Musculoskeletal group-based interventions

This case study follows the 5-step process for accessing and using evidence in response to a request from commissioners to support the work of the Musculoskeletal (MSK) programme.

Identify

Using PICO, the scope of the evidence search was defined as:

Population: Adults with back pain, lower limb osteoarthritis, TKR, THR or ACL reconstruction

Intervention: Group interventions

Comparison: 1:1 interventions

Outcomes: Pain, function, system impact, cost, safety.

Access

A Clinical Effectiveness Programme Officer was asked to conduct the search and report findings.

The following search questions were addressed:

1. What evidence is available for the delivery and effectiveness of MSK groups in the management of back pain?
2. What evidence is available for the delivery and effectiveness of MSK groups in the management of lower limb osteoarthritis?
3. What evidence is available for the delivery and effectiveness of MSK groups in the management of post-operative Total Knee Replacement (TKR) and Total Hip Replacement (THR)?
4. What evidence is available for the delivery and effectiveness of MSK groups in the management of post-operative Anterior Cruciate Ligament Reconstruction (ACLR)?

The search strategy involved searching the following databases and websites:

• Cochrane Database of Systematic Reviews
• PubMed

The following search strategies were used:

1. “back pain” AND (group OR “group intervention” OR “group-based” OR “group based” OR “class” OR “school”).
2. (“knee osteoarthritis” OR “hip osteoarthritis”) AND (group OR “group intervention” OR “group-based” OR “group based” OR “class” OR “school”).
3. (“total knee replacement” OR “total hip replacement” OR arthroplast*) AND (group OR “group intervention” OR “group-based” OR “group based” OR “class” OR “school”).
4. “anterior cruciate ligament” AND (group OR “group intervention” OR “group-based” OR “group based” OR “class” OR “school”).

Appraise

A range of study types were reviewed including systematic reviews (SRs), randomised controlled trials (RCTs) and mixed-methods studies. Appraisal was conducted according to the strengths and limitations of each piece of evidence, including issues concerning sample sizes and potential for bias.

Apply

Findings were reported in an evidence review. Key points of this review included:

• There is a range of evidence, much of which is good quality, to suggest that group-based and individual physiotherapy interventions are equally effective in reducing pain and disability
• The evidence-base for Back Schools is currently of very poor quality. Consequently, their effectiveness in the management of lower back pain is uncertain
• Other group-based interventions may be effective in the management of chronic lower back pain
• Group-based physiotherapy post-TKR may lead to improvements in patient reported function, although this improvement may not be clinically important at 12 months
• Participation in an exercise group post-ACLR is perceived by patients to have a range of psychosocial and physical benefits.

Share & manage

The findings of the review were consolidated into two documents, a full evidence review and a briefing version with the headline findings. This was done to enable greater accessibility of the evidence to stakeholders and commissioners who may be limited on time. To promote sharing of learning, this review was uploaded to Health Innovation West of England’s Evidence Repository on the Futures NHS platform.