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Following on from our CRE launch in 2018, the 2019 meeting aimed to update members on the progress of ANZMUSC, the plans for its’ future, and provide the opportunity to discuss research proposals for potential endorsement. This year we had a total of 17 research proposals presented over the 2 days including 9 which had been granted early endorsement. The meeting also had education sessions on Data Linkage and Adaptive Trial Designs, and updates from 8 endorsed trials currently being conducted by members; Effectiveness of an electronic patient-centred self-management tool for Gout sufferers; Trial of glucocorticoids in acute sciatica; Implementation of an evidence-based model of care for low back pain in emergency departments: Protocol for the Sydney Health Partners Emergency Department (SHAPED) trial; Preventing Falls in Older Aboriginal people: The IRONBARK Trial’ Expedited cataract surgery to prevent falls: the BRIGHT trial – Best practice surgical and Refractive management for cataract; A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE); SUcceSS: SUrgery for Spinal Stenosis – a randomised placebo-controlled trial; Come BACK – Physical activity coaching for adults with mobility limitations: a pragmatic randomised controlled trial.
The 2019 meeting was attended by 77 delegates from across Australia and New Zealand representing 25 different universities and research institutes, as well as various consumer organisations and professional associations. We were also fortunate to have 5 of our Consumer Advisory Group members attend: Annie McPherson (VIC), Ms Charlotte Hewson (NZ), Ms Linda Spurrier (ACT), Mr Dan Philp (QLD) and Mr Ben Horgan (WA). This years meeting also contained a pre-meeting workshop for the Consumer Advisory Group and Early Career Researchers to discuss the needs of these groups and how members could be better integrated into ANZMUSC activities, and the planning meeting for first ANZMUSC special interest group: the OA special interest group. We also announced the winners of the 2019 seeding grants; Dr Michele Hall (University of Melbourne), Dr Ben Darlow (University of Otago), Dr Matthew Fernandez (Macquarie University), and Professor Anne Tiedemann (University of Sydney).
Session 1: Education Session and updates
Professor Louisa Jorm (Director, Centre for Big Data Research in Health, University of New South Wales), provided an overview of data research in Australia including the work of the Population Health Research Network, and described the manner in which patient data gathered from various sources is linked in a manner which maintains anonymity. The examples she discussed highlighted the manner in which individual patient data can be plotted to visually detect patterns and changes in health events such as hospitalisations and shared patient care. Professor Jorm also discussed some of the upcoming projects the Centre is working on including an analysis of variations in surgical care and outcomes in collaboration with the Australian Orthopaedic Association National Joint Replacement Registry and the Australian and New Zealand Society for Vascular Surgery, and another project on the prevalence and predictors of re-operation after breast conservation surgery. Her presentation concluded with a discussion of the risks and future of big data research including the issues of data breaches, and the increasing role that data scientists will play in helping to inform and shape the health services sector in Australia.
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. 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. 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.
Associate Professor Will Taylor (University of Otago), presented an update of the work he is leading to generate a multi-attribute decision-making tool to inform prioritisation of MSK research for ANZMUSC. 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, 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:
The 6 key attributes that have been identified as most important are: ;
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.
Session 1: Advisory Group updates
Dr Mary O’Keeffe (Institute for Musculoskeletal Health, University of Sydney), described the outcomes of the Early Career Ideation Workshop held prior to the annual meeting to inform the members about the groups thoughts on the ways and means through which ECR involvement in ANZMUSC could be increased. Some of the suggestions to come out of the workshop included creating an ECR working group with the ECR chair on the executive committee, creating an ECR stream within ANZMUSC (separate mailing list, online discussions), involving ECRs in grant review process, and reduced meeting fees for ECRs to facilitate attendance.
Ms Ornella Clavisi (Musculoskeletal Australia), provided a summary of the CAG pre-meeting workshop to discuss how to integrate consumers into all aspects of ANZMUSC. Some of the suggestions to come out of the meeting included developing an “involvement bank” to help researchers actively engage with consumers throughout life of the project, including consumer involvement as an ANZMSUC endorsement criteria, and including CAG members in seeding grants and PhD scholarships. Ornella also provided an update of the national MSK Research Registry being generated with researchers from ANZMUSC and Melbourne University which aims to involve consumers as research partners by providing a mechanism for consumers to be involved in all aspects of a research project including design, participation and dissemination. The website is still in testing phase.
Session 2: ANZMUSC Trial visits and Roadmap
Professor Chris Maher (Institute for Musculoskeletal Health, University of Sydney), presented on trial site visits that were conducted to assess the operational resources and needs of ANZMUSC trialists to understand what central services and training is needed to enhance the quality and efficiency of ANZMUSC trials. These visits were conducted for 7 endorsed trials and identified several strengths as well as a few weaknesses for which the group should consider providing templates and/or training. These included recommendations to address weaknesses for project plans, sites, data management, committee management, and training for individuals. Potential solutions for ANZMUSC to consider include specifying documentation required, providing exemplar SOPs for those without institutional access, and providing guidance on Data Safety and Monitoring Committees. Associate Professor Manuela Ferreira (Institute of Bone and Joint Research, University of Sydney), CIA for SUcceSS: SUrgery for Spinal Stenosis – a randomised placebo-controlled trial presented on her groups experience with the trial visits and the improvements that her team is undertaking to address the weaknesses found in the assessment of her trial.
Dr Anita van der Meer (Manager, Clinical Trials Support Unit at NSW Office of Health and Medical Research), gave a presentation on Trial support from the NSW Office of Health and Medical Research which aims to enable clinical trial capacity and capability in NSW. This support was particularly for phase 1 research in which dedicated early phase HRECs have been established.
Professor Jane Latimer, (Institute for Musculoskeletal Health, University of Sydney), gave a presentation on the achievements of ANZMUSC to date and described the manner in which the group has evolved over the last 4 years into an organisation with >300 members from >30 disciplines, with 9 consumers, 25 organisation members, 17 endorsed trials, 6 published protocols and 2 journal articles. Professor Latimer also presented the results of a recent member survey on ANZMUSC policies and facilitated a group discussion on some of the ways in which ANZMUSC could grow including through the expansion of working groups to address the needs of the organisation.
Session 3: Education Session
Associate Professor Laurent Billot (Director, Statistics Division, The George Institute for Global Health), presented on the topic of Adaptive Trial Designs and discussed the manner in which the may be useful for MSK trials. He discussed the main features and processes involved in the three main methods; combination testing (combines phases), multi-arm, multi-stage trials (extension of group sequential trials) and Bayesian adaptive designs (using posterior probabilities), as well as the challenges and advantages of these approaches.