Shared decision making in musculoskeletal pain consultations in low- and middle-income countries: a systematic review

Sam, Sreya; Sharma, Radha; Corp, Nadia; Igwesi-Chidobe, Chinonso; Babatunde, Opeyemi O.

Abstract

Background
Global populations, especially those in low- and middle-income countries (LMICs), are at an increased risk of musculoskeletal (MSK) pain, a leading cause of years lived with disability. Shared decision making (SDM) in the management of these conditions may drive improvements in healthcare outcomes and quality. This study aimed to synthesize and appraise available evidence regarding SDM in MSK pain consultations in LMICs.

Methods
Comprehensive literature searches were conducted in 12 databases for primary studies investigating SDM in MSK pain consultations across all healthcare and community settings in LMICs. Study eligibility screening, data extraction and quality appraisal (using the Critical Appraisals Skills Programme tool) were completed by pairs of reviewers. Findings were brought together using thematic synthesis of data from all the primary studies.

Results
Seven studies (mostly moderate quality) were included. There was low awareness of SDM among healthcare professionals (HCPs); however, this is not explicitly practised due to cultural and operational barriers. HCP training and patient empowerment through health literacy were proposed facilitators. The traditional paternalistic approach to treatment poses a key barrier to SDM, decreases adherence to prescribed treatments and raises the risk of poor clinical outcomes.

Conclusions
SDM is still a relatively ‘foreign concept’ within consultations and management of MSK pain patients in LMICs. There is a dearth of research in SDM and patient-centred care. Given the socio-economic impact of MSK pain, further research into the value of SDM in LMIC healthcare settings requires further consideration.

Citation

Sam, S., Sharma, R., Corp, N., Igwesi-Chidobe, C., & Babatunde, O. O. (2020). Shared decision making in musculoskeletal pain consultations in low- and middle-income countries: a systematic review. International Health, 12(5), 455-471. https://doi.org/10.1093/inthealth/ihz077

• Journal Article Type: Article
• Acceptance Date: Jul 29, 2019
• Online Publication Date: Nov 15, 2019
• Publication Date: 2020-09
• Deposit Date: Jun 27, 2023
• Journal: INTERNATIONAL HEALTH
• Print ISSN: 1876-3413
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 12
• Issue: 5
• Pages: 455-471
• DOI: https://doi.org/10.1093/inthealth/ihz077
• Keywords: global health, musculoskeletal pain, patient-centred care, quality of care, shared decision making