File
Chan M1, Le CY1,2, Dennett L3, Defreitas T1,4, Whittaker JL2
1University of Alberta, Glen Sather Sports Medicine Clinic, Edmonton, Canada, 2University of Alberta, Physical Therapy, Edmonton, Canada, 3University of Alberta, John W. Scott Health Sciences Library, Edmonton, Canada, 4University of Alberta, Family Medicine, Edmonton, Canada
Background: Musculoskeletal conditions such as osteoarthritis and low back pain are highly prevalent and represent a substantial individual and societal burden. With a growing and aging population, the global demand for musculoskeletal care is expected to rise. The care pathway for patients with musculoskeletal conditions varies considerably within and across jurisdictions and conditions. One strategy that has been adopted to address this enormous and expanding burden are multidisciplinary team-based musculoskeletal-assessment services delivered at the interface between primary and secondary care aimed at directing care. Little is known about the efficacy of these services or their impact on indicators of healthcare quality. There is a need to critically appraise and summarize the evidence related to team-based musculoskeletal-assessment services and their impact on healthcare quality.
Purpose: The primary objective of this systematic review was to assess the association between team-based musculoskeletal-assessment aimed at directing patient care and healthcare quality indicators (HQIs). Secondary objectives included determining which healthcare practitioners most commonly comprise musculoskeletal-assessment teams, level of team collaboration, and most commonly assessed HQIs.
Methods: The review was registered with PROSPERO (CRD42016052631) and followed PRISMA guidelines. Five electronic databases (Medline, EMBASE, CINAHL, Sport Discus, SCOPUS) were systematically searched using keywords and Medical Sub-Heading terms. Studies selected included: English language; original data; patients with a musculoskeletal condition that underwent team-based (≥2 healthcare practitioners) assessment in a primary or intermediate care setting aimed at directing treatment; and a HQI outcome (i.e., acceptability, accessibility, appropriateness, effectiveness, efficiency, safety). Two independent raters assessed study quality [Downs and Black (DB) criteria] and level of evidence (Oxford Centre of Evidence-Based Medicine model).
Results: Of 1159 potentially relevant studies, 10 were included. The majority (6/10) of studies were low-quality pre-experimental studies (level 4 evidence), with significant bias [median DB score 13.5/32 (range 6-18)], with only 4/10 including a comparison assessment group. The most common condition assessed was hip fracture (3/10 studies). Heterogeneity in methodology and HQI assessed precluded meta-analyses. Teams were most commonly comprised of a physiotherapist and another healthcare practitioner (i.e., occupational therapist, primary care physician, social worker) with most (7/10 studies) demonstrating a low level of collaboration (i.e., members assessed the patient and developed discipline specific treatment plans independently). Pain scores (3/10 studies) and length-of-stay (LOS; 3/10 studies) were the most common HQI investigated. Limited low level evidence suggests that team-based musculoskeletal-assessment may be associated with improved clinical outcomes (i.e., pain, quality-of-life) and reduced hospital LOS, admission rate, and time-to-meet discharge criteria.
Conclusion(s): There is limited low level evidence to suggest that team-based musculoskeletal-assessment may positively impact HQIs including; accessibility (admission rate, LOS), appropriateness (admission rate, LOS), effectiveness (pain, quality-of-life scores), and efficiency (admission rate, LOS, time-to-meet discharge criteria). Further high-quality studies that include a comparison to alternate assessment models and economic analyses are required.
Implications: Team-based musculoskeletal-assessment may hold promise as a method to improve the quality of healthcare for the growing number of patients with musculoskeletal conditions. A better understanding of the efficacy of these services is required before recommending widespread implementation.
Keywords: Interdisciplinary, Multidisciplinary, Triage
Funding acknowledgements: There was no funding received to support this study.
Purpose: The primary objective of this systematic review was to assess the association between team-based musculoskeletal-assessment aimed at directing patient care and healthcare quality indicators (HQIs). Secondary objectives included determining which healthcare practitioners most commonly comprise musculoskeletal-assessment teams, level of team collaboration, and most commonly assessed HQIs.
Methods: The review was registered with PROSPERO (CRD42016052631) and followed PRISMA guidelines. Five electronic databases (Medline, EMBASE, CINAHL, Sport Discus, SCOPUS) were systematically searched using keywords and Medical Sub-Heading terms. Studies selected included: English language; original data; patients with a musculoskeletal condition that underwent team-based (≥2 healthcare practitioners) assessment in a primary or intermediate care setting aimed at directing treatment; and a HQI outcome (i.e., acceptability, accessibility, appropriateness, effectiveness, efficiency, safety). Two independent raters assessed study quality [Downs and Black (DB) criteria] and level of evidence (Oxford Centre of Evidence-Based Medicine model).
Results: Of 1159 potentially relevant studies, 10 were included. The majority (6/10) of studies were low-quality pre-experimental studies (level 4 evidence), with significant bias [median DB score 13.5/32 (range 6-18)], with only 4/10 including a comparison assessment group. The most common condition assessed was hip fracture (3/10 studies). Heterogeneity in methodology and HQI assessed precluded meta-analyses. Teams were most commonly comprised of a physiotherapist and another healthcare practitioner (i.e., occupational therapist, primary care physician, social worker) with most (7/10 studies) demonstrating a low level of collaboration (i.e., members assessed the patient and developed discipline specific treatment plans independently). Pain scores (3/10 studies) and length-of-stay (LOS; 3/10 studies) were the most common HQI investigated. Limited low level evidence suggests that team-based musculoskeletal-assessment may be associated with improved clinical outcomes (i.e., pain, quality-of-life) and reduced hospital LOS, admission rate, and time-to-meet discharge criteria.
Conclusion(s): There is limited low level evidence to suggest that team-based musculoskeletal-assessment may positively impact HQIs including; accessibility (admission rate, LOS), appropriateness (admission rate, LOS), effectiveness (pain, quality-of-life scores), and efficiency (admission rate, LOS, time-to-meet discharge criteria). Further high-quality studies that include a comparison to alternate assessment models and economic analyses are required.
Implications: Team-based musculoskeletal-assessment may hold promise as a method to improve the quality of healthcare for the growing number of patients with musculoskeletal conditions. A better understanding of the efficacy of these services is required before recommending widespread implementation.
Keywords: Interdisciplinary, Multidisciplinary, Triage
Funding acknowledgements: There was no funding received to support this study.
Topic: Musculoskeletal; Service delivery/emerging roles; Orthopaedics
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: This was a systematic review and did not involve primary data collection in human participants, therefore no ethical approval was required.
All authors, affiliations and abstracts have been published as submitted.
