This systematic review aimed to determine the percentage of clinical trials evaluating conservative management of OA in Australia that reported data on measures of cultural or ethnic diversity. The secondary aim was to report the percentage of CALD participants in trials that reported cultural or ethnicity data.
A systematic review of randomised controlled trials (RCTs) evaluating lifestyle-based core and adjunctive interventions for OA at any joint was undertaken. Six databases (MEDLINE, CINAHL, Embase, PsycINFO, Scopus, Web of Science) were searched from inception to October 2023 for full reports published in English and conducted in Australia. Two independent reviewers conducted title, abstract, and full text screening using the Covidence online software. A third reviewer was consulted to settle disagreements. Full text papers were screened for inclusion of cultural or ethnic diversity measures in the baseline participant characteristics table, including cultural group, ethnicity, race and/or percentage born in Australia. Two authors independently extracted data using a custom form. Results were described using counts and percentages. Risk of bias was not evaluated, as only descriptive results were included.
From a total of 3,907 RCTs identified in the initial search, 62 articles were included in the final review. Only 8 (12.9%) papers, published between 2001 and 2023, reported on measures of cultural or ethnic diversity. Six papers (9.7%) reported on race, ethnicity or cultural group, and 4 papers (6.5%) reported on the percentage of participants who were born in Australia. Ethnicities or cultural groups with the highest proportion of people participating in trials were reported as Caucasian/White (85%, n=275/323, n=2 studies) or Australian/New Zealander (69%, n=548/793, n=2 studies). The most reported CALD groups were Australian Aboriginal and Torres Strait Islanders and Asians, representing only 1% (n=15/1339 across 4 studies) and 6% (n=53/912 across 3 studies) of participants across 5 OA clinical trials, respectively. Across the 4 studies which reported on country of birth, 73% of participants were born in Australia.
Cultural and ethnicity data are seldom reported in Australian OA clinical trials. Of the trials identified that did report these data, CALD populations only represented a small sample of the participants, despite Australia being a multi-cultural nation.
The lack of representation in clinical trials limits the generalisability of trial findings in Australia. This work highlights the importance of reporting these data and provides opportunities for clinicians and researchers to explore the underrepresentation of CALD populations in Australian OA clinical trials.
culturally and linguistically diverse populations
clinical trials
