The April 2022 ANZMUSC meeting was held via Zoom. This online event attracted 125 attendees in total (101 attending across day 1 and 81 attending across day 2). These included researchers/clinicians from at least 42 universities, research institutes, hospitals, and local health districts (from Australia, New Zealand, Argentina, Brazil, Denmark, Greece and Spain), two consumer representatives: Annie McPherson (VIC) and Ben Horgan (WA), and guest speakers including Prof. Anthony Harris (Centre for Health Economics, Monash University), Mr. Blaise Agresta (Manager of Health Technology Assessment, NHMRC Clinical Trials Centre, University of Sydney), Assoc. Prof. Jo-Anne Manski-Nankervis (Academic GP, Department of General Practice, University of Melbourne), and Dr. Jocelyn Bowden (Kolling Institute of Medical Research, University of Sydney).
The meeting included keynote sessions on economic evaluation in musculoskeletal research (organised by Dr. Sean Docking and Prof. Haxby Abbott) and conducting research in the general practice setting (hosted by the OA SIG). There was a discussion on the new Low Back Pain (LBP) Clinical Care Standards, presentations from our ANZBACK-postdocs, an educational session on how to partner with consumers (led by the CAG) and progress updates for 2 ANZMUSC-endorsed trials.
Session 1: ANZBACK Postdoctoral Presentations
Dr. Hazel Jenkins (Department of Chiropractic, Macquarie University) talked about her work, focusing on a major project that aimed to identify evidence gaps and research redundancy (too much evidence) assessing the effectiveness of ten approaches to managing non-specific LBP. She utilised evidence mapping, the methods of which were presented at a previous ANZMUSC meeting, and this time she discussed the results.
Dr. Julie Ayre (School of Public Health, University of Sydney) talked about the importance of including consumer/patient perspectives in research and provided an overview of some qualitative and co-design methods. She has published in the journal PAIN on this topic.
Dr. Duong Tran (Centre for Big Data Research in Health, University of New South Wales) presented the fascinating trends of elective spinal procedures in NSW according to funding type (i.e. public, private, and workers compensation), as well as patients’ post-op outcomes.
Dr. Michael Di Donato (School of Public Health and Preventive Medicine, Monash University) talked about his work which utilises large health datasets and identifying factors associated with health service use for people with low back pain. Specifically, he discussed an exploration of medicine data for compensated Australian workers with LBP and other musculoskeletal disorders.
Dr. Nathalia Costa (Menzies Centre for Health Policy, University of Sydney) gave a brief overview of recent work and a new upcoming work – What hinders low back pain and how to improve it?: An investigation of stakeholders’ perspectives, which aims to identify gaps, overlaps, and systems inefficiencies within the Australian healthcare system in terms of low back pain care.
Ms. Anagha Killedar (School of Public Health, University of Sydney) shared the early stages of a new project to develop a health economic model of low back pain care pathways. Her talk focused on the aims, methods and possible outcomes of the model. Populating the proposed decision tree nodes with appropriate parameters could help to answer ‘what-if’ questions such as “If we reduced admissions following ED presentation by 5%, what would the saving be to the health payer within one year?”
Session 2: ANZBACK discussion: The Low Back Pain Clinical Care Standards
Dr. Fiona Blyth, Dr. Carmen Huckel Schneider, Dr. Nathalia Costa and Prof. Chris Maher facilitated a discussion around the role, dissemination and use of the upcoming Australian low back pain clinical standards developed by the Australian Commission on Quality and Safety in Health Care.
Clinical care standards aim to encourage delivery of best-practice care, differing from guidelines primarily by distilling a small number of quality statements which are major priorities to get right. They also provide a set of indicators to support local monitoring in terms of whether or not the standards are being met.
There were three questions posed for comment in Padlet followed by discussion. These were:
Session 3: Making sense out of dollars – Incorporating economic evaluations to advance
Prof. J Haxby Abbott (Centre for Musculoskeletal Outcomes Research, University of Otago) presented an introduction into health economic evaluations for clinical trialists. He described the framework of a traditional randomised controlled trial, with the addition of measuring costs completely and consistently across arms and across time. He described how economic evaluation can help us to answer the question “Should we use a treatment that has been found to be ‘effective’ in a clinical trial?”, particularly by looking at trade-offs. He described cost-effectiveness and cost-utility analyses and some of the figures commonly calculated and presented.
Prof. Anthony Harris (Centre for Health Economics, Monash University) gave a talk on conducting trial-based economic evaluations. He illustrated some of the main concepts that Prof. Abbott discussed using a trial that he has recently completed. He explained the aim of economic evaluation, to determine the net benefits of an intervention, however he explained that the data collected can vary greatly depending on how narrow or wide the scope that is considered e.g. exploring non-health outcomes or modelling beyond the study/over a lifetime. He raised a number of helpful limitations and considerations such as measurement errors in data collection, sensitivity and precision of cost measures and quality of life and moving towards a Bayesian approach.
Mr. Blaise Agresta (Manager of Health Technology Assessment, NHMRC Clinical Trials Centre, University of Sydney) then explained how drugs, tests, and procedures are funded through Medicare – building on the previous talks in relation to policy and implementation. He summarised the basics of the Australian healthcare system and the pathway to listing on the MBS/PBS, and what influences PBAC/MSAC. He also emphasised the importance of including quality of life instruments when developing a clinical trial, and that this will ultimately impact other aspects like productivity.
All speakers contributed to a panel discussion.
Session 1: Insights from conducting research in the general practice setting
Assoc. Prof. Jo-Anne Manski-Nankervis (Academic GP, Department of General Practice, University of Melbourne) presented “Not about us without us: How to engage with general practice to design and implement research”. She explained the opportunity for research participation within general practice but the need for research to be highly clinically relevant for GPs to consider involvement. She discussed Practice Based Research Networks (PBRNs) that provide infrastructure for and facilitate research, and gave an overview of feasibility analysis, recruitment and budgeting.
Dr. Jocelyn Bowden (Kolling Institute of Medical Research, University of Sydney) talked about optimising primary care management of knee osteoarthritis, drawing on implementation and fidelity considerations from the PARTNER trial. She summarised the core and adjunctive care that are recommended for OA. To address lack of knowledge, time constraints for delivering care, and a lack of additional support services to undertake necessary lifestyle and behavioural changes, the team developed a new model of service delivery for primary care. This model involved 2 distinct and interrelated parts targeting GPs and a Care Support Team. She touched on the primary effectiveness results and the preliminary results from the process evaluation, including some of the barriers faced along the way.
Assoc. Prof. Ben Darlow (Primary Health Care and General Practice, University of Otago) provided a highly practical session entitled “Ten lessons from working with GPs”. He recommended things like understanding their context, fix their problems, use their time wisely and give tools not rules.
Prof. Mark Nelson (Menzies Research Institute, University of Tasmania) has conducted numerous large clinical trials in general practice related to cardiovascular disease prevention. He presented some lessons learnt from a past trial (ANBP2) and ongoing studies ASPREE and STAREE. These lessons included recognition of the GP’s role, keeping practice and practitioner burden low, and having flexibility to accommodate variety in general practice.
Session 2: Partnering with consumers on a MSK research team and project
Ms. Annie McPherson presented a summary from the formation of the ANZMUSC Consumer Advisory Group (CAG) until now. She summarised the contributions and milestones of the committee and some of their current focuses.
Mr. Ben Horgan introduced consumer and community involvement (CCI) and highlighted the difference of involvement vs. participation or engagement. He discussed how one might do this at all stages of the research cycle including deciding what to research, how to do so, doing it, disseminating results, and knowing what to research next. He provided a summary of the recent ANZMUSC recruitment of new consumers for the CAG and reiterated that this group is invaluable for researchers.
Session 3: New trial proposals & trial updates
Mr. Rana Dhillon (University of Melbourne & St. Vincent’s Hospital) presented a proposal for an Australian arm of “POsterior Laminectomy and FIXation for Degenerative Cervical Myelopathy (POLYFIX)”. He described the DCM condition, treatment options and patient outcomes. He also explained how the trial addresses a key question identified through a community engagement process.
Prof. Ian Harris (University of New South Wales) presented an update of the ARC (Australian Rotator Cuff) Trial, a placebo controlled randomised trial of repair of degenerative rotator cuff tears that is currently recruiting patients. He described why they are doing the trial, participant support, maintaining blinding, and why a patient would want to participate.
ANZMUSC Update and Meeting Close
Prof. Rachelle Buchbinder first thanked all the organisers, speakers, and attendees. She gave a few final announcements including: