February 11th – 12th 2020,
University of Otago, Wellington New Zealand
Meeting and venue sponsors:
ANZMUSC was delighted this year to strengthen connection within and between its New Zealand members by holding its first annual meeting in Wellington at the University of Otago. Over the course of 2 days we brought together 60 delegates from 18 different research institutes and/or hospitals including 3 consumer representatives: Mr Dan Philp (QLD), Mr Ben Horgan (WA) and Ms Jane Clark (NZ); 4 consumer health organisation representatives and guest speakers and panellists including Dr Sarah-Jane Paine (Tamairo Research Co-Director, Auckland), Professor Kathryn McPherson (Deputy VC of Auckland University of Technology, Auckland and former CEO and former Chief Executive of the Health Research Council of New Zealand) and Professor Rachael Morton (Director – Health Economics from the NHRMC Clinical Trials Centre, Sydney).
The 2020 meeting included a mix of 6 new and developing trial proposal presentations (4 of which were focused on osteoarthritis) as well as 2 more advanced trial proposal presentations. The meeting also had updates on the progress of 13 endorsed trials (Table 1).
Table 1: Progress updates of ANZMUSC endorsed trials
|Update on the feasibility of NUDGED: a trial of a behavioural intervention to reduce unnecessary imaging in Emergency Departments||Dr Adrian Traeger, Institute for Musculoskeletal Health, The University of Sydney|
|A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE)||Professor Ian Harris, University of New South Wales, Sydney|
|SUcceSS: Surgery for Spinal Stenosis – a randomised placebo-controlled trial||Professor Manuela Ferreira, The University of Sydney|
|Best pRactice surgical and refracTive management of cataract: the BRIGhT trial randomised controlled trial pilot study||Professor Lisa Keay, UNSW, The George Institute|
|Effectiveness of an electronic patient-centred self-management tool for Gout sufferers||Dr Matthew Coleshill, University of New South Wales|
|Oral steroids in acute sciatica: The OASIS Randomised Control Trial||Professor Chris Maher, Institute for Musculoskeletal Health, The University of Sydney|
|OPAL – Opioids for Acute spinal pain||Ms Caitlin Jones, Institute for Musculoskeletal Health, The University of Sydney|
|WalkBack: Preventing the recurrence of low back pain||Ms Tash Pocovi, Macquarie University|
|Implementation of an evidence-based model of care for low back pain in emergency departments : the Sydney Health Partners Emergency Department (SHAPED) trial||Professor Chris Maher, Institute for Musculoskeletal Health, The University of Sydney|
|DICKENS – A randomised controlled trial of DiaCerein to treat KneE osteoarthritis with effusion-Synovitis||Associate Professor Dawn Aitken, Menzies Institute for Medical Research, Tasmania|
|PEAK – A non-inferiority trial comparing different modes of physiotherapy service delivery and their effect on knee pain and physical function in people with knee osteoarthritis||
Professor Rana Hinman, University of Melbourne
|ECHO – Effects of an intensive diet program in addition to exercise in people with hip osteoarthritis who are overweight or obese: a randomised controlled trial||Professor Kim Bennell, University of Melbourne|
|Physical activity coaching for adults with mobility limitations: the ComeBACK pragmatic randomised controlled trial||Professor Rana Hinman, University of Melbourne|
On the evening prior to the start of the meeting, 21 early career and 12 senior researchers came together for an informal networking session. During this session, Dr Ben Darlow encouraged participants to meet and get to know each other using the Māori principles of ‘Whakawhanaungatanga’ where people are encouraged to make connections by sharing details of who their family is, where they are from and their culture. It was also a chance for them to ask each other questions about their career plans to date and offer words of wisdom to each other.
We also had an Osteoarthritis Special Interest Group breakfast meeting (sponsored by the Centre for Musculoskeletal Outcomes Research, University of Otago). A presentation was provided by Mr Simon Duff, Acting Manager, System Flow, and Ms Laura Seary, Clinical Principal Advisor – Allied Health titled “Ministry of Health Priorities, programmes, initiatives, and plans for the future related to musculoskeletal health”. There was also an informative presentation on the impact and management of the rising osteoarthritis burden in New Zealand presented by Professor Haxby Abbott.
DAY 1 Presentations:
Session 1: Māori health advancement in MSK Research
Following on from a traditional Mihi whakatau and welcome from Professor William Levack (University of Otago Dean and Wellington Campus Head) we heard from Dr Sarah-Jane Paine (Tomaiora Research Co-Director, University of Auckland). Dr Paine presented on the NZ Health Research Strategy’s guiding principles to enhance the impact of research investment including: 1) encouraging research excellence by embracing diverse approaches; 2) encouraging environments that stimulate innovative ideas; and 3) conducting ethical trials that respect participants and their mana (respect and prestige).
Dr Paine spoke of the principles underpinning the priorities of the research strategy including advancing Māori health, achieving health equity and of the importance of establishing meaningful connections (both planned and random). She highlighted the NZ Ministry of Health’s framework for equity of healthcare for Māori and its central focus on leadership, knowledge and commitment including the need for clinicians to consider the impact of themselves and their own culture. Dr Paine highlighted some of the successful clinical research and public health campaigns conducted recently in New Zealand and discussed some of the factors involved in their achievement in improving health equity for Māori groups. This included Māori governance, Māori researcher nurses and targeted recruitment to ensure Māori people were well represented in study populations. Dr Paine finished her presentation by highlighting the value of commitment and effective partnering practices that ensure that the principles of the Waitangi treaty are included in health research and the need for ANZMUSC to consider integrating these practices into its work.
Professor Nicola Dalbeth (Faculty of Medical and Health Sciences, University of Auckland) presented on the value of working with Māori in gout research. This work is part of a larger suite of work aiming to improve musculoskeletal outcomes in Aotearoa/New Zealand.
The session ended with a brief update from the ANZMUSC Chair, Professor Rachelle Buchbinder (Monash University & the Cabrini Institute) on the achievements and activities of ANZMUSC including a brief history of the development of the groups’ mission, values, guiding principles and the evolution of its structure. Professor Buchbinder also highlighted the many achievements of the group to date including several publications, presentations and additional grants including being one of several collaborative partners of an Australian Department of Health grant led by the Australian National Prescribing Service (NPS). She concluded her presentation by highlighting some the ongoing research work being supported by ANZMUSC including support for the 20 endorsed trials, living reviews and guideline development projects, development of a multi-attribute priority setting tool, and PhDs and Masters scholarships that ANZMUSC is continuously establishing in collaboration with its numerous university, hospital, consumer and professional association supporters.
Session 2: Updated ANZMUSC endorsement process
Professor Ian Harris (University of New South Wales) spoke on the role and value of trial endorsement for both individual researchers, as well as ANZMUSC and the broader community as a whole. He provided an update of the endorsement process which includes presentation at an annual scientific meeting, an application for endorsement, review by the Scientific and Consumer Advisory Committee and a final decision by the Executive Committee. He also highlighted the requirement for endorsed trials to adhere to the ANZMUSC publication policy (now simplified to remove confusion around authorship) which requires trial registration prior to recruitment and acknowledgment of endorsement on publications, and presentation of updates at ANZMUSC annual meetings.
Session 4: Research prioritisation tool and frameworks
Professor Racheal Morton (Director, Health Economics – NHMRC Clinical Trials Centre) presented on work being conducted by the Australian Clinical Trials Alliance (ACTA) to develop a Research Prioritisation Framework for Clinical Trial Networks and Funders. The development of this framework has involved three key steps:
1) Pragmatic review
The review identified 3 main prioritisation methods; interpretive, quantitative and blended approaches. All of these methods have strengths and weakness with regard to their engagement, transparency and evidence which must be considered in adopting any of these methods.
2) Survey of prioritisation processes used by clinical trial networks
This identified several factors that the clinical trial networks have considered in developing priorities but noted that since trials must be funded, the criteria of the funding scheme often became the groups’ criteria to ensure ‘fundability’. Professor Morton also discussed the manner in which the topics of the groups’ priorities are limited by the funding landscape and highlighted the fact that most groups attempted to assess priorities based on some combination of their significance, scientific quality, feasibility, fundability, equity and importance to consumers to varying extents.
3) Stakeholder consultation
Professor Morton described the engagement of stakeholders to inform the framework with the identification of 4 final criteria; relevance; appropriateness; significance; feasibility and value for money.
The newly developed framework consists of 10 steps: formation of a leadership team; develop objectives of the exercise; engage stakeholders; develop selection criteria; develop methods to weigh and score criteria; identify topics select topics; generate research proposals; select research proposals; conclude and evaluate the process.
Lastly, Professor Morton discussed the next steps for the ACTA group including weighting criteria and assessing the value for money for proposed ideas to ensure that ideas consider maximum return on investment.
Associate Professor William Taylor (University of Otago), presented an update in the development of the Research Question Importance Tool (RQIT) which 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 and has consisted of several steps to date including a literature review of priority-setting projects for MSK trials to identify how priorities have been identified (and the priorities themselves); Delphi survey and workshop to identify the key attributes and their scales; and consensus workshop to refine the attributes. A reliability exercise was conducted which resulted in refinement of the framework wording and the development of a “how-to” handbook to help improve the reliability.
Finally further validation work was conducted based upon trials published in ‘top’ and ‘bottom’ MSK journals according to Impact Factor. Overall, the study found mixed results for the attributes with regard to their association with journal impact factor, citation and reliability. Further refinement of the framework is being considered including removal of the ‘Implementability’ attribute and then a final study will be performed to develop weightings for the attributes of the tool using discrete choice experiments.
DAY 2 Presentations
Session 5: Funding opportunities, difficulties and strategies for MSK Research
Associate Professor William Taylor (University of Otago) gave an overview of the funding landscape in New Zealand. Similar to Australia, a major concern is that MSK is not seen as having a high burden, does not have a unique category within the HRC scheme and is not included as a priority condition for the National Science Challenges. He noted that there have been many government strategy documents related to healthcare and research, but that these have focused on improving IT infrastructure. Finally he noted that priorities discussed in the NZ Health prioritisation framework aligned with the values, mission and work being conducted by ANZMUSC.
Professor Chris Maher (Director, Institute for Musculoskeletal Health, The University of Sydney) spoke of the MSK research landscape in Australia. While the AIHW does report high burden of MSK conditions (3rd highest disease burden), MSK data is completely missing from the more detailed assessments that policy makers use to develop priorities. He outlined the lower amount of amount of NHMRC funding for MSK research compared to other priority conditions such as diabetes (but same proportionally indicating a workforce shortage), and showed that this is also true of MRFF funding noting that MSK is not a current MRFF priority. To increase chances of research success he discussed alternate strategies from the traditional clinical trials portal.
Session 6: Osteoarthritis – Perspectives, priorities and possibilities in Australia and New Zealand
Professor Haxby Abbott (Department of Surgical Sciences, Dunedin School of Medicine, University of Otago) gave the New Zealand perspective noting the many NZ OA research groups such as the Bone and Joint Research group, Christchurch Regenerative Medicine and Tissue Engineering Group, and Centre for Musculoskeletal Outcome Research Group. He described the NZ model of care for OA and the Mobility Action Plan Programme being piloted currently. He also described high-level priorities identified at the 2017 Australian OA Summit including prevention, non-surgical and surgical interventions. A NZ OA Summit is planned for in 2020. He also outlined his plans for an OA fundraising road trip from the top to the bottom of New Zealand.
Professor David Hunter (University of Sydney and Royal North Shore Hospital) presented priorities that had been identified in the US, Europe and UK and the National OA strategy which was developed as part of the 2017 Australian OA summit which was based upon identification of priorities by stakeholders and then group consensus based upon 1000 minds discrete choice software. The top 3 priorities include treatment adherence and behaviour change; disease modification to slow progression, and prevention.
Session 8: Embedding PROMS and trials in registries, ANZBACK and ECR activities
Professor Rachael Morton (Director, Health Economics – NHMRC Clinical Trials Centre) presented a project that is using the ANZDATA registry at haemodialysis units to monitor patient symptoms which are then reported to the treating clinicians for consideration at the next clinical encounter. Using the registry has simplified data collection and minimised the amount of extra work required by dialysis nurses. Each patient has a unique QR code that is attached to their records. To enter responses to the symptom monitoring questionnaire directly into ANZDATA registry the code is scanned which opens the questionnaire on an iPAD. This system has been particularly useful in getting a high level of survey completion and retaining a high level of staff engagement.
Professor Ian Harris (University of New South Wales, Sydney) presented on an MRFF application for funding to enhance and improve clinical trial infrastructure in rural, region and remote areas of Australia that he is preparing in association with the Australian Orthopaedic Association. The application will be based on using a clinical trials platform for MSK conditions such as OA, back pain, sports injuries and falls that the AOA developed.
Professor Chris Maher (Director, Institute for Musculoskeletal Health, The University of Sydney) described the new ANZBACK Special Interest Group that received CRE funding commencing in 2020. This group aims to specifically address poor care, lack of data systems to routinely monitor quality of care & health outcomes and significant knowledge gaps. Plans include development of Clinical Care Standards which will include development of indicators of high- and low-value care; identifying drivers of poor care; a core back pain curriculum for healthcare programmes; and improving communication of scientific results through training of both clinicians and reporters.
Dr Ben Darlow (University of Otago) provided some light-hearted and serious thoughts about the early and senior researcher networking session. He shared of pearls of wisdom: making dedicated time for research; persistence in the face of rejection; embracing opportunities even if outside of planned career direction); acknowledging that there is no one career path but many; and senior researchers are really not that scary so they can be approached without fear. He outlined the Māori principles of ‘Whakawhanaungatanga’ and suggested consideration be given to consider methods of meeting and greeting specific to indigenous Australians and other cultures at the next ANZMUSC meeting.