ABSTRACT
OBJECTIVE: To evaluate the extent to which Cochrane Musculoskeletal systematic reviews assess and analyze health equity considerations. METHODS: We included Cochrane Musculoskeletal systematic reviews that included trials with participants aged ≥ 50 years and that were published from 2015 to 2020. We assessed the extent to which reviews considered health equity in the description of the population in the PICO (Patient/Population - Intervention - Comparison/Comparator - Outcome) framework, data analysis (planned and conducted), description of participant characteristics, summary of findings, and applicability of results using the PROGRESS-Plus framework. The PROGRESS acronym stands for place of residence (rural or urban), race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital, and Plus represents age, disability, relationship features, time-dependent relationships, comorbidities, and health literacy. RESULTS: In total, 52 systematic reviews met our inclusion criteria. At least 1 element of PROGRESS-Plus was considered in 90% (47/52) of the reviews regarding the description of participants and in 85% (44/52) of reviews regarding question formulation. For participant description, the most reported factors were age (47/52, 90%) and sex (45/52, 87%). In total, 8 (15%) reviews planned to analyze outcomes by sex, age, and comorbidities. Only 1 had sufficient data to carry this out. In total, 19 (37%) reviews discussed the applicability of the results to 1 or more PROGRESS-Plus factor, most frequently across sex (12/52, 23%) and age (9/52, 17%). CONCLUSION: Sex and age were the most reported PROGRESS-Plus factors in any sections of the Cochrane Musculoskeletal reviews. We suggest a template for reporting participant characteristics that authors of reviews believe may influence outcomes. This could help patients and practitioners make judgments about applicability.
Subject(s)
Health Equity , Humans , Socioeconomic Factors , Social Class , OccupationsABSTRACT
BACKGROUND: Musculoskeletal conditions are the leading cause of years lived with disability for older adults. Limitations in functional ability affect healthy aging for aging populations worldwide. Thus, it is important to assess effects of interventions on the multiple dimensions of function for older adults. OBJECTIVES: To assess: (1) which domains of function are assessed in reviews published by the Cochrane Musculoskeletal Group inclusive of older adults, and (2) the extent to which these reviews evaluate effects and/or applicability of findings for older adults. METHODS: We included all reviews published by the Cochrane Musculoskeletal Review Group after 2015 including participants over the age of 50 (n = 52). We extracted data on how the activities and participation domains of the International Classification of Functioning (ICF) were measured. We assessed the extent to which reviews included methods to evaluate effects across age, according to the framework in the Cochrane Handbook chapter on equity and specific populations. RESULTS: The median age of participants across reviews was 54 years (range 16-94). ICF domains assessed in reviews, in descending order of frequency, were: domestic life (90%), mobility (89%), self-care (87%), interpersonal interactions and relationships (65%), community, social, and civic life (64%), major life areas (31%), communication (2%), general tasks and demands (0%) and learning and applying knowledge (0%). In evaluating effects across age, the age of participants was described by 73% of reviews and 54% mentioned age in the description of the condition, 21% planned subgroup analysis by age and none were able to conduct this analysis. Only 17% described applicability of results to older people. CONCLUSIONS: Reviews published by the Cochrane Musculoskeletal Group inclusive of older adults assess most domains of functional ability with the exception of communication, general tasks and knowledge domains. None of these reviews were able to conduct a subgroup analysis across age, indicating a need to improve the consideration of age in both Cochrane reviews as well as in primary studies.
