J. Bowden1,2, D. Hunter1,2, Y. Feng1
1The University of Sydney, Institute of Bone and Joint Research, the Kolling Institute, Sydney, Australia, 2Royal North Shore Hospital, Department of Rheumatology, Sydney, Australia
Background: The health of our communities is shaped by changing influences arising from personal, social, built, and economic environments. The association between health and the built environment has long been recognised, yet the potential of using the neighbourhood to support the management of musculoskeletal conditions such as osteoarthritis (OA) is frequently overlooked. OA is a leading cause of pain and disability internationally, and commonly managed by physiotherapists and other primary care practitioners. Recommended first-line treatments for OA focus on structured exercise, physical activity and weight management, along with support for self-management. Yet, the uptake of these interventions is still low, and excessive use of unnecessary, ineffective or expensive interventions continues. New and innovative ways to encourage support for these interventions and address barriers to uptake are needed. Exploring ways to embrace the neighbourhood built environment is one option.
Purpose: To synthesize existing literature examining how neighbourhood built environments can support OA self-management by targeting physical, psychological and social health aspects.
Methods: A literature search between 2000-2019 was undertaken in five databases using a scoping methodology. Literature examining the influence of neighbourhood built environments on physical and psychological health and other outcomes (e.g. quality-of-life, community participation) in people with OA, mixed or unspecified arthritis were screened by two reviewers. Results were mapped to seven pre-determined domains from the World Health Organization Healthy Cities Framework. Sub-domains and themes were further synthesized.
Results: Twenty-seven studies were mapped across the seven domains and 23 sub-domains. The most widely studied domains were healthy urban design and liveability (n=14 studies); healthy transport and active living (n=16); safety and security (n=19); and age and ability friendly design (n=19). Access to green space (n=7); local health services (n=2) and healthy food (n=1) were less studied. We identified 6 key outcomes around physical activity, quality-of-life, community participation, resource use, psychological health and other physical health. Facilitating physical activity and the importance of accessibility were the most researched themes, although all studies emphasised the potential of appropriate built environments for promoting health and supporting OA self-management. Notable research gaps were local access to healthy food, and the potential of well-designed neighbourhoods to influence sleep, pain coping, social isolation and psychological health.
Conclusion(s): This review highlights the potential of better utilising the built environment to support OA management, and address many different health outcomes. Understanding the impact of different built environments is the first step, and designing new and novel ways to utilize the neighbourhood are now needed. Implementing strategies and public policies at a neighbourhood level may be a more viable way to curb further increases in the OA epidemic than addressing individual factors alone.
Implications: The consumer perspectives provided in these studies can aid healthcare providers to tailor OA management to both the individual and their neighbourhood. Discussions around appropriate exercise locations and consideration of neighbourhood features as part of the treatment planning process is one example. Discussions around suitable walking routes based on local walking audits, or stressing the mental and physical benefits of being outdoors are another.
Funding, acknowledgements: This research did not receive any specific grant from any funding agency. DJH is supported by an NHMRC Investigator Grant.
Keywords: Osteoarthritis, Built Environment, Neighbourhoods
Topic: Musculoskeletal
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: This work is a scoping review of existing studies
All authors, affiliations and abstracts have been published as submitted.
