-Curie Program; personal fees from Galapagos-Servier; personal fees from Image Analysis Group (IAG); personal fees, non-financial support and other from Artialis SA; personal fees and other from Aché (Aché Laboratórios Farmacêuticos); personal fees and other from Abbvie; personal fees from Guidepoint Global,; personal fees from Alphasights; personal fees from Science Branding Communications; personal fees and non-financial support from Pfizer Consumer Healthcare; non-financial support from GSK Consumer Healthcare; personal fees and other from Flexion Therapeutics; personal fees from Pacira Biosciences; other from Genacol; personal fees, non-financial support and other from Sterifarma; other from Henry Stewart Talks; non-financial support from GlaxoSmithKline (GSK); grants from Versus Arthritis (Arthritis Research UK); personal fees and other from Korean Society for Osteoarthritis and Cartilage Repair; personal fees from American College of Rheumatology; personal fees and other from Spanish Society of Rheumatology; personal fees and other from Heilongjiang Rheumatology Association; personal fees and other from Zhujiang Hospital of Southern Medical University; non-financial support and other from International Cartilage Regeneration and Joint Preservation Society (ICRS); non-financial support and other from Osteoarthritis Research Society International (OARSI); non-financial support from AxDev International; other from Gordian Biotechnology; other from UNITY Biotechnology; personal fees and other from Bioiberica; other from The Dutch Arthritis Society (ReumaNederland); other from Kolon Life Science; personal fees from SANOFI; personal fees from European Commission; other from BRASIT/BRASOS, Brazil; other from GEOS, Brazil; other from European Orthopaedic Research Society (EORS); other from Brazilian Society of Rheumatology (SBR); other from Society for Osteoarthritis Research (SOAR), India; other from MCI Group, Geneva outside the submitted work. LMwaniki has nothing to disclose. MCN has nothing to disclose. MP has nothing to disclose. FJJR has nothing to disclose. ERS reports grants, personal fees and non-financial support from Abbvie; personal fees from Amgen; personal fees from BMS; grants from Glaxo; grants and personal fees from Janssen; personal fees from Lilly; grants and personal fees from Novartis; grants, personal fees and non-financial support from Pfizer; grants and personal fees from Roche; grants, personal fees and non-financial support from UCB outside the submitted work. HT reports having authored two books: Life Beyond the Carpal Tunnel (2007) and Holistic Pain Relief (2014). JW has nothing to disclose. DW has nothing to disclose. ADW has nothing to disclose. LMarch reports personal fees from Lilly, personal fees from Pfizer, personal fees from Abbvie, grants from Janssen outside the submitted work. LMarch is an executive member of OMERACT which receives funding from 30 different companies.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.