University of Oulu

Briggs AM, Huckel Schneider C, Slater H, et al. Health systems strengthening to arrest the global disability burden: empirical development of prioritised components for a global strategy for improving musculoskeletal health. BMJ Global Health 2021;6:e006045,

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

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Author: Briggs, Andrew M.1; Huckel Schneider, Carmen2; Slater, Helen1;
Organizations: 1Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
2Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
3HealthSense (Aust) Pty, Ltd, Melbourne, Victoria, Australia
4Department of Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
5Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
6Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
7Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
8Sydney 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
9Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Malmö, Sweden
10Department of Orthopedics, Skane University Hospital, Malmö, Sweden
11Health Improvement, Public Health England, London, UK
12Global Alliance of Partners for Pain Advocacy, International Association for the Study of Pain, Washington, DC, USA
13Neil Betteridge Associates, London, UK
14World Federation of Chiropractic, Toronto, Ontario, Canada
15Rehabilitation International (Africa Region), Addis Ababa, Ethiopia
16Medical Park Berlin Humboldtmühle, Berlin, Germany
17Center for Musculoskeletal Surgery, Charité Universitätsmedizin, Berlin, Germany
18Global Alliance for Musculoskeletal Health, Berlin, Germany
19International Federation of Orthopaedic Manipulative Physical Therapists Incorporated (IFOMPT), World Physiotherapy, London, UK
20Sussex MSK Partnership, Physiotherapy Department, National Health Service, Brighton, UK
21Population Health Institute, Newcastle University, Newcastle upon Tyne, UK
22Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
23Department of Neurology, University of California, Irvine, California, USA
24Southern California University of Health Sciences, Whittier, California, USA
25Faculty of Health Sciences, University of Ontario Institute of Technology, Toronto, Ontario, Canada
26World Spine Care, Santa Ana, California, USA
27Rheumatology Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
28Consumer and Community Involvement Program, West Australian Health Translation Network, Perth, Western Australia, Australia
29Department of Physical Medicine and Rehabilitation, Santokba Durlabhji Memorial Hospital, Jaipur, India
30AO Alliance Foundation, Davos, Switzerland
31Department of Medicine, University of Cape Town, Cape Town, South Africa
32Norwegian Council for Musculoskeletal Health, Oslo, Norway
33Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
34Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
35Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
36Departments of Orthopedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
37Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University Guangzhou, Guangdong, People's Republic of China
38Global Alliance for Musculoskeletal Health, Kenya
39Department of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York City, NY, USA
40Department of Occupational and Industrial Orthopedic Center, NYU Grossman School of Medicine, New York University, New York City, NY, USA
41World Federation of Occupational Therapists (WFOT), London, UK
42MPOT/Access Fitness and Talking Matters, Adelaide, South Australia, Australia
43Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
44Clinical Medicine Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
45Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
46Rheumatology Unit, Internal Medicine Services and University Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
47Pan-American League of Associations for Rheumatology, Miami, Florida, USA
48Department of Family Medicine and Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
49Academic Consortium for Integrative Medicine and Health, New Buffalo, Michigan, USA
50Saint Michael's Hospital Department of Surgery, University of Toronto, Toronto, Ontario, Canada
51People with Arthritis and Rheumatism, European Alliance for Associations for Rheumatology (EULAR), Kilchberg, Switzerland
52Bone and Joint Research Group, Royal Cornwall Hospitals Trust, Truro, UK
53Department of Rheumatology, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 4.9 MB)
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Language: English
Published: BMJ, 2021
Publish Date: 2021-11-24


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.

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Series: BMJ global health
ISSN: 2059-7908
ISSN-E: 2059-7908
ISSN-L: 2059-7908
Volume: 6
Issue: 6
Article number: e006045
DOI: 10.1136/bmjgh-2021-006045
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This research was funded by a grant awarded by the Bone and Joint Decade Foundation. Additional funding was provided by Curtin University and The University of Sydney.
Copyright information: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.