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Table 1 Summary of recommendations for future trials of non-pharmacological interventions for musculoskeletal problems

From: Research priorities for non-pharmacological therapies for common musculoskeletal problems: nationally and internationally agreed recommendations

  Recommendation Reached consensus in UK Clinical Trials Thinktank Reached consensus in International Symposium Level of agreement(% agreement)*
1 Focus on implementation (research into practice) for musculoskeletal conditions * * 90.1%
2 Develop national musculoskeletal research networks in which large trials can be sited and smaller trials supported * * 87.9%
3 Develop more innovative trial designs (such as those based on stepped care, subgrouping patients and targeting treatment) * * 83.2%
4 Include more patient-individualised outcomes * * 83.9%
5 Develop core sets of outcomes for new trials to allow comparisons across trials * * 81.2%
6 Include cost-effectiveness analysis within clinical trials * * 77.3%
7 Focus on studies that advance clinical trials methodology * * 77.1%
8 Compare non-pharmacological interventions to 'real life' controls (groups receiving no treatment or usual primary care) *   77.4%
9 Investigate the specific versus non-specific effects of treatments to determine what it is about the interventions that is effective *   73.8%
10 Develop intervention models that match the natural history of common musculoskeletal problems (long-term conditions require long-term model of care such as that used in diabetes or asthma) *   69.9%
11 Conduct pilot studies to develop innovative trial designs *   68.2%
12 Capture the effects of treatment earlier (eg. weeks not months) *   65.4%
13 Distinguish first the natural history of conditions and then look at effects of interventions    -
14 Test treatments that are already in practice within future trials    -
15 Focus more on phase 1 and 2 studies (modelling and piloting) before proceeding to clinical trials    -
16 Focus on earlier timing of interventions in the history of the musculoskeletal problem    -
17 Use new trial designs but use them to answer specific research questions more efficiently    -
18 Go back to some of the key basics within trials and improve the measurement of process issues, improve outcomes and ensure quality of treatment    -
19 Explore how to engage private providers of care in research and clinical trials in more optimal ways    -
20 Use equivalence and non-inferiority trials rather than the traditional superiority trial design, when appropriate    -
21 Develop 'mega-trials' (national and multi-national clinical trials)    -
22 Make better use of data from previous trials    -
  1. * Percentage agreement (agreed or strongly agreed) by 133 participants of International Symposium