PROSPERO International prospective register of systematic reviews What is the application of ultrasound imaging in primary care for musculoskeletal disorders? Mark Karaczun, Toby Smith, Robert Fleetcroft, Andrea Stockl Citation Mark Karaczun, Toby Smith, Robert Fleetcroft, Andrea Stockl. What is the application of ultrasound imaging in primary care for musculoskeletal disorders?. PROSPERO 2015:CRD42015015905 Available from http://www.crd.york.ac.uk/prospero_rebranding/display_record.asp?id=crd42015015905 Review question(s) What is the application of ultrasound imaging in primary care for musculoskeletal disorders? Who uses diagnostic ultrasound imaging of the musculoskeletal system in primary care? (e.g. GPs, physios) For what musculoskeletal presentations/ conditions is it used? For what purposes / clinical goal(s)? For whom? What types of patients/ groups/ presentations? Why do they do so? [Demonstrated and/or perceived] - Patient factors (convenience) - Temporal factors (expedience) - Clinician factors (e.g. diagnostic acumen) - Financial factors - Other reasons: How do they or their patients benefit (actual or perceived) from this application of POCUS? What harm(s) (actual or perceived) have been reported by the ultrasound imaging for musculoskeletal conditions in primary care? How did they come to use ultrasound imaging in primary care? (+/- stop using it?) What barriers and enabling factors did they encounter? How were such barriers overcome? How has the use of ultrasound imaging for musculoskeletal conditions impacted the clinician-patient relationship within primary care? How has it affected relationships with the wider healthcare sector? Searches Full details of the databases searched and the relevant search strategies are contained in the accompanying PDF document. Types of study to be included All; including clinical trials, audits, case reports/series, letters, descriptive narratives. Condition or domain being studied Page: 1 / 6
Musculoskeletal disorders defined as primarily soft tissues such as ligaments, tendons, muscles, fascia, bursae, and/or joint spaces. More commonly this involves the appendicular skeleton, though ultrasound imaging of the axial skeleton would not be excluded per se. Excluded: viscera/organs within the cranium, thorax, abdomen, or pelvis alone without soft tissues as defined above. Participants/ population Patients of any age with musculoskeletal complaints or conditions in primary care. Primary care is defined as the first point of contact with a clinician (doctor, nurse practitioner, nurse, physiotherapist, physician's assistant). In the UK, this equates to general practice. In the USA, this would include family medicine or named 'primary care physician' of the patient even if they had more specialist qualifications (e.g. female patients of some HMOs in the USA often have their gynaecologist as their named primary care physician). We recognised that access to health care is poor in many areas of the world and that the distinction between primary and secondary care may be much less clear in some local health systems. Where unclear, we will attempt to apply the WONCA definition of primary care to each publication. Intervention(s), exposure(s) Ultrasound imaging used in primary care settings. USS/Ultrasound is defined as imaging (as opposed to thermal therapeutic ultrasound or handheld Dopplers like SonicAids used to amplify arterial or venous sounds, foetal heart beats, etc. without production of an image for the clinician to view). Comparator(s)/ control Not applicable Context Primary care including general practice, family practice, family medicine, rural medicine. Outcome(s) Primary outcomes Trial data. Audit data. Case reports. Description of how and/or why ultrasound imaging is used. n/a Secondary outcomes Demonstrated benefits or harms. Perceived benefits or harms with respect to the patient, their carers, the clinician, the clinician-patient relationship, local health services, and the community. Health economic data. Barriers or enabling factors regarding primary care ultrasound within the local health service (All dates) Data extraction, (selection and coding) Titles and abstracts will be reviewed by at least two team members for relevancy (i.e. inclusion and exclusion criteria). Where discrepancies occur, a third team member (e.g. TS) will moderate the decision to include or exclude the publication. References of relevant publications will also be screened for additional relevant publications. Data will include: Page: 2 / 6
- Lead author - Date of publication: - Full citation: - Country: - Type of publication: (e.g. quantitative / qualitative/ trial / editorial) - Type of clinician using ultrasound (e.g. GP, physio, etc.) - Location descriptors: e.g. rural/ urban - Time frame: e.g. longitudinal / cross-sectional - Population(s) - Intervention(s) e.g. Anatomical area(s) of ultrasound (e.g. shoulder, knee, etc.) - Risks (demonstrated/ perceived) - Benefits (demonstrated / perceived) - Conflicts of interested (stated or potential) (+/- where relevant...) - Comparisons / controls - Outcomes - Unit of allocation - Unit of observation - Unit of analysis - Analytical/ Statistical method(s) used. - Theoretical underpinnings of enquiry Risk of bias (quality) assessment Formal studies per se will be evaluated for their quality using the appropriate appraisal tool(s) such as checklists (CASP, QARI, etc.), or other methods appropriate to the publication type. Publications such as opinion, policies, etc. may naturally fall outside the scope of formal checklists. Therefore, we propose a more flexible approach modified from Pawson et al, (2004, pp. 22-29): Overall, each publication must be evaluated for Relevancy - Addressing ultrasound imaging for musculoskeletal complains in primary care? - Having some basis in fact/ honest discourse (i.e.. not satire, etc.) - Based on actual primary care healthcare systems. (i.e. not just conjecture) Page: 3 / 6
- Rigour / coherence - Methodological rigour (how well carried out / expected rigour for this type of publication) - Theoretical rigour: (esp. qualitative enquiry) What are the underlying assumptions or theoretical basis of their approach? Transparency - Biases recognised and dealt with appropriately - Trustworthiness, meaning is it - Credible? Reflecting truth / internal validity - Transferable: Applicability / generalizable - Dependable? Consistent, reliable - Confirmable? Objective / neutral Persuasiveness - How much did it change the views of the reviewer? The above is incorporated into a generic data extraction form to which the relevant checklists may be attached. These will be analysed by the initial reviewers and then discussed within the team. Strategy for data synthesis Where feasible, meta-analyses will be performed. However, as many of these will involve case reports or descriptions of health services the analysis will somewhat be shaped by the content of what we uncover. Qualitative, mixed methods, and commentary will undergo thematic analysis. Here, the chance to compare taxonomy, themes, and theories may present itself more readily. For qualitative or mixed-methods research, meta-narrative review (Wong et al., 2013) will be applied in an attempt to identify overarching themes. A quantitative assessment of frequency of different applications of ultrasound in this setting will be determined and assessed as percentages. Descriptive statistics will be used to assess the frequency for dichotomous data and mean and standard deviation values for continuous data. When assessing the attitudes and experiences of clinicians to ultrasound through qualitative investigation, a thematic analysis with meta-ethnography, will be the principle approach used for such data. Through this, after emersion in the included studies, all emerging themes or metaphors will be identified and placed in a grid to examine how the concepts juxtaposed or related to one another amongst the included studies. The relevant themes will then be grouped into categories by two reviewers independently. Through this, the categories will be created on the basis of primary data rather than prior knowledge. Analysis of subgroups or subsets Quantitative and qualitative components will be analysed separately. If feasible, we will attempt to group publications by - anatomical area studied (e.g. upper limb / lower limb) - type of clinician using ultrasound (e.g. physiotherapist, GP, nurse practitioner) - type of setting in which ultrasound used (e.g. rural v. urban) Page: 4 / 6
Dissemination plans We aim to publish our findings in relevant journal(s) and disseminate findings at relevant conferences (e.g. British Medical Ultrasound Society). In addition to publication in relevant journals (e.g. The British Journal of General Practice) and presentation at relevant conferences, the following will be offered a report of our findings: NHS Trusts NHS Clinical Commissioning Groups Patient representatives Government e.g. Parliamentary Office of Science and Technology The Point of Care Testing (POCT) working group of WONCA Research councils / funding bodies Ultrasound users e.g. BMUS Medical Education community e.g. EFSUMB International community: e.g. key authors such as those performing studies in low-income countries. Inclusion of abstracts of our report in various key language may also help disseminate our findings. Contact details for further information Dr Karaczun Norwich Medical School (2w) University of East Anglia Chancellor's Drive Norwich Norfolk NR4 7TJ m.karaczun@uea.ac.uk Organisational affiliation of the review University of East Anglia http://www.uea.ac.uk/ Review team Dr Mark Karaczun, UEA (Norwich Medical School) Dr Toby Smith, UEA (School of Allied Health Professions) Dr Robert Fleetcroft, UEA (Norwich Medical School) Dr Andrea Stockl, UEA (Norwich Medical School) Details of any existing review of the same topic by the same authors Key findings from a larger literature review of ultrasound in primary care were presented at the Royal College of General Practitioners Annual Conference in Liverpool, England on Friday, 03 October, 2014, Session F8, (MK). Anticipated or actual start date 19 January 2015 Page: 5 / 6
Powered by TCPDF (www.tcpdf.org) Anticipated completion date 31 July 2015 Funding sources/sponsors NIHR-funded Academic Clinical Fellowship in Primary Care post (MK) Conflicts of interest None known Other registration details None Language English Country England Subject index terms status Subject indexing assigned by CRD Subject index terms Diagnostic Imaging; Humans; Musculoskeletal Diseases; Primary Health Care; Ultrasonography Stage of review Ongoing Date of registration in PROSPERO 15 January 2015 Date of publication of this revision 15 January 2015 DOI 10.15124/CRD42015015905 Stage of review at time of this submission Started Completed Preliminary searches No No Piloting of the study selection process No No Formal screening of search results against eligibility criteria No No Data extraction No No Risk of bias (quality) assessment No No Data analysis No No PROSPERO International prospective register of systematic reviews The information in this record has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Page: 6 / 6