Given difficulties in planning both trans-Tasman and Australian interstate travel, the 2021 ANZMUSC annual meeting was held virtually. This online event attracted ~100 attendees, including researchers/clinicians from approximately 40 research institutes and/or hospitals, two consumer representatives: Annie McPherson (VIC) and Ben Horgan (WA), and guest speakers including Prof. Paul Garner (Coordinator, Centre for Evidence Synthesis for Global Health; Coordinating Editor, Cochrane Infectious Diseases; and Director, Research, Evidence and Development Initiative (READ-It), UK) and Assoc. Prof. Philip Robinson (Senior staff specialist, Royal Brisbane and Women’s Hospital; and Associate Professor, University of Queensland).
The 2021 meeting included progress updates of five ANZMUSC endorsed trials, presentations relating to the ANZMUSC priority topic of opioid deprescribing, and two new trial proposals. In addition, 8 ANZBACK-associated early career researchers presented projects.
Session 1: From the personal to the academic
Professor Paul Garner (Liverpool School of Tropical Medicine). Paul shared his personal experiences of contracting COVID-19 and suffering from ‘Long COVID’, which he has also written about in the BMJ and the Guardian.
Paul recounted contracting COVID-19 followed by 6 weeks of a variety of strange and extreme symptoms which made him think he might not survive. He described his subsequent lapse into a post-viral fatigue which brought severe headaches and made it near-impossible for him to read. Despite being in the medical field, he found it hard to negotiate the disease. For him, this translated into excessive monitoring of sleep patterns, fears of having Myalgic Encephalomyelitis (ME) for life, to suspecting sugar allergies after consuming too much cake. He believed he had a biological illness crippling him from the inside out. This is when he discovered activist groups on Facebook that shared similar experiences of never fully recovering after COVID. He participated in conversations in this group where members tried to identify a cure. Seven months after his initial diagnosis, he was referred to an ME specialist.
In a desperate attempt to find a remedy, Paul reached out to his networks and ended up chatting to someone from Norway who had recovered from post viral fatigue syndrome (CFS/ME). It was through this connection that he began thinking about his illness in a different light, and which ultimately helped him to recover. Prof. Garner indicated that for him, both mindset and graded exercise therapy were instrumental in his recovery. Paul also discussed how his experience of recovery has been seen as a threat to some Long COVID advocacy groups.
Associate Professor Philip Robinson (University of Queensland) presented on the COVID-19 Global Rheumatology Alliance (GRA), established in March 2020 to collect and disseminate accurate information for improving care for rheumatic patients in the pandemic.
Collaborating with EULAR database, ACR, and many others, a REDCap registry was formed for healthcare providers to enter data about their rheumatology patients with COVID-19 infections. Assoc. Prof. Robinson spoke about the organic and fast-paced formation of the registry which was sparked by social media.
He presented findings from this registry work which have been recently published (https://doi.org/10.1136/annrheumdis-2020-219498). He also reflected on the durability of the GRA, specifically relating it to ANZMUSC. He explained some of the factors which worked well, including having an urgent common goal, having heavyweights present yet not driving the process, collaboration across locations and career stages, and patient engagement.
Some of the main difficulties faced were other time commitments including clinical COVID care, working across different time zones, language and cultural integration, and engaging in a large collaborative project where many collaborators were unknown. Being a committee-driven process with broad representation and collaboration as well as having strong patient involvement were positive aspects that stood out. He closed by offering some points for reflection about whether the model could be improved and expanded to answer important questions in MSK disease, and how this sort of activity could be funded.
Session 2: Endorsed Trial Updates
Tash Pocovi (Macquarie University) presented an update of the Walkback trial which is evaluating a walking and education intervention to prevent recurrence of low back pain (ACTRN12619001134112). She noted and reflected on key learnings and necessary modifications to the trial as a result of COVID. Over the last year, the trial has expanded beyond NSW to include trained clinicians in QLD. Enrolled participants have increased by more than 6-fold, the follow-up rate has remained high and compliance with sessions has also been high. Recent modifications include intervention delivery via telehealth and expanding the use of REDCap. The trial is progressing well and is on track to be complete by the end of 2021.
Andrew Lawson (University of New South Wales) presented the recently published 12-month results of CROSSFIRE which compared operative and non-operative treatment for people with wrist fracture (https://doi.org/10.1001/jamasurg.2020.5672). The 24-month outcomes and radiographic outcomes will be reported separately.
Dr Verinder Sidhu (University of New South Wales) presented an update of the CRISTAL trial, a cluster-randomised crossover trial of aspirin versus low-molecular weight heparin (LMWH) for prevention of DVT and PE after hip or knee replacement surgery (ACTRN12618001879257). Challenges have included compliance with the study protocol and clinical equipoise, and suspension of the trial at one site that necessitated formation of a DSMC and early cessation of recruitment based upon a pre-specified stopping rule. The trial results are expected to be published later this year.
Professor Christine Lin (University of Sydney) gave a quick update about both OPAL (ACTRN12615000775516) and OASIS (ACTRN12619001716156). Follow up of OPAL investigating the benefits and safety of opioids for acute low back pain or neck pain is expected to be completed by March 2022. She noted that it has taken five years from first to last participant recruited. OASIS, which is assessing the value of oral glucocorticoids for acute lumbar radiculopathy, has only just commenced recruitment due to significant delays in obtaining all necessary approvals. She presented eye-opening metrics around the thousands of hours spent on trial activities as well as valuable additions including having a study website where clinicians and patients can find information and where a video is housed to complement the trial explanation given by doctors, and successful use of social media for recruitment.
Session 3: ANZBACK Early Career Researchers
Dr Julie Ayre (University of Sydney) presented ‘Exercise programs for low back pain prevention: An interview study with people living with recurrent or fluctuating low back pain’.
Michael Di Donato (Monash University) presented his plan to identify population-level healthcare quality indicators for compensated workers with low back pain using data from a multi-jurisdictional database (MJD).
Alla Melman (University of Sydney) presented on reducing avoidable hospital admissions for LBP, specifically, a systematic review of global rates of hospital admission for non-serious LBP.
Professor Rachelle Buchbinder (Monash University & Cabrini Health) presented a brief update on the activities of ANZMUSC since the last meeting in October 2020 and welcomed Helen Ramsay as the new network manager and research assistant.
The 2020 survey results describing the impact of COVID-19 on the MSK trial sector has now been accepted for publication as a letter in the Internal Medicine Journal.
ANZMUSC continues to provide advice to new clinical trial networks and it also contributed to an ACTA paper to be submitted to Trials that outlines the steps in forming a new network. ANZMUSC have also commissioned
The George Institute to provide a library of best practice trial documents that will be available on the website shortly.
The first set of recommendations in the National Living Guidelines for pharmacologic management of inflammatory arthritis are currently being considered for NHMRC endorsement
National Living Guidelines for the management of juvenile idiopathic arthritis are underway.
A call for applications for 2021 seeding grants will be made shortly.
Session 1: ANZMUSC priority topics and new trial proposals
Amanda Cross (Monash University) presented the results of a qualitative evidence synthesis describing the barriers and enablers to deprescribing opioids for chronic non-cancer pain. This data will inform the development of theory-based interventions for deprescribing opioids for these conditions.
Melanie Hamilton (University of Sydney) presented the results of two qualitative studies (GPs and patients) also identifying barriers, facilitators and resources needed for opioid deprescribing in primary care. She noted there were some similarities and some differences between qualitative studies.
Professor Simon French (Macquarie University) described a trial to test the effectiveness of a team-based model of care early in LBP which involves GPs and rapid referral to MSK clinicians as case managers. This trial plans to replicate a Canadian trial but taking into account the Australian context. ANZMUSC endorsement for this trial has not been sought (as yet).
Session 2: ANZBACK Early Career Researchers
Dr Gustavo Machado (University of Sydney) presented on behalf of Simon Vella whose research program will consider paramedic care for people with LBP.
Dr Danielle Tran (University of New South Wales) presented preliminary utilisation data for elective spinal procedures in NSW.
Dr Giovanni Ferreira (University of Sydney) presented a trial proposal about a second opinion program to reduce unnecessary lumbar fusion in the workers’ compensation sector based upon a similar study that was performed in Brazil.
Bayden McKenzie (Monash University and Cabrini Health) discussed his PhD project concerning the environmental impact of back pain care.
Dr Hazel Jenkins (Macquarie University) presented her programs of work to identify evidence gaps and evidence to practice gaps relating to LBP using evidence mapping.
Professor Chris Maher (University of Sydney) provided an overview of the ANZBACK CRE and how this has drawn in collaborators from different fields with expertise in qualitative studies, data linkage, evidence gaps, health policy, media/education, trials/reviews, health economics and the workers’ compensation setting.