November 2018 update meeting summary

ANZMUSC UPDATE MEETING 28/11/2018

Participants

  1. Rachelle Buchbinder
  2. Chris Maher
  3. Ian Harris
  4. Matthew Coleshill
  5. Marcel Schulz
  6. Sam Whittle
  7. Jane Latimer
  8. Christine Lin
  9. Laurent Billot
  10. Tim Austin (on behalf of Aus Pain Society)
  11. Eindra Aung
  12. Mark Hancock
  13. Jac Grangier
  14. Mary O’Keefe
  15. Amabile Dario
  16. Joshua Zadro
  17. Giovanni Ferreira
  18. James McAuley
  19. Simon French
  20. Lyn March
  21. Will Taylor
  22. Milena Simic
  23. Denise O’Connor
  24. Kim Bennell (via zoom)
  25. Anita Wluka (via zoom)
  26. Renea Johnston (via zoom)
  27. Rana Hinman (via zoom)

 

ANZMUSC Update – Professor Rachelle Buchbinder (ANZMUSC chair)

Professor Buchbinder provided an update on ANZMUSC activities and achievements to date including;

  • Awarding 4 seeding grants of up to $10,000 to; Associate Professor Christine Lin (University of Sydney), Professor Cathie Sherrington (University of Sydney), Associate Professor Mark Hancock (Macquarie University) and Dr Milena Simic (University of Sydney)
  • Operational Support – ANZMUSC is offering i) support for research proposal development for a new trial (e.g. biostatistical support to develop a step-wedge trial design) or (ii) support for an existing ANZMUSC trial (setting up a data safety monitoring board)
  • Trial review – The trials of Professor Ric Day, Associate Professor Christine Lin and Professor Ian Harris will be reviewed by the George Clinical to identify each sites capabilities and limitations in order to understand what support ANZMUSC members need to facilitate the highest quality research
  • OA Special Interest Group – Has been established by Professors Kim Bennell and David Hunter (co-chairs). The group has 39 members to date and all ANZMUSC members including consumers are welcome to join
  • Medibank Private PhD scholarship – applications will open early 2019
  • PhD, Postdoctoral positions – ANZMUSC is currently seeking a PhD student and Postdoctoral Fellow to work on CRE projects including implementing the Clinical Care Standards for hip fracture and knee osteoarthritis into routine clinical care
  • ANZMUSC publications – “Early development of the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network” has been accepted by Internal Medicine Journal and “A scoping review of priority-setting of research topics for musculoskeletal conditions” has been accepted by BMJ Open
  • We plan to put links to the papers on the website
  • If anyone wants to talk about ANZMUSC at other meetings then welcome to contact RB for slide set as required
  • 2019 meeting in planning – dates to follow but meeting planned to be in Sydney

 

Questions and comments:

  • Chris Maher suggested establishing a committee to rewrite the criteria for seeding grant applications to make clear these were explicitly to support development of full multicentre trial ideas. Simon French, Milena Simic and Jane Latimer supported this idea and agreed to join this committee.
  • Mark Hancock suggested it would be useful to track feedback on seeding grant applications over time so prior feedback could be considered in the event of re-application. The Exec Committee will consider this but there were a lot of applications and a lot of work to provide feedback so will try to work on a structured feedback form (by same committee as above)
  • Lyn March offered to share criteria and tools/templates for providing feedback on grant applications to this group.

 

Use of multi-attribute decision-making to inform prioritisation of MSK research for ANZMUSC – Associate Professor Will Taylor

Associate Professor Will Taylor presented on the development of the ANZMUSC priority setting tool. The tool considers attributes that make a research questions important in order to rank research questions in order of importance. He spoke of the limitations of other priority setting processes (namely the “top 10” approach exemplified by the James Lind Alliance) that do not allow for new priorities to be added without repeating the whole process and do not order the priorities in terms of relative importance and is dependent on the stakeholders involved in the process. He outlined the multi-criteria decision-making process that ANZMUSC is using and the benefits that it provides in being a transparent, fair, immediate and updateable process of assigning a priority level to research proposals. He presented work to date:

  1. a) Literature review of priority-setting projects for MSK trials (accepted for pub as above) to identify attributes previous groups have considered
  2. b) A Delphi survey and workshop to identify the attributes and how each would be scored (held in November 2017)

The 6 key attributes that have been identified as most important are: ;

  • the extent to which the question is important to patients and other health decision-makers
  • that it addresses an area of high patient burden
  • that is addresses an area of high social burden
  • potential reduction in patient and/or social burden due to (clinical or implementation) intervention
  • potential scalability and uptake of intervention
  • extent to which the question addresses health equity
  1. Following this, each attribute/category will be weighted using a discrete choice
  2. A reliability exercise to verify the reliability of the framework (To be sent to ANZMUSC members via email Jan-Feb 2019) The reliability exercise will ask respondents to classify a series of research questions in terms of these attributes and will information similar to the background/justification section of a research proposal.
  3. A weighting survey using a discrete choice experiment design to assign meaningful numeric scores to each criteria and to identify a scoring threshold that corresponds to stakeholder opinion about where the cut off might be between high and low priority questions.

 

Once the framework is completed, ANZMUSC members will be invited to submit research ideas/questions that could form an updateable research agenda for the network.

 

Questions and comments:

  • Lyn March asked about authorship of the prioritisation paper and potential inclusion of participants in rating exercise. Rachelle said this would be worked through closer to the time of publication but this contribution could be reflected in the acknowledgements or by including ‘on behalf of ANZMUSC CTN’ to the authorship list.
  • Lyn March and Simon French queried the best way of involving consumers given the complexity and burden of the rating task. Will said a few options were being considered to facilitate consumer participation, including face-to-face administration (individually or via group at workshop).
  • Lyn March also asked what approach would be taken if there was discordance in ratings between consumers and other ANZMUSC members. Rachelle suggested this could be explored later, potentially via qualitative interviews with consumers.
  • Laurent Billot suggested that the prioritisation criteria could form the basis for a tool/template for applicants to use when preparing their grant applications.
  • James McAuley suggested using recently funded grant proposals to test the validity of the criteria.

 

Sam Whittle – ANZMUSC and Living Evidence presentation (slides)

‘Living Systematic reviews (LSRs)

Dr Sam Whittle (rheumatologist and ANZMUSC Practitioner Fellow) gave an update on his work on ‘living’ systematic reviews (LSRs) which are continuously updated reviews that aim to be kept up to date in a more rapid and efficient manner than current reviews.

 

‘Living’ guidelines

Dr Whittle also spoke about ‘living’ clinical guidelines that aim to produce guidelines in which individual recommendations are rapidly updated as soon as relevant new evidence becomes available. Living guidelines seek to address the limitations of current guidelines including duplication of existing work, lack of a central data repository, variable uptake at point of care and an ad hoc update process. He noted the associated challenges, including the need for living guidelines to be linked to living systematic reviews and living summary tables, on-call guideline panels and reviewers, a living publications process and streamlined endorsement process, and the associated financial and workforce costs.

 

ANZMUSC projects

Dr Whittle is leading two ANZMUSC pilot LSRs on autologous blood product and stem cell injections for knee OA. He is also mapping the current therapeutic guidelines for rheumatology and the EULAR guidelines to identify topics in which there has been rapid change in recommendations. The aim is to identify predictable triggers for rapidly-changing recommendations in order to determine which topics should be prioritised for a switch to living reviews and recommendations. He concluded his presentation with a discussion about collaborations being undertaken around Australia and internationally including participation in the Australian Living Evidence Consortium, collaboration with the Canadian Rheumatology Association on a living network meta-analysis of treatments for rheumatoid arthritis, and efforts to include funding for Australian living guidelines in the National Strategic Action Plan for Arthritis.

 

Questions and comments:

  • Lyn March commented that the proposed project would need to feed into the priority setting for new ANZMUSC trials, otherwise she considered the developing of guidelines to be a bit off track for ANZMUSC. RB responded that guidelines fall within our mission and were included in the ANZMUSC CRE proposal; we want to be more than a trial network.
  • Laurent Billot said it would be important to consider how the living recommendations could be pushed to the point of care, possibly via digital technology. SW/RB responded that we are working with Therapeutic Guidelines Ltd to do just that.
  • Chris Maher commented that he liked the format of the BMJ Rapid Rec guidelines (concise and likely more useful for clinicians) and that any model should aim for a similar format. He also suggested it would be good to link with MBS and PBS choices, and have indicators for guideline recommendations.
  • Jane Latimer asked Sam how long would the proposed work is likely to take? Sam indicated that the project team would set short term goals and complete the living review pilot in the first instance.
  • Rachelle Buchbinder invited any interested collaborators to contact Sam.