Health systems strengthening to arrest the global disability burden: empirical development of prioritised components for a global strategy for improving musculoskeletal health

Andrew M Briggs; Carmen Huckel Schneider; Helen Slater; Joanne E Jordan; Sarika Parambath; James J Young; Saurab Sharma; Deborah Kopansky-Giles; Swatee Mishrra; Kristina E Akesson; Nuzhat Ali; Joletta Belton; Neil Betteridge; Fiona M Blyth; Richard Brown; Demelash Debere; Karsten E Dreinhöfer; Laura Finucane; Helen E Foster; Francesca Gimigliano; Scott Haldeman; Syed A Haq; Ben Horgan; Anil Jain; Manjul Joshipura; Asgar A Kalla; Jakob Lothe; Shuichi Matsuda; Ali Mobasheri; Lillian Mwaniki; Margareta C Nordin; Marilyn Pattison; Felipe J J Reis; Enrique R Soriano; Heather Tick; James Waddell; Dieter Wiek; Anthony D Woolf; Lyn March

doi:10.1136/bmjgh-2021-006045

Health systems strengthening to arrest the global disability burden: empirical development of prioritised components for a global strategy for improving musculoskeletal health

BMJ Glob Health. 2021 Jun;6(6):e006045. doi: 10.1136/bmjgh-2021-006045. Epub 2021 Jun 18.

Authors

Andrew M Briggs¹, Carmen Huckel Schneider², Helen Slater³, Joanne E Jordan⁴, Sarika Parambath², James J Young^{5

6}, Saurab Sharma⁷, Deborah Kopansky-Giles^{5

8}, Swatee Mishrra⁹, Kristina E Akesson^{10

11}, Nuzhat Ali¹², Joletta Belton¹³, Neil Betteridge¹⁴, Fiona M Blyth², Richard Brown¹⁵, Demelash Debere¹⁶, Karsten E Dreinhöfer^{17

18

19}, Laura Finucane^{20

21}, Helen E Foster²², Francesca Gimigliano²³, Scott Haldeman^{24

25

26

27}, Syed A Haq²⁸, Ben Horgan²⁹, Anil Jain³⁰, Manjul Joshipura³¹, Asgar A Kalla³², Jakob Lothe³³, Shuichi Matsuda³⁴, Ali Mobasheri^{35

36

37

38}, Lillian Mwaniki³⁹, Margareta C Nordin^{40

41}, Marilyn Pattison^{42

43}, Felipe J J Reis^{44

45

46}, Enrique R Soriano^{47

48}, Heather Tick^{49

50}, James Waddell⁵¹, Dieter Wiek⁵², Anthony D Woolf⁵³, Lyn March^{9

54}

Affiliations

¹ Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia a.briggs@curtin.edu.au.
² Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
³ Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
⁴ HealthSense (Aust) Pty, Ltd, Melbourne, Victoria, Australia.
⁵ Department of Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
⁶ Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
⁷ Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.
⁸ Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.
⁹ Sydney 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.
¹⁰ Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden.
¹¹ Department of Orthopedics, Skane University Hospital, Malmö, Sweden.
¹² Health Improvement, Public Health England, London, UK.
¹³ Global Alliance of Partners for Pain Advocacy, International Association for the Study of Pain, Washington, DC, USA.
¹⁴ Neil Betteridge Associates, London, UK.
¹⁵ World Federation of Chiropractic, Toronto, Ontario, Canada.
¹⁶ Rehabilitation International (Africa Region), Addis Ababa, Ethiopia.
¹⁷ Medical Park Berlin Humboldtmühle, Berlin, Germany.
¹⁸ Center for Musculoskeletal Surgery, Charité Universitätsmedizin, Berlin, Germany.
¹⁹ Global Alliance for Musculoskeletal Health, Berlin, Germany.
²⁰ International Federation of Orthopaedic Manipulative Physical Therapists Incorporated (IFOMPT), World Physiotherapy, London, UK.
²¹ Sussex MSK Partnership, Physiotherapy Department, National Health Service, Brighton, UK.
²² Population Health Institute, Newcastle University, Newcastle upon Tyne, UK.
²³ Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy.
²⁴ Department of Neurology, University of California, Irvine, California, USA.
²⁵ Southern California University of Health Sciences, Whittier, California, USA.
²⁶ Faculty of Health Sciences, University of Ontario Institute of Technology, Toronto, Ontario, Canada.
²⁷ World Spine Care, Santa Ana, California, USA.
²⁸ Rheumatology Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
²⁹ Consumer and Community Involvement Program, West Australian Health Translation Network, Perth, Western Australia, Australia.
³⁰ Department of Physical Medicine and Rehabilitation, Santokba Durlabhji Memorial Hospital, Jaipur, India.
³¹ AO Alliance Foundation, Davos, Switzerland.
³² Department of Medicine, University of Cape Town, Cape Town, South Africa.
³³ Norwegian Council for Musculoskeletal Health, Oslo, Norway.
³⁴ Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan.
³⁵ Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
³⁶ Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania.
³⁷ Departments of Orthopedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
³⁸ Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University Guangzhou, Guangdong, People's Republic of China.
³⁹ Global Alliance for Musculoskeletal Health, Kenya.
⁴⁰ Department of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York City, NY, USA.
⁴¹ Department of Occupational and Industrial Orthopedic Center, NYU Grossman School of Medicine, New York University, New York City, NY, USA.
⁴² World Federation of Occupational Therapists (WFOT), London, UK.
⁴³ MPOT/Access Fitness and Talking Matters, Adelaide, South Australia, Australia.
⁴⁴ Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil.
⁴⁵ Clinical Medicine Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
⁴⁶ Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
⁴⁷ Rheumatology Unit, Internal Medicine Services and University Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
⁴⁸ Pan-American League of Associations for Rheumatology, Miami, Florida, USA.
⁴⁹ Department of Family Medicine and Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
⁵⁰ Academic Consortium for Integrative Medicine and Health, New Buffalo, Michigan, USA.
⁵¹ Saint Michael's Hospital Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
⁵² People with Arthritis and Rheumatism, European Alliance for Associations for Rheumatology (EULAR), Kilchberg, Switzerland.
⁵³ Bone and Joint Research Group, Royal Cornwall Hospitals Trust, Truro, UK.
⁵⁴ Department of Rheumatology, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia.

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.

Keywords: cross-sectional survey; health policy; health services research; health systems; qualitative study.