The second ANZMUSC meeting for 2021 was once again held virtually. This online event attracted 168 attendees in total (124 attending across day 1 and 126 attending across day 2). These included researchers/clinicians from at least 20 research institutes (from Australia, New Zealand, the USA, and Brazil), two consumer representatives: Annie McPherson (VIC) and Dan Philp (QLD), and guest speakers including Prof. Joe Proietto (University of Melbourne), Dr. Caryn Zinn (Auckland University of technology), Prof. Stephen Messier and Prof. Shannon Mihalko (Wake Forest University), Ms Kathryn Craft (Nepean Family Metabolic Health Service), Dr. Nikki-Anne Wilson (NeuRA), Adj. Assoc. Prof. Rebecca Haddock (Deeble Institute), and Dr. Danilo de Oliveira Silva (La Trobe University).
The meeting included a session on the topic of weight management in chronic conditions (hosted by the OA SIG), a session on communicating research to target audiences including policy-makers and consumers (hosted by the ECF Committee), presentations from our ANZBACK-postdocs and clinical experts, progress updates of 2 ANZMUSC endorsed trials, and 12 new trial proposals (6 for MSK conditions and 6 back-specific).
DAY 1 Presentations:
Session 1: Welcome and Intro to our new SIG
Prof. Rachelle Buchbinder (Monash University & Cabrini Health) opened the meeting, providing some brief updates on the ANZMUSC Executive Committee (EC) as outlined below:
Outgoing: We thank Assoc. Prof. Will Taylor for his contribution to the ANZMUSC EC, particularly his valuable work on the priority setting tool. We also thank Prof. Jane Latimer and recognise her as being instrumental in the set up of ANZMUSC.
Incoming: We welcome Prof. Haxby Abbott as a New Zealand representative and Prof. Paul Hodges as he heads up the new Basic Science Special Interest Group (BSc SIG).
Rachelle thanked Dr. Sam Whittle, ANZMUSC Practitioner Fellow who leads the ANZMUSC national living guidelines. The first six of the ANZMUSC-produced guidelines are now NHMRC endorsed and we are part of the Australian Living Evidence Consortium. Rachelle recognised this as a really important output of ANZMUSC that has progressed significantly in the last two years.
Prof. Paul Hodges (University of Queensland), Prof. Chris Little (The University of Sydney), and Dr. Sam Whittle (University of Adelaide) introduced the new ANZMUSC Basic Science Special Interest Group (BSc SIG).
Prof. Paul Hodges spoke about ANZMUSC’s strong foundation for clinical trials, but the missing link of translation from basic science to clinical research. He defined the scope of the BSc SIG as including both:
- fundamental knowledge – new ideas, predicting and understanding phenomena etc.; and
- applied research – developing techniques and technology from basic research to alter outcomes (e.g new treatments
He described the SIG’s purpose as being a group of members with a common interest in advancing and conducting high quality basic science research (including pre-clinical translational animal research) within the area of musculoskeletal health and fostering interaction between basic science and clinical trials. He summarised the SIG objectives and terms of membership (which will be available to all ANZMUSC members).
Prof. Chris Little gave an overview of the ‘what, why, when, where’ of Basic Science research. He also described the bidirectional benefit the new SIG will have, for networking and connectivity, improving research rigour, and increasing funding/research opportunities.
Dr. Sam Whittle gave a report of interventional animal studies in rheumatology (slides courtesy of Dr. Kimberley Ting). He reflected on the spectrum of quality of reporting of animal studies, and suggested that the translational gap from successful animal studies through to humans may be hampered by poor quality animal studies as exemplified in their systematic review. He talked about successes such as the development of The Animal Research: Reporting of in vivo Experiments (ARRIVE) guidelines to improve the standards for reporting in animal studies. He emphasised the need for basic scientists and clinical researchers to work more closely together.
Slides from these presentations are available on the BSc SIG page.
Session 2: OA SIG: Weight management for OA and other chronic musculoskeletal conditions
Prof. Joe Proietto (University of Melbourne) presented on the biological regulation of weight. He gave examples of food restriction in mice, and how a genetic defect (the deletion of single receptor in the hypothalamus) can lead to a higher set point weight. He gave a brief overview of the hypothalamus and its multiple stimulators and inhibitors of eating, interactions with the brainstem, pleasure pathways, and modulators.
Dr. Caryn Zinn (Auckland University of Technology) presented on dietary interventions for weight loss. She described sustainability as what remains the largest challenge in overweight and obesity treatment. She profiled some of the translational research from the National Weight Control Registry (a US-based weight registry which is one of the longest running and most extensive), highlighting a number of traits or individual characteristics that positively influence success, including regular self weighing, food tracking, planning, less TV watching, and more exercise. Interestingly, common food based characteristics which influence success are varied, which highlights that one size doesn’t fit all. Dr. Zinn displayed results from a number of studies, all of which show some weight regain over time. However she did show how the low carb, high fat (LCHF) diet performs quite well in producing clinically meaningful short-term and long-term results including a change in metabolic and inflammatory markers. Whole foods and higher protein foods were also recommended. Prof. Zinn’s presentation slides are available here.
Prof. Stephen P. Messier (Wake Forest University) talked about the maintenance of weight loss, with consideration of self efficacy as a mediator between weight loss and key clinical outcomes. He shared findings about the pattern of pain reduction from combined diet and exercise compared to each done individually. This is a highly cost effective intervention, and has been shown to reduce pain by ~50% in the long-term. While a dietary weight loss recommendation is that 10% weight loss should be the primary goal, he reported that patients continue to see additional benefits (less pain and disability) from long-term intensive diet and moderate exercise. Prof. Messier also summarised the recently completed Weight-loss and Exercise for Communities with Arthritis in North Carolina (we-can) trial, a pragmatic trial addressing the common response of physicians – that there is a lack of practical means to implement weight loss and exercise treatments.
Prof. Shannon L. Mihalko (Wake Forest University) followed on from Prof. Messier to provide a clinical psychologist’s perspective to behaviour change. She explained the role of the program directors, interventionists, and staff not to make participants be adherent, confront things for them, or be their personal therapist, but instead to get to know them by talking to them and negotiating. She talked about the importance of SMART goals as a simple strategy for participants to receive feedback by seeing their own incremental success. Enjoyment, preference, leader behaviour, social support, and group dynamics are also important. She discussed tools and theory for self efficacy and participant confidence.
Ms. Kathryn Craft (Nepean Family Metabolic Health Service) presented on the topic of weight stigma. She summarised the many avenues through which stigma occurs. She reported that despite simplistic views of obesity being inconsistent with research, there is an alarming prevalence of weight stigma in healthcare settings which is associated with an increase in unhealthy eating and stress amongst many other damaging effects to overall health. Prof. Craft provided a number of helpful resources for considering weight stigma in clinical practice and research:
- UConn Rudd Center for Food Policy & Obesity
- Obesity Evidence Hub
- Canadian Adult Obesity Clinical Practice Guidelines (CPGs)
- World Obesity CME accredited e-learning modules
- Rubino, F., Puhl, R.M., Cummings, D.E. et al. Joint international consensus statement for ending stigma of obesity. Nat Med 26, 485–497 (2020). https://doi.org/10.1038/s41591-020-0803-x
Session 3: ANZBACK SIG: Postdoctoral presentations
Dr. Nathalia da Costa (The University of Sydney) presented about a current work-in-progress to build a repository of low back pain directives to help map the policy landscape and identify novel ways to transfer research outcomes into health policy and practice. Prof. Costa’s presentation slides are available here.
Dr. Hazel Jenkins (Macquarie University) presented about a pilot cluster-RCT (supported by ANZMUSC seed funding) to decrease imaging for low back pain (LBP). She also presented about the development of the LBP patient education booklet which was incorporated in this trial. This booklet was designed for a clinician to go through with the patient during a consultation. Slides available here.
Mr. Bayden McKenzie (Monash University & Cabrini Health) presented about a meta-review examining the consistency and agreement of treatment recommendations in high-quality clinical practice guidelines for low back pain. Guidelines exist for both clinicians and patients for the diagnosis and management of LBP based on the best available evidence however some are based on less rigorous methodologies. Mr. McKenzie presented his findings that there are many clinical practice guidelines but few of high quality and consistency.
To conclude the session, Prof. Mark Hancock (Macquarie University) discussed what ANZBACK set out to do as a CRE and focused attention forward about what we want to achieve in the next three years. ANZBACK has been developing a clinical advisory committee (eight members and growing) to give input to the CREs direction. Dr. Lari Trease, Mr. Micheal Ryan, and Mr. Tim Reus (clinicians from the clinical advisory committee) introduced themselves and provided feedback to some of the CRE’s main aims as outlined by Dr. Hazel Jenkins and Dr. Michael Di Donato.
DAY 2 Presentations:
Session 1: Trial Updates and Proposals
Dr. Eindra Aung (University of New South Wales) presented an update on the GAPP Trial (Effectiveness of an electronic patient-centred self-management tool for gout sufferers: the Gout App) which was endorsed by ANZMUSC in October 2017. She explained how gout is a chronic condition but can be given low priority by patients and practitioners alike, especially given co-morbidities may take precedence. While there are therapies to help lower serum urate to target levels (which is important to prevent flares), adherence is often low. Hence the development of a gout self-management app to improve adherence to ULT, thereby decreasing serum urate, decreasing gout attacks, and increasing quality of life. The last patient for the GAPP Trial was recruited in February 2020. Dr. Aung shared successful techniques for advertising of study which included flyers, hospitals, pharmacies, rheumatologists, GPs, and media interviews. Slides are available here.
Dr. Juliana Oliveira (The University of Sydney) provided an update on the progress of the Successful AGEing (SAGE) yoga randomised controlled trial. She gave background of the strong evidence for exercise programs in preventing falls, with high-challenge and high-dose working best. She highlighted the lack of RCTs to date that have been large enough to detect the affect of yoga on falls over the long term. SAGE addresses this gap and compared 12-month group-based yoga exercise to seated unsupervised yoga. Dr. Oliveira discussed alterations to the program due to the COVID-19 pandemic and reasons behind increasing their sample size. The trial has been highly successful and received positive feedback from participants. Slides are available here.
Assoc. Prof. Diana Perriman (Australian National University) shared a trial proposal related to knee alignment strategies. There are a substantial number of people who have alignment issues yet 15-20% of patients are not satisfied with surgery results. This trial aims to address patient dissatisfaction through investigating the effectiveness of Inverse kinematic alignment (iKA) which avoids tibial over-resection.
Prof. Haxby Abbott (University of Otago) presented a proposal for a dietary education, exercise therapy, and self management intervention for multi-morbidity in the New Zealand context including an ethnically diverse population. He explained methods to tailor the intervention to achieve equitable outcomes.
Session 2: Communicating research to your target audience (Hosted by the ECF Committee)
Dr. Giovanni Ferreira and Dr. Stephanie Filbay introduced the new ECF committee. They described the initial activities which include a survey for ANZMUSC ECRs and MCRs which will help form the 12-month priorities for the committee. They then introduced the session which focused on increasing research impact through effective communication to target audiences.
Dr. Nikki-Anne Wilson (NeuRA) presented on public speaking – which is a top fear for most people. She encouraged that conveying your love of your research is what is important, more-so than your personality, skills, or experience in presenting and engaging with audiences. She encouraged simplification, avoidance of jargon, and narrowing down key messages. Participating in Three Minute Thesis (3MT) or rapid fire presentations is great as this will form the basis of every talk you ever need to give.
Adj. Assoc. Prof. Rebecca Haddock (Deeble Institute) talked about engaging with policy makers. She discussed the realities of policymaking, which are not made in a vacuum but require the right evidence, at the right time, with the right people. Building on what Dr. Wilson said, she emphasised the importance of having a pitch. She acknowledged that it takes time and effort to have a compelling message which includes a call to action and takes into account the broader objectives of your audience. She encouraged researchers not to be afraid of using narratives and whitespace.
Dr. Danilo de Oliveira Silva (La Trobe University) provided an overview of the issue of researchers producing too many papers, with which no one can possibly keep up with. He discussed how to make research stand out and be visible. This is likely through a combination of strategies which he outlined. Open access is one great option for achieving geographical reach and increasing number of full text downloads. Dr. Oliveira Silva’s slides are available here.
Ms. Ornella Clavisi (MSK Australia & ANZMUSC CAG Chair) presented on “Translating research jargon to create empowered health consumers”. She discussed how often after research is conducted it appears in peer review journals, is published in health professional resources, or presented at scientific meetings – all of which are largely inaccessible to consumers. These may be quite technical, text heavy, or have pay walls associated with them. She spoke about how we live in a climate of misinformation and getting research to consumers in important – although our objectives need to be considered. Are we trying to raise awareness, change behaviour, call to action? Ornella encouraged collaboration with consumer organisations who can help with crafting messages and have networks. Ornella’s presentation slides are available here.
Session 3: New trial proposals
Dr. Jordan Davis and Dr. Catherine Bacon (The University of Auckland) proposed a trial for Adhesive Capsulitis (AC) or frozen shoulder. This condition takes months to years to get under control and often causes long-term pain. It also represents a significant burden for the New Zealand health system. They propose a large study comparing PRPI to intra-articular corticosteroid injections.
Dr. Christine Lin (University of Sydney) presented a proposal for the ORACLE trial. This is a cluster randomised trial for adults undergoing hip or knee arthroplasty, testing the effectiveness of an intervention package in reducing persistent opioid use after surgery.
Prof. Lyn March (University of Sydney) presented PROSPECT: PRedicting disease-mOdifying anti-rheumatic drug doSe reduction response in rheumatoid and Psoriatic arthritis with EConomic evaluaTion. The aim is to identify optimal down-titration strategies for DMARDs in people with severe RA or PsA.
Dr. Gustavo Machado (University of Sydney) presented ADAPT-ED. This trial addresses back pain, which is a top reason for emergency apartment visits. The aim of the trial is to compare effectiveness of non-opioid analgesic treatment strategies against opioids in managing LBP in the ED.
Prof. James McAuley (University of New South Wales) presented a proposal for the ZEUs trial. Given that most prescribed medicines for acute low back pain have limited analgesic effects, this trial aims to address an urgent priority. They plan to compare non-benzodiazepine hypnotic medicines or ‘z drugs’ (commonly used for promoting sleep for acute insomnia) with placebo for acute LBP.
Dr. Giovanni Ferreira (University of Sydney) presented a proposal for antidepressants for sciatica. They are still in the early stages of planning the trial but are interested in exploring antidepressant use for sciatic pain. This idea is rooted from systematic review findings, which are based on only very few studies with small sample size and high risk of bias.
Dr. Joshua Zadro (University of Sydney) presented a trial proposal to investigate a new treatment system to reduce waiting times for people with back pain.
Prof. Manuela Ferreira (University of Sydney) presented a proposal for a sham-controlled trial of radiofrequency denervation for chronic low back pain.
Dr. Gustavo Machado (University of Sydney) presented a second proposal for managing backpain. This trial focuses on a multifaceted strategy to reduce opioid use to those presenting to the ED with LBP.
Prof. Ian Harris (University of New South Wales) presented a proposal for a trial of reversed vs conventional shoulder replacement. This trial is also being conducted in the UK.
Prof. Rachelle Buchbinder thanked all speakers and attendees and closed the meeting.
