Musculoskeletal care pathways for adults with hip and knee pain referred for specialist opinion: a systematic review
Objective Musculoskeletal care pathways are variable and inconsistent. The aim of this systematic review was to evaluate the evidence for the clinical and/or cost effectiveness of current care pathways for adults with hip and/or knee pain referred for specialist opinion.Design Systematic review.Data...
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| Format: | Article |
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BMJ Publishing Group
2019-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/9/e027874.full |
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| author | Stephen Jones Fiona Morgan Alison Lesley Weightman Kate Button |
| author_facet | Stephen Jones Fiona Morgan Alison Lesley Weightman Kate Button |
| author_sort | Stephen Jones |
| collection | DOAJ |
| description | Objective Musculoskeletal care pathways are variable and inconsistent. The aim of this systematic review was to evaluate the evidence for the clinical and/or cost effectiveness of current care pathways for adults with hip and/or knee pain referred for specialist opinion.Design Systematic review.Data sources Electronic database searches were carried out in MEDLINE, MEDLINE In-Process, Cumulative Index of Nursing and Allied Health Literature, Embase, PEDro, PubMed, Web of Science, Cochrane Central and Health Management Information Consortium without language restriction from 1990 onwards. Websites were reviewed for grey literature.Eligibility criteria All study designs and documents that considered care pathways for adults with musculoskeletal hip and/or knee pain referred for specialist opinion were screened by two reviewers. Risk of bias was assessed using The Critical Appraisal Skills Programme checklist for randomised controlled trials and the Joanna Briggs Institute checklists.Data extraction and synthesis Data extraction and quality assessment were performed by one reviewer and checked by a second. Findings are reported narratively.Results The titles and abstracts of 1248 articles were screened and 140 full-text articles retrieved. 19 papers reporting 17 studies met the study inclusion criteria. Quality was low due to study design and methodological flaws. Most of the outcomes relate to organisational process at the ‘meso’ level of a whole systems approach.Conclusion It can be concluded that the pathway is not linear, containing variations and activity loops. The available evidence suggests that, from the point of referral for specialist opinion, a model is required that integrates the skills of all the different healthcare professionals and streamlining is required to ensure that individuals are seen by the healthcare professional that best meets their needs. There is very limited evidence of patient experience informing knee and hip care pathways.PROSPERO registration number CRD42016035510. |
| format | Article |
| id | doaj-art-6b1fbb288f6e4261b378461a39fa7296 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-6b1fbb288f6e4261b378461a39fa72962025-08-20T02:06:49ZengBMJ Publishing GroupBMJ Open2044-60552019-09-019910.1136/bmjopen-2018-027874Musculoskeletal care pathways for adults with hip and knee pain referred for specialist opinion: a systematic reviewStephen Jones0Fiona Morgan1Alison Lesley Weightman2Kate Button3managing director of Synapse Medical Resourcing Ltd and consultant to the pharmaceutical industrySpecialist Unit for Review Evidence, Cardiff University, Cardiff, UKSpecialist Unit for Review Evidence, Cardiff University, Cardiff, UKSchool of Healthcare Sciences, Cardiff University, Cardiff, UKObjective Musculoskeletal care pathways are variable and inconsistent. The aim of this systematic review was to evaluate the evidence for the clinical and/or cost effectiveness of current care pathways for adults with hip and/or knee pain referred for specialist opinion.Design Systematic review.Data sources Electronic database searches were carried out in MEDLINE, MEDLINE In-Process, Cumulative Index of Nursing and Allied Health Literature, Embase, PEDro, PubMed, Web of Science, Cochrane Central and Health Management Information Consortium without language restriction from 1990 onwards. Websites were reviewed for grey literature.Eligibility criteria All study designs and documents that considered care pathways for adults with musculoskeletal hip and/or knee pain referred for specialist opinion were screened by two reviewers. Risk of bias was assessed using The Critical Appraisal Skills Programme checklist for randomised controlled trials and the Joanna Briggs Institute checklists.Data extraction and synthesis Data extraction and quality assessment were performed by one reviewer and checked by a second. Findings are reported narratively.Results The titles and abstracts of 1248 articles were screened and 140 full-text articles retrieved. 19 papers reporting 17 studies met the study inclusion criteria. Quality was low due to study design and methodological flaws. Most of the outcomes relate to organisational process at the ‘meso’ level of a whole systems approach.Conclusion It can be concluded that the pathway is not linear, containing variations and activity loops. The available evidence suggests that, from the point of referral for specialist opinion, a model is required that integrates the skills of all the different healthcare professionals and streamlining is required to ensure that individuals are seen by the healthcare professional that best meets their needs. There is very limited evidence of patient experience informing knee and hip care pathways.PROSPERO registration number CRD42016035510.https://bmjopen.bmj.com/content/9/9/e027874.full |
| spellingShingle | Stephen Jones Fiona Morgan Alison Lesley Weightman Kate Button Musculoskeletal care pathways for adults with hip and knee pain referred for specialist opinion: a systematic review BMJ Open |
| title | Musculoskeletal care pathways for adults with hip and knee pain referred for specialist opinion: a systematic review |
| title_full | Musculoskeletal care pathways for adults with hip and knee pain referred for specialist opinion: a systematic review |
| title_fullStr | Musculoskeletal care pathways for adults with hip and knee pain referred for specialist opinion: a systematic review |
| title_full_unstemmed | Musculoskeletal care pathways for adults with hip and knee pain referred for specialist opinion: a systematic review |
| title_short | Musculoskeletal care pathways for adults with hip and knee pain referred for specialist opinion: a systematic review |
| title_sort | musculoskeletal care pathways for adults with hip and knee pain referred for specialist opinion a systematic review |
| url | https://bmjopen.bmj.com/content/9/9/e027874.full |
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