Table 1 Summary of recommendations for future trials of non-pharmacological interventions for musculoskeletal problems
| Â | 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) | * | Â | 77.4% |
9 | Investigate the specific versus non-specific effects of treatments to determine what it is about the interventions that is effective | * | Â | 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) | * | Â | 69.9% |
11 | Conduct pilot studies to develop innovative trial designs | * | Â | 68.2% |
12 | Capture the effects of treatment earlier (eg. weeks not months) | * | Â | 65.4% |
13 | Distinguish first the natural history of conditions and then look at effects of interventions | Â | Â | - |
14 | Test treatments that are already in practice within future trials | Â | Â | - |
15 | Focus more on phase 1 and 2 studies (modelling and piloting) before proceeding to clinical trials | Â | Â | - |
16 | Focus on earlier timing of interventions in the history of the musculoskeletal problem | Â | Â | - |
17 | Use new trial designs but use them to answer specific research questions more efficiently | Â | Â | - |
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 | Â | Â | - |
19 | Explore how to engage private providers of care in research and clinical trials in more optimal ways | Â | Â | - |
20 | Use equivalence and non-inferiority trials rather than the traditional superiority trial design, when appropriate | Â | Â | - |
21 | Develop 'mega-trials' (national and multi-national clinical trials) | Â | Â | - |
22 | Make better use of data from previous trials | Â | Â | - |