Do recommended interventions widen or narrow inequalities in musculoskeletal health? An equity-focussed systematic review of differential effectiveness

Peat, G; Jordan, KP; Wilkie, R; Corp, N; Van Der Windt, D; Yu, D; Narle, G; Ali, N

Abstract

Background It is unclear whether seven interventions recommended by Public Health England for preventing and managing common musculoskeletal conditions reduce or widen health inequalities in adults with musculoskeletal conditions. Methods We used citation searches of Web of Science (date of 'parent publication' for each intervention to April 2021) to identify original research articles reporting subgroup or moderator analyses of intervention effects by social stratifiers defined using the PROGRESS-Plus frameworks. Randomized controlled trials, controlled before-after studies, interrupted time series, systematic reviews presenting subgroup/stratified analyses or meta-regressions, individual participant data meta-analyses and modelling studies were eligible. Two reviewers independently assessed the credibility of effect moderation claims using Instrument to assess the Credibility of Effect Moderation Analyses. A narrative approach to synthesis was used (PROSPERO registration number: CRD42019140018). Results Of 1480 potentially relevant studies, seven eligible analyses of single trials and five meta-analyses were included. Among these, we found eight claims of potential differential effectiveness according to social characteristics, but none that were judged to have high credibility. Conclusions In the absence of highly credible evidence of differential effectiveness in different social groups, and given ongoing national implementation, equity concerns may be best served by investing in monitoring and action aimed at ensuring fair access to these interventions.

Citation

Peat, G., Jordan, K., Wilkie, R., Corp, N., Van Der Windt, D., Yu, D., …Ali, N. (2022). Do recommended interventions widen or narrow inequalities in musculoskeletal health? An equity-focussed systematic review of differential effectiveness. Journal of Public Health, 44(3), e376–e387. https://doi.org/10.1093/pubmed/fdac014

• Journal Article Type: Article
• Acceptance Date: Mar 6, 2022
• Online Publication Date: Mar 6, 2022
• Publication Date: 2022-09
• Journal: Journal of Public Health
• Print ISSN: 1741-3842
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 44
• Issue: 3
• Pages: e376–e387
• DOI: https://doi.org/10.1093/pubmed/fdac014
• Keywords: musculoskeletal disorders; social stratifiers; health inequalities; health outcomes; interventions; systematic review
• Publisher URL: https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdac014/6543030