- Title
- New perspectives to improve the impact of musculoskeletal research
- Creator
- Gleadhill, Connor Patrick Colin
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2024
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background Musculoskeletal conditions, such as spinal pain and osteoarthritis, create the most burden of all chronic health conditions and represent a significant global challenge. An ageing population and the significant cost of care provision calls for changes to improve outcomes and reduce the burden associated with musculoskeletal conditions. Primary care delivery, as the first access point to the healthcare system, must change. Significant system-wide, structural changes are needed. However musculoskeletal care must be guided by evidence and the translation of evidence into practice is often inefficient and wasteful. Efforts to bridge the musculoskeletal evidence-practice gap and improve the impact of research are needed. This thesis aims to improve knowledge translation for musculoskeletal research. I have done this through reviewing and recommending better structural support for care delivery, piloting ways to bridge the evidence-practice gap and exploring issues with evidence dissemination and implementation. Chapters and Results Chapter Two is a review of the systemic, organisational, and interprofessional barriers to allied health integration in Australian primary care. Recommendations from Chapter Two include developing regionally specific integrated funding models (e.g., bundled care models unique to local workforce and population needs), supporting shared governance through clinical networks, and improving digital connectivity. Chapter Three is a description of the establishment process of a practice-based research network in the Hunter Region of New South Wales. The network aimed to connect clinicians and researchers and support research coproduction. Chapter Three provides data on clinicians’ motivations to become involved in the network. Motivations include improving the relevance of research and connecting with researchers to promote evidence-based care and solve problems with care delivery. Chapter Four is a three-stage consensus study to define high value musculoskeletal care. This work stemmed from, and was coproduced with, the network from Chapter Three. The findings from Chapter Four demonstrate that evidence shows high value care as a comprehensive construct involving four domains (patient values, cost-effectiveness, waste reduction, and high-quality care). The study provided additional aspects of high-value care from the physiotherapist’s perspective, including additional themes, definitions, and consensus statements, alongside a conceptual model for care delivery. Chapter Five is a mixed-methods study that assessed physiotherapist’s barriers and enablers to accessing and applying evidence in practice. Results demonstrate that environmental, social and systemic factors like workplace support, resource availability, funding issues and research relevance can hinder or facilitate evidence access and application. Chapter Six is a systematic review that assessed the language and methods in musculoskeletal observational research. The results show that almost two-thirds of observational studies have ambiguous or misaligned language and methods. Chapter Seven is a causal mediation analysis of a randomised trial of a healthy lifestyle intervention for low back pain. The study found that two mediators (pain self-efficacy and diet quality) explained the majority of the total effect. Implications of findings To improve structural support for primary care delivery, policy changes to funding models should take an evidence-based approach and involve methods to target behavioural barriers on a practice level. In addition to these changes, overcoming systemic barriers to integration can be achieved through collaborative commissioning between the state and federal governments. Improved interprofessional integration can be achieved by ensuring allied health are included in existing digital infrastructure like My Health Record. To improve knowledge translation and evidence impact, researchers working with end-users (e.g., by collaborative production (coproduction)) is enthusiastically embraced by funders. While there is motivation from clinicians to work collaboratively, end-user led research may be an unrealistic proposition for busy clinicians. Further research should aim to understand the impact of networks, such as the one established in Chapter Three, because there may be additional benefits to membership beyond traditional knowledge advancement metrics (like publishing peer-reviewed papers). Coproduction was applied in Chapter Four and additional themes - effective and accountable care – demonstrate a potential disconnect between clinical practice and policy. Procedural elements of delivering evidence-based care could be added to current guidelines and policy makers could establish mechanisms to ensure physiotherapists more regularly peer-review each other’s practice. The environmental factors that hinder (and facilitate) evidence application from Chapter Five can be targeted with implementation strategies to improve evidence uptake. For example, researchers could work with clinicians to determine the effect of workplace support for evidence-based practice by providing paid time to access evidence. Chapter Six highlights the need to further explore the hesitation behind researchers’ use of language, particularly causal, in musculoskeletal observational research reporting. While including lists of recommended terms in existing reporting guidelines is a worthwhile start following Chapter Six, evidence suggests researchers behaviour is not impacted through the passive dissemination of reporting guidelines. Finally, the causal mediation analysis in Chapter Seven provides evidence suggesting that clinicians may improve low back pain outcomes by targeting pain self-efficacy. Lifestyle coaching may enhance patient’s confidence and mastery over other behaviours, and this could contribute to an increased confidence to function despite pain. More regularly embedding causal mediation analyses into musculoskeletal research will allow the understanding of causal mechanisms and enhance the translation of evidence into practice.
- Subject
- primary care; musculoskeletal conditions; research impact; chronic conditions; integrated care; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1510668
- Identifier
- uon:56439
- Rights
- Copyright 2024 Connor Patrick Colin Gleadhill
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 52 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 290 KB | Adobe Acrobat PDF | View Details Download |