Burden of musculoskeletal-related disorders resulting from non-fatal road traffic collisions in Africa: a protocol of a systematic review

Introduction In addition to their high mortality rates, road traffic collisions (RTC) are considered a burden within those who do survive. In Africa, injuries related to RTC have been identified as the 10th most common cause of disability-adjusted life years lost for all ages and categories. Moreover, non-fatal RTC are the biggest cause associated with the burden of musculoskeletal disorders (MSD) in Africa. Despite this, the epidemiology of MSD related to non-fatal RTC within this region is still unknown. The objective of this review is to identify and summarise available data regarding the prevalence, incidence and patterns of MSD resulting from non-fatal RTC in Africa. Methods and analysis A systematic review of observational epidemiological studies will be conducted. On October 2019, MEDLINE, Embase, CINAHL Plus, PsycINFO, Web of Science, Global Health and African Journals OnLine will be searched for literature that is in English and published between 1990 and 2018. Two reviewers (MY ad TG) will independently screen results and extract the data, with a third reviewer (FF) resolving any discrepancies through discussion. Additionally, two reviewers (MY and TG) will independently assess the quality of the eligible studies using the US National Institutes of Health National Heart, Lung, and Blood Institute Quality Assessment Tool. Within the eligible studies, data on citation, methods and results will be extracted. Extracted data will be analysed using a narrative synthesis. Findings will be presented in tables, with the main outcomes being prevalence, incidence and disease pattern of MSD and determinants of non-fatal RTC. The final systematic review will be conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Ethics and dissemination As individual patients will not be involved in this study, no ethical approval will be sought. Findings from this review will be disseminated through peer-reviewed journals and relevant conferences. Trial registration number CRD4201913953

Direct Costs of Systemic Lupus Erythematosus in Alberta in Real World

Background: Systemic lupus Erythematosus (SLE) is a chronic multi-system autoimmune disease that can affect a person’s physical, mental, and social life. It imposes a substantial economic burden up on patients, carers, healthcare systems, and wider society. This study estimated the direct costs of SLE in Alberta. Methods: Alberta maintains a publicly funded, universally available health care system. Health service use and direct healthcare costs of SLE and non-SLE cases were determined from inpatient hospital services, fee-for-physician services, emergency services, and ambulatory care services. All costs were estimated for calendar year 2016. Data were analysed using central measures specifically the mean to determine the annual costs of SLE and non-SLE. Results: A total number of 10,932 (Male = 2,546; Female = 8,386), and 41,851,36 (Male = 21,157,76; Female = 20,693,60) of SLE and non-SLE cases, respectively were included in this study. The mean annual costs of SLE, and non-SLE per case were $7,740.19 (Male =$7,986.59; Female = $7,665.38), and$2,479.53 (Male = $2,265.57; Female =$2,698.30), respectively. The mean annual costs of fee-for-physician services (SLE = $2,160.03; non-SLE =$840.00), inpatient hospital services (SLE = $3,462.86; non-SLE =$1,007.29), emergency services (SLE = $440.28; non-SLE =$176.65), and ambulatory care services (SLE = $1,677.03; non-SLE =$455.05) per case were estimated. Conclusion: The findings showed that the costs of SLE were considerably high for patients and healthcare system. This highlights the importance of appropriate treatment and management of SLE. Further studies are required to fully investigate both the direct and indirect economic burden of SLE including out-of-pocket expenses, costs to patients and caregivers and productivity loss

Global and regional prevalence and incidence of systemic lupus erythematosus in low and-middle income countries: a systematic review and meta-analysis

Systemic lupus erythematosus (SLE) may be more prevalent among most ethnic groups in the low-and-middle income countries (LMICs), still these countries are under-represented in epidemiological data on SLE. The aim of this study was to review the prevalence and incidence of SLE in LMICs and use meta-analytic techniques. The MEDLINE, CINHAL, Web of Science, Scopus and Global Index Medicus databases were searched for relevant studies published up to July of 2022. Papers selected for full-text review were included in the systematic review if they provided the prevalence or incidence of SLE in LMICs and published in English language. The reference lists of included articles were also searched for additional studies. Two individuals independently performed abstract and full-text review, data extraction, and quality assessment of the papers. The prevalence and incidence of SLE were pooled through random effects model. Pooled estimates were expressed with 95% confidence. Out of 2340 papers, 23 studies were included in the review. The mean age at diagnosis ranged from 25.5 to 45.8 years. Three studies were conducted in Argentina and Brazil, two studies in China and one study in Cuba, Colombia, Democratic Republic Congo, Ecuador, Egypt, India, Kenya, Malaysia, Mexico, Nigeria, Pakistan, Turkey, Ukraine, Venezuela, and Zimbabwe. The SLE prevalence and incidence varied from 3.2 to 159 per 100,000 and 0.3–8.7 per 100,000 persons, respectively. In a random effects meta-analysis (n = 10), the pooled prevalence of SLE was 103 (95% confidence interval [CI] – 17 to 224) per 100,000. Meta‐analysis of data from 6 incidence studies revealed an incidence of 5 cases per year (95% CI 2–8) per 100,000. According to WHO regions, the pooled prevalence of American and Western Pacific regions was 300 (95% CI – 200 to 900) and 36 (95% CI 35–37) per 100,000, respectively. The pooled incidence of the American region was 10 (95%, 0–14) per 100,000 inhabitants. Systemic lupus erythematosus is a common disease with considerable variation in prevalence and incidence among the general population in LMICs. Accurate estimates of prevalence and incidence of SLE are required to put in place appropriate programmes to reduce its burden in LMICs. PROSPERO registration number: CRD: 42020197495, https://www.crd.york.ac.uk/prospero/

Direct health system costs for systemic lupus erythematosus patients in Alberta, Canada

Systemic lupus Erythematosus (SLE) is a chronic multi-system autoimmune disease that can affect a person’s physical, mental, and social life. It imposes a substantial economic burden up on patients, carers, healthcare systems, and wider society. This is the first study to examine the direct health care costs of SLE in Alberta using real-world data. Alberta maintains a publicly funded, universally available health care system. Health service use and direct healthcare costs of SLE and non-SLE cases were determined from inpatient hospital services, fee-for-physician services, emergency services, and ambulatory care services. All costs were estimated for calendar year 2016. Data were analysed using central measures specifically the mean to determine the annual costs of SLE and non-SLE. A total number of 10,932 (Male = 2,546; Female = 8,386), and 41,851,36 (Male = 21,157,76; Female = 20,693,60) of SLE and non-SLE cases, respectively were included in this study. The mean annual costs of SLE, and non-SLE per case were $7,740.19 (Male =$7,986.59; Female = $7,665.38), and$2,479.53 (Male = $2,265.57; Female =$2,698.30), (p < 0.001) respectively. The mean annual costs of fee-for-physician services (SLE = $2,160.03; non-SLE =$840.00) (p < 0.001), inpatient hospital services (SLE = $3,462.86; non-SLE =$1,007.29), (p < 0.001) emergency services (SLE = $440.28; non-SLE =$176.65), (p < 0.001) and ambulatory care services (SLE = $1,677.03; non-SLE =$455.05) (p < 0.001) per case were estimated. The findings showed that the costs of SLE were considerably high for patients and healthcare system. This highlights the importance of appropriate treatment and management of SLE. Further studies are required to fully investigate both the direct and indirect economic burden of SLE including out-of-pocket expenses, costs to patients and caregivers and productivity loss

The Economic Burden of Musculoskeletal Disorders Resulting from Road Trafic Accident in Low and Middle Income Countries: A Systematic Review

Objectives Approximately 20 – 50 million people sustain nonfatal injuries as a result of road traffic accidents (RTA). Treatment costs as well as lost wages associated with this nonfatal injury are substantial. The study reviewed the economic burden of musculoskeletal (MSK) disorders caused from RTA in low and middle-income countries (LMICs). Methods We performed a systematic search of MEDLINE, CINAHL, Cochrane Database of Systematic Reviews (CDSR), Health Economic Evaluations Database (HEED), and Web of Science Database from inception to September 2019. Studies that assessed the economic burden of MSK resulting from RTA in LMICs published in English language were included. The quality of the included studies was assessed using the Drummond and Jefferson criteria. A descriptive data synthesis was used to present the results. Results The search identified 456 studies, and nine of them met the inclusion criteria and were included in this review. The studies were conducted in Iran (n = 3), Nigeria (n = 2), Vietnam (n = 1), India (n = 1), Thailand (n = 1), and Nepal (n = 1). The quality score of the included studies were ≥ 50%. The mean age of the patients in the included studies ranged between 24.6 to 40.3 years. Mean direct and indirect costs in the included studies ranged from $11.04 to$2494 and $33.3 to$189.2, respectively over 12 months. Hospitalisation and treatment were identified as the major cost drivers. Conclusions The findings of the review showed that the costs of injuries resulting from RTA were considerably high relative to health expenditures levels. Hence, it is important that prevention strategies be in place to reduce the economic burden of MSK disorders caused by RTA in LMICs

Global and regional estimates of clinical and economic burden of low-back pain in high-income countries: a systematic review and meta-analysis

Background: Low-back pain (LBP) is a common health problem, and the leading cause of activity limitation and work absence in people of all ages and socioeconomic status. Purpose: This study aimed to analyse the clinical and economic burden of LBP in high income countries via systematic review and meta-analysis. Methods: The systematic review was carried out using the PubMed, Medline, CINAHL, PsycINFO, AMED, Embase and Scopus databases with studies published from inception to December 10th, 2021. We also searched prescribing information, relevant web sites, reference lists and citation sections of recovered articles. Two reviewers independently assessed studies for inclusion and extracted data manually. Differences were resolved by consensus. Meta-analyses were conducted for clinical and economic outcomes. Results: Literature search identified 3571 potentially relevant articles and 19 studies met the inclusion criteria and were therefore reviewed. The included studies were from region of America (n = 5); European region (n = 12) and the Western Pacific region (n = 2). The average annual direct and indirect costs estimate per population for LBP ranged from € 2.3 billion to € 2.6 billion; and € 0.24 billion to $8.15 billion, respectively. In the random effects meta-analysis, the pooled rates of hospitalisation for LBP was 3.2% (95% confidence interval 0.6% - 5.7%). The pooled direct costs and total costs of LBP per patients were USD 9231 (95% confidence interval -7126.71 - 25588.9) and USD 10143.1 (95% confidence interval 6083.59 - 14202.6), respectively. Conclusion(s): Low-back pain led to high clinical and economic burden in high income countries that varied significantly across the geographical contexts. Implications: Knowledge of the clinical and economic impact of LBP in high income countries may be useful to influence programmes and behaviour in healthcare systems, through guiding policy makers and funding agencies to improve health outcomes of individual with this condition

Real-world Persistence and Adherence with Oral Bisphosphonates for Osteoporosis - A Systematic Review

Objectives This study examined patient adherence and persistence to oral bisphosphonates for the treatment of osteoporosis in real-world settings. Methods A systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) and National Health Service Economic Evaluation Database NHS EED) databases were searched for studies published in English language up to April 2018. Prospective and retrospective observational studies that used prescription claim databases or hospital medical records to examine patient adherence and persistence to oral bisphosphonate treatment among adults with osteoporosis were included. The Newcastle–Ottawa quality assessment scale (NOS) was used to assess the quality of included studies. Results The search yielded 540 published studies, of which 89 were deemed relevant and were included in this review. The mean age of patients included within the studies ranged between 53 to 80.8 years, and the follow-up varied from 3 months to 14 years. The mean persistence of oral bisphosphonates for 6 months, 1 year and 2 years ranged from 34.8% to 71.3%, 17.7% to 74.8% and 12.9% to 72.0%, respectively. The mean medication possession ratio ranged from 28.2% to 84.5%, 23% to 50%, 27.2% to 46% over 1 year, 2 years and 3 years, respectively. All studies included scored between 6 to 8 out of 9 on the NOS. The determinants of adherence and persistence to oral bisphosphonates included geographic residence, marital status, tobacco use, educational status, income, hospitalisation, medication type and dosing frequency. Conclusions While a number of studies reported high levels of persistence and adherence, the findings of this review suggest that patient persistence and adherence with oral bisphosphonates medications was poor and reduced notably over time. Overall, adherence was suboptimal. To maximise adherence and persistence to oral bisphosphonates, it is important to consider possible determinants, including characteristics of the patients

The Effectiveness of Personalisation on Health Outcomes of Older People: Systematic Review

Purpose: As people get older, they tend to have long-term conditions requiring health and social care intervention such as personalisation. Personalisation is person centred ensuring independence and control. To date, no systematic review has examined the effectiveness of personalisation. This review examined the effectiveness of personalisation in older people. Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken. Databases searched included: Science Direct and Medline (PubMed) NHSEED and CINAHL. Inclusion criteria were older people living in their own homes receiving personalisation. Excluded were studies carried out in nursing homes. Newcastle-Ottawa Scale was used for quality of assessment. Results: Search yielded 151 published studies with titles and abstracts; 143 studies were excluded and eight included. Studies included showed health outcomes of older people receiving personalisation improved significantly. Conclusions: Review found evidence of improvement in quality of life and mobility in older people

Effectiveness of telerehabilitation on quality of life in stroke survivors: a systematic review and meta analysis

Background: Recent advances in technology have made possible the delivery of health services to patients remotely, and telerehabilitation for stroke survivors has emerged as a promising intervention. Purpose: This systematic review was aimed to assess the clinical effectiveness of telerehabilitation programmes on quality of life of stroke survivor. Methods: We searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), AMED, Web of Science and Scopus databases from inception to 10th of June 2022. Search terms related to the clinical effectiveness of telerehabilitation interventions were used. Studies meeting the inclusion criteria were identified and key data were extracted. A comprehensive meta-analysis software was used to obtain the meta-analysis according to the standardised mean difference (SMD) and 95% CIs. Results: A total of 11 eligible studies that met the inclusion criteria were reviewed. These studies were conducted in Brazil (n = 1), Italy (n = 2), Netherland (n= 1), South Korea (n = 1), Switzerland (n = 1), Taiwan (n = 1), United Kingdom (n = 1) and United States (n = 3) between 2004 and 2020. Except for blinding of participants to study group allocation, all the studies were (> 50%) at low risk of bias to considering adequate sequence generation, allocation concealment, blinding of trial personnel or outcome assessors, evaluation of incomplete outcome data, and lack of selective reporting. The meta-analysis included 1,206 individuals with duration of follow up ranged between 4 weeks and 6 months. We found that there was no statistically significant difference (SMD = 0.590, Confidence Interval (CI) 95% = -0.226 to 1.405, p = 0.157) for Stroke Impact Scale (based on health utility weighting of the Modified Rankin Scale) between telerehabilitation interventions and standard care. Conclusion(s): Effectiveness of telerehabilitation interventions on quality of life in stroke survivors in a short term is comparable to standard care. Implications: Further research studies are required to examine the effectiveness of telerehabilitation interventions for improving quality of life of stroke survivors in a long term follow up

Adoption of a societal perspective in economic evaluation of musculoskeletal disorders: a conceptual paper

Economic evaluations are used to compare the costs and consequences of healthcare interventions, including those for musculoskeletal (MSK) disorders, which are very common and a major source of morbidity and absence from work. Reimbursement decisions for interventions for MSK disor-ders by decision-makers rely on the findings of economic evaluations, the design and results of which depend largely on the perspective adopted. Despite methodological advancements in economic evaluations, there are no clear guidelines on the perspective to adopt. This paper ex-plores the adoption of a societal perspective in economic evaluations of MSK disorders. Within health economics evaluations, the most commonly used perspectives include the payer perspec-tive, the healthcare perspective, and the societal perspective. To facilitate optimal resource allo-cation decisions in order to reduce the significant economic burden of MSK disorders and improve the health outcomes of individuals with these disorders, all costs and benefits associated with in-terventions for them should be included. Thus, the societal perspective is arguably a preferable option to the others for economic evaluations of interventions for MSK disorders