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P. Rajan1, C. Hiller1, J. Lin1, K. Refshauge1, M. Lincoln2, A. Leaver1
1The University of Sydney, Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, Australia, 2University of Canberra, Faculty of Health, Canberra, Australia

Background: Chronic musculoskeletal health conditions are major contributors to the global burden of disease and have been identified as the most common causes of disability. They have a negative impact on self-rated health and are associated with frequent healthcare utilisation, and increased risk of developing multimorbidity. This impact is magnified in rural and remote populations; prevalence is higher and outcomes worse. To reduce this health burden, there is a need for interventions that are effective in rural and remote areas, for chronic musculoskeletal health conditions. The major focus to date has been on delivery of interventions in urban areas, with little known about the effectiveness of these interventions in rural community settings.  

Purpose: The purpose of the review was to evaluate the effectiveness of community-based interventions for management of chronic musculoskeletal health conditions in rural and remote populations.

Methods: A systematic review was undertaken of the major databases: Medline, Scopus, Web of Science, Rural and Remote Health, Embase and Pedro to April 2020 with no restrictions on language or publication date. Randomised controlled trials, controlled non-randomised studies and controlled before-after design studies were included. Studies that delivered non-pharmacological and non-surgical intervention in primary care settings (heath care provided in the community by a healthcare practitioner) in “rural or remote” areas in developed or developing countries were included.

Results: From a total of 3219 articles, five studies were eligible, with a total of 2831 participants. Interventions evaluated included education alone, exercise with education, and ergonomic modifications. Community-based education and exercise had significant effect on pain reduction between groups (OR=1.85; p<0.00). Significant difference in average prevalence of back pain was reported with ergonomic stove installation (0.25% reduction in pain prevalence; p<0.05); however, no significant effect (OR=1.02; p=0.93) was found when transformed to Odds Ratio. The studies found divergent outcomes with education: one study reported a positive effect (OR=1.78; p <0.00), while another study reported no significant effect [delivered either in home (OR: 1.21; p=0.40) or in small groups (OR=0.95; p=0.84)]. A significant improvement in knowledge was found with community-based education delivered either in home (SMD: 1.27; p<0.00), in small groups (SMD: 0.79; p<0.00), using traditional puppetry (SMD: 4.79; p<0.00), and with education and exercise (SMD: 0.29; p=0.015).

Conclusion(s): The limited available literature suggests that education with or without exercise effectively improves knowledge of health condition, but that their effectiveness to reduce chronic musculoskeletal pain is unclear. The studies also provide preliminary evidence suggesting that ergonomic interventions, such as stove installation, should be further explored.

Implications: Education about health condition and exercise delivered in a culturally appropriate way specific to the rural and remote communities improves knowledge.
Community-based intervention using education with or without exercise improves knowledge of health conditions in rural and remote populations.
Some successful strategies to optimise effectiveness of the interventions are: engaging local staff in the intervention delivery, using acceptable and accessible community locations, and focusing on cultural-specificity, and such strategies should be more widely adopted.
Although ergonomic strategies appear promising, they have rarely been studied, and would benefit from further rigorous studies.

Funding, acknowledgements: Pavithra Rajan has received the University of Sydney International Scholarship. 

Keywords: Arthritis, Education, Exercise

Topic: Musculoskeletal

Did this work require ethics approval? No
Institution: The University of Sydney, Australia
Committee: Human Research Ethics Committee
Reason: Study is a systematic review.

All authors, affiliations and abstracts have been published as submitted.

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