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Patients’ perceptions with musculoskeletal disorders regarding their experience with healthcare providers and health services: an overview of reviews
Archives of Physiotherapy volume 10, Article number: 17 (2020)
This overview of reviews aimed to identify (1) aspects of the patient experience when seeking care for musculoskeletal disorders from healthcare providers and the healthcare system, and (2) which mechanisms are used to measure aspects of the patient experience.
Four databases were searched from inception to December 20th, 2019.
Systematic or scoping reviews examining patient experience in seeking care for musculoskeletal from healthcare providers and the healthcare system were included. Independent authors screened and selected studies, extracted data, and assessed the methodological quality of the reviews. Patient experience concepts were compiled into five themes from a perspective of a) relational and b) functional aspects. A list of mechanisms used to capture the patient experience was also collected.
Thirty reviews were included (18 systematic and 12 scoping reviews). Relational aspects were reported in 29 reviews and functional aspects in 25 reviews. For relational aspects, the most prevalent themes were “information needs” (education and explanation on diseases, symptoms, and self-management strategies) and “understanding patient expectations” (respect and empathy). For functional aspects, the most prevalent themes were patient’s “physical and environmental needs,” (cleanliness, safety, and accessibility of clinics), and “trusted expertise,” (healthcare providers’ competence and clinical skills to provide holistic care). Interviews were the most frequent mechanism identified to collect patient experience.
Measuring patient experience provides direct insights about the patient’s perspectives and may help to promote better patient-centered health services and increase the quality of care. Areas of improvement identified were interpersonal skills of healthcare providers and logistics of health delivery, which may lead to a more desirable patient-perceived experience and thus better overall healthcare outcomes.
Systematic review registration: PROSPERO (CRD42019136500).
Musculoskeletal (MSK) disorders including neck and low back pain, hip and knee osteoarthritis, and rheumatoid arthritis, are some of the most burdensome conditions in terms of disability worldwide, associated high healthcare utilization and costs [1,2,3]. Because of the high incidence of chronicity  of these disorders, seeking treatment from and recurring visits to healthcare services are frequent and common [5,6,7]. Efforts to optimize the overall quality of healthcare could promote better outcomes and patient satisfaction as well as minimize the burden of healthcare delivery in MSK settings [8,9,10]. Patient experience has been recognized as a significant contributing factor to the quality of healthcare and has recently drawn more research interest [5, 11,12,13,14]. A deeper understanding of patients’ experience of healthcare-seeking, their perspectives while receiving medical services and, patients’ perceptions of the impact of the process of care may provide a different point of view regarding healthcare delivery .
The context of patient experience is multi-dimensional. Any feedback provided by patients regarding their perceptions of met needs after a clinical encounter or ward rounds is considered a component of the patient experience [16, 17]. Through applying patient-reported experience measures (PREMs), researchers or clinicians would be able to identify what patients value the most during patient-healthcare provider interaction and acknowledge feedback directly from patients regarding how to fine-tune provision of integrated care and improving outcomes . Doyle et al.  outlined a framework from a cluster of terms related to the patient experience into relational and functional aspects. Relational aspects refer to the interactions between patient and healthcare provider. Empathy, respect, and building mutual trust are factors that enable providers to offer self-care interventions to patients and adequately engage them in their own decision-making. Functional aspects emphasize the logistics of healthcare delivery that entail the efficiency and effectiveness of healthcare services, smooth transition between facilities, clean and safe environment as well as physical access to healthcare services.
There is an increasing focus on capturing, measuring and analyzing the patient experience for a variety of high-volume conditions (including osteoarthritis, osteoporosis, and low back pain, and rheumatoid arthritis) [10, 19,20,21,22,23,24,25,26], as a means to drive better patient-centered care and improve the quality of healthcare delivery. There could be value in providing an overview of the patient experience when seeking care from healthcare providers and services in the healthcare system. An overview of reviews aims to appraise and summarize the evidence from multiple reviews on the same topic, which can support healthcare provider’s decision-making and facilitate the development of clinical guidelines .
Thus, the objectives of this overview of reviews is to 1) identify aspects of the patient experience when seeking care for musculoskeletal disorders from healthcare providers and the healthcare system. 2) identify which mechanisms are used to measure aspects of the patient experience. This overview focused on adults as it was considered challenging to collect patient-reported experience outcomes from pediatric populations. It was our interest to critically appraise, summarize, and identify gaps in the current evidence about the experiences of patients when seeking care from healthcare providers and services in the healthcare system.
Protocol and registration
The protocol of this overview of reviews is registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42019136500). This overview of reviews was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)  checklist and the Cochrane Handbook of Systematic Reviews of Interventions (overview of reviews section) .
Search methods for identification of reviews
A systematic literature search was conducted in electronic bibliographic databases: CINAHL, PubMed, EMBASE, and Scopus from their inception up to December 2019, without language restrictions. The search strategies were developed by the biomedical librarian (LL). Controlled vocabulary and keywords related to musculoskeletal disorders, patient experience, and reviews were combined for the search and were adjusted for each of the databases previously mentioned. The searches were re-run just before the final analyses and further studies retrieved for inclusion. In addition to the electronic database search, the authors conducted citation tracking on the reference list of included reviews to identify any potentially eligible reviews. Reviews meeting the inclusion criteria that were not originally included during the electronic search and citation tracking were manually selected. The full search strategy is outlined in Appendix 1. All citations were imported into Covidence Software and dual-screened by the authors.
Criteria for considering reviews for inclusion
Population of interest
The population of interest were adults (≥18 years of age), with at least one type of musculoskeletal disorders (i.e., low back pain, neck pain, osteoarthritis, rheumatoid arthritis, fibromyalgia, surgical pain after joint replacement or spinal fusion, and osteoporosis). Reviews investigating participants with systemic or non-musculoskeletal pathology (e.g. tumors or infection) or pregnancy were excluded, since there would be different expectations for healthcare providers and services from these populations and other confounding factors such as life expectancy.
Study design and selection
Considering the substantial amount of existing evidence on the topic of interest, we decided to include systematic reviews (with or without meta-analysis) or scoping reviews that examined any related concepts that fall within the definition of “patient experience”. If an eligible study was published in a language outside the primary or secondary languages of the authorship team (English, Portuguese, Chinese and Spanish) all possible efforts would be made to get a translation; if that was not feasible the study was excluded. Articles that investigated healthcare delivery aspects were also included.
Outcomes of interest
For this review, we considered the patient experience as “the sum of all interactions that patients have with the healthcare system, including their care from health plans, and from doctors, nurses, and staff in hospitals, physician practices, and other healthcare facilities, shaped by an organization’s culture, that influence patient perceptions across the continuum of care” .
Doyle et al.  proposed compiling the patient experience into relational (interpersonal) and functional (logistics of healthcare delivery) aspects. We adopted this general framework into Table 1 in an attempt to identify patient experience for our target population.
Mechanisms used to measure relational and functional aspects of patient experience
We included several methods such as paper and electronic survey, focus group, patient journal, and interview, and patient-reported experience measures that have been utilized as instruments to measure and track changes of different aspects of patients’ perceptions.
Selection of reviews
Four reviewers (working in groups of two: AC and MC, KB and BG) independently screened titles and abstracts to identify relevant studies for full texts based on the agreed eligibility criteria checklist and approved by the senior advisors (AG and CC). The same reviewers independently screened full texts for final inclusion. Any disagreement between reviewers was resolved by discussion and reaching consensus. If the initial reviewers failed to reach a consensus, a third reviewer from the other group arbitrated. Agreement between reviewers (on the independent inclusion of title/abstracts and full-text articles) were quantified using a kappa statistic [31, 32].
Data extraction and management
Four reviewers (AC, MC, KB, and BG) independently extracted data from the included studies, using a standardized data extraction form. The following data were extracted: a) authors, year of publication, b) study design (systematic or scoping reviews), c) review country, d) settings of the individual studies, e) number and study designs of the individual studies, f) musculoskeletal disorder, g) relational and functional aspects of patient experience, h) data collection method, i) and main findings. Disagreement in the data extracted between reviewers was resolved by discussion and if necessary, arbitration by a third reviewer (AG).
Assessment of methodological quality of included reviews
Four reviewers (AC, MC, KB, and BG) independently assessed the methodological quality of included studies using A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) . AMSTAR-2 is a validated instrument that uses 16 questions to assess the quality of systematic reviews that include randomized and/or non-randomized studies of healthcare interventions. Reviewers rated either “yes” or “no” for each question based on the extent an article met certain criteria; and “partial yes” or “not applicable” for a few questions. The reviews were rated in overall confidence into four categories: “high”, “moderate”, “low”, and “critically low”, which was calculated using the AMSTAR checklist .
We considered critical domains of reviews, which included 1) whether or not protocol registered before commencement of the review, 2) the adequacy of the literature search, 3) the justification for excluding individual studies, 4) the methodological quality from individual studies being included in the review, 5) consideration of methodological quality when interpreting the results of the review and 6) the assessment of presence and likely impact of publication bias. It is not mandatory for scoping reviews to have a protocol, an article appraisal risk of bias tool, or syntheses of findings from individual studies, hence, when appraising scoping reviews with AMSTAR-2, all criteria related to any of these were considered not applicable . Disagreements between the reviewers were resolved by discussion with the involvement of a third reviewer (AG) when necessary.
We used the PRISMA flow diagram to summarize the selection of reviews and summarized the characteristics of the included reviews in structured tables. Because the outcome data included in this review are not quantitative, the results of patient experience aspects were reported descriptively. We calculated the proportion of relational and functional aspects reported by the included reviews. Themes were identified and categorized based on the definition of aspects of patient experience outlined by Doyle et al.  (Table 1).
From the electronic search, 7307 potentially relevant articles were identified from four databases after the removal of duplicates based on titles and abstracts. Of these, 7080 were not relevant and 227 were retrieved in full texts. For the screening of titles and abstracts, the inter-rater agreement rate between the reviewers [(AC and MC) and (KB and BG)] resulted in a Cohen’s Kappa rate of 0.32 (fair agreement) and 0.51 (moderate agreement). The full-text review resulted in 30 included reviews [10, 19,20,21,22,23,24,25,26, 36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56] (Fig. 1). Of these, two [10, 36] were manually included when searching for relevant studies on PubMed and met the eligibility criteria; and one  was included after a manual search from reference lists of the included studies. The most common reasons for exclusion at the full-text reading stage were outcomes not related to our study purpose (n = 157), study designs that were neither systematic nor scoping reviews (n = 21), and other conditions not related to musculoskeletal disorders (n = 17) (Fig. 1). We have provided a list of relevant studies read in full-text, but excluded from the review with their respective reasons for exclusion (Appendix 2).
Characteristics of the included reviews
All the included reviews were written in English and published between 2004 and 2019. The majority of the studies were conducted in Australia [19,20,21,22, 25, 26, 36, 41, 42, 52, 54], followed by the United Kingdom [10, 23, 24, 37, 40, 44,45,46,47, 49, 56] Canada [12, 48, 53, 55], the Netherlands [24, 38, 50], Ireland , Italy , Denmark , Belgium , and the United States . There were twelve scoping reviews [19,20,21,22, 25, 26, 38, 46, 47, 52, 54, 55], eighteen systematic reviews [10, 23, 24, 36, 37, 39,40,41,42,43,44,45, 48,49,50,51, 53, 56] and six systematic reviews with meta-analyses [39,40,41, 49, 51, 53]. The numbers of the included studies for individual reviews ranged from 10 [37, 39, 40] to 323 . Of all the available data, the combined numbers of participants in a single review ranged from 223  to 31,791 . The designs of the included studies varied among reviews, including qualitative, quantitative studies, mixed methods (qualitative and quantitative studies), cohort studies, cross-sectional and cohort studies (Table 2).
Each review targeted various health conditions and populations such as non-specific low back pain [19, 20, 23, 36, 37, 41, 44, 47, 49, 50, 52] (n = 11 reviews, n = 37,408 participants), osteoporosis [21, 39, 45] (n = 3 reviews, n = 17,534 participants), osteoarthritis [22, 25, 40] (n = 3 reviews, n = 3157 participants), rheumatoid arthritis [26, 38, 42, 43] (n = 4 reviews, n = 9406 participants), and other musculoskeletal disorders (e.g., chronic pain, soft tissue injuries, lower-limb sports-related injuries, traumatic musculoskeletal injuries, mixed and unspecified) [10, 24, 46, 48, 51, 53,54,55,56] (n = 9 reviews, n = 61,772 participants) that sought unspecified physical therapy services or rehabilitative cares. Table 2 provides an overview of the characteristics of the included reviews.
Methodological quality of included reviews
As reported in Table 3, the majority of the included reviews (n = 16 reviews) [19,20,21,22, 24,25,26, 38, 39, 42, 46, 47, 52,53,54,55] have “moderate” quality, which were determined based on AMSTAR-2; with the remainders rated as “critically low” (n = 6 reviews) [10, 23, 37, 40, 48, 56] or “low” quality (n = 8 reviews) [36, 41, 43,44,45, 49,50,51]. In this study, questions 2, 9, and 13 in AMSTAR-2 were considered not applicable for scoping reviews because a written protocol and a risk of bias assessment are not mandatory in scoping review designs . All of the reviews specified their population of interest and main outcome (question 1) and all listed their databases, keywords, and inclusion/exclusion criterion in their search strategies (questions 2 and 4). Eighteen (60%) out of the 28 reviews [19,20,21,22, 25, 36, 38, 41, 43, 44, 46,47,48,49, 52, 53, 55, 56] involved at least two reviewers independently performed study selection (question 5) and eighteen (60%) of them [20,21,22, 25, 36, 38, 41,42,43, 45,46,47,48,49,50,51, 53, 56] involved at least two reviewers independently performing data extraction and reaching consensus (question 6). For question 8, most of the reviews (n = 27, 90%) [10, 19,20,21,22, 24,25,26, 36, 39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56] described and organized their included studies in adequate detail, providing information such as population, outcomes, research designs, and study settings. For systematic reviews, 12 of them [24, 36, 37, 39, 41, 42, 44, 45, 49, 53, 56] utilized the risk of bias assessment tools to appraise included studies. Questions 11, 12, and 15 are designed specifically for meta-analysis. All of the reviews with meta-analyses (n = 6, 20%) [39,40,41, 49, 51, 53] included in this study used appropriate methods for statistical combination of results, but none of them reported the potential impact of risk of bias in individual studies on the results nor carried out an adequate investigation of publication bias. None of the reviews reported the source of funding for the individual studies (question 10).
Patient experience with healthcare providers and health services outcomes (Table 4)
There was a broad range of patient experience aspects reported by the included reviews. As stated in the methods, we considered patient experience from the perspective of relational and functional aspects. All reviews except one  reported patient experience outcomes from the perspective of relational aspects (n = 29, 97%), 26 reviews (87%) [10, 19, 21,22,23,24, 26, 36,37,38, 40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55] from the perspective of functional aspects; and 25 (83%) [10, 19, 21,22,23,24, 26, 36,37,38, 40,41,42,43,44,45,46,47,48,49,50,51,52,53,54] of the reviews included both relational and functional aspects. Among the included reviews, only three [41, 51, 53] specifically investigated the interactions between patients and physical therapists. The majority of the included reviews stood from the patient’s perspective focusing on a certain musculoskeletal diagnosis, and they reported the overall patient experience while seeking healthcare services regardless of the providers they encountered.
Relational aspects of patient experience outcome (Table 4)
In this overview of reviews, we found 13 (43%) reviews [10, 19, 23, 24, 26, 36, 38, 39, 44, 46, 53, 54, 56] which investigated psychological support for patient emotions and respectfully provide comfort and soothing fear and anxiety; 18 (60%) [10, 19, 21, 23, 24, 26, 37, 39,40,41, 47,48,49,50,51,52,53, 56] discussed healthcare providers’ understanding of patient expectations with respect of their beliefs and values; 24 (80%) [10, 19,20,21,22,23,24, 26, 36,37,38,39, 41, 42, 44, 45, 47, 49,50,51, 53, 54, 56] demonstrated the importance of patients’ perceived information needs that could be fulfilled by patient education; 12 (40%) [10, 19, 23, 24, 26, 37, 40, 48, 50, 51, 54, 56] entailed shared decision-making by involving and engaging patients and their families as part of crucial patient experience when receiving healthcare services; and 16 (53%) [10, 19, 22, 24, 26, 36, 37, 41, 43, 47, 49,50,51, 53, 54, 56] presented communication that minimizes the perceived information imbalance or gap between patients and healthcare providers, as relational aspects, that entail interpersonal skills during healthcare providers’ delivery of care.
Functional aspects of patient experience outcome (Table 4)
According to our findings, 12 (40%) [10, 22, 24, 37, 41, 43, 47, 49,50,51,52,53] of the included reviews took effectively, individualized treatment delivered in a timely manner into consideration as functional aspects of patient experience; 16 (53%) [10, 19, 21,22,23,24, 37, 38, 40, 41, 45,46,47, 50, 53, 54] talked about trusted expertise and perceived social roles, traits, and characteristics of healthcare providers; 16 (53%) [10, 22, 23, 26, 36, 38, 40,41,42,43,44,45, 48, 51, 53, 54] discussed physical and environmental needs including access to healthcare and social support; 13 (43%) [10, 19, 22, 26, 37, 41, 42, 44, 46, 47, 50, 51, 55] introduced continuity of care, coordination in interdisciplinary healthcare team and smoothness of transition; and only 3 (10%) [23, 48, 51] mentioned privacy.
Mechanisms used to measure patient experience aspects (Table 4)
Individual interviews were the most commonly used (n = 23 reviews) mechanism to collect data [10, 19,20,21,22, 24,25,26, 36, 37, 39,40,41,42,43, 45,46,47, 50,51,52,53, 56], followed by focus groups [19,20,21, 24,25,26, 36, 37, 39,40,41,42,43, 45,46,47,48, 50, 52, 53, 56], survey [10, 19,20,21, 25, 26, 42, 43, 47, 48, 51, 53], PREMs questionnaires [19,20,21, 25, 26, 36, 42, 43, 47, 48, 50, 56], phone interviews [20, 26, 39, 42, 45, 46, 50, 56] and diaries .
The main purpose of this study was to investigate the experience of people with musculoskeletal disorders when seeking healthcare services and their perception of healthcare providers. While considering abstract concepts about the patient experience, delineation and definition of relational and functional aspects provide a useful framework to scrutinize different themes and constructs in this field of study. In this overview of reviews, we identified five key themes in both the relational and functional aspects. In relational aspects, patients’ needs for education on and explanations about their conditions and interventions were of most prevalent findings [10, 22,23,24, 36, 38, 39, 41, 42, 45, 47, 49,50,51,52,53,54, 56]. In functional aspects, patients reported receiving effective individualized treatment [22, 24, 37, 41, 47, 49, 51, 52], and attention to physical support, such as expecting a clean, safe, comfortable, accessible clinical environment was important [10, 23, 26, 48, 51, 53, 54]. Based on our findings, we feel that there are key messages that need to be discussed.
Relational aspects of patient experience
The patients’ understanding of their health condition and appropriate management highly depends on their health literacy . Education about the natural course of certain diagnoses, multiple domains that drive pain and disability, as well as the psychosocial aspect of the pain experience, is recommended during patient-healthcare provider encounters . It is also reported that delivering clear information with good communication skills would help patients cope with their health conditions and prognoses, which would facilitate establishing a trustworthy patient-healthcare provider relationship [47, 59].
Effective communication helps healthcare providers develop a clearer idea of patients’ feelings and their needs . Meanwhile, patients would have an increased understanding of the scope and impact of their musculoskeletal disorder(s) and possible treatment options . Such processes facilitate shared decision-making models whereby patients are empowered to participate in their medical management [26, 60]. Furthermore, psychological support can be influential, especially for those suffering from chronic pain, in diminishing possible fear-avoidance of initiating movement as well as compliance with their exercises throughout healthcare-seeking . Therefore, to better promote quality and outcomes in healthcare, providers should consider improving their interpersonal skills to address the relational aspects of patient experience.
Functional aspects of patient experience
First, the application of individualized, tailored treatment has been proposed in the management of musculoskeletal disorders, with emphasis on customizing interventions for any given individual pathological, functional, and psychosocial variations [62,63,64]. In a shared decision-making model, patient’s diagnoses, clinical manifestations, severity of symptoms, cognitive and mental status as well as their needs should all be taken into consideration to formulate holistic, personalized plans of care . Second, continuity during transitions among different healthcare settings, and physical access to healthcare should also be addressed in integrated care . Providing downstream transfer services after discharging patients from acute or subacute hospitals to rehabilitation facilities, nursing homes, or outpatient clinics is recommended to ensure that patients receive required medical attention and care without disruptions.
Third, physical accessibility of healthcare sites influences the patient experience. Environmental factors including commute distance , cleanliness, and barrier-free designs in clinics need to be considered. The flexibility of scheduling  and the complexity of paperwork also impact patients’ overall impression of healthcare facilities. Fourth, patients perceive the professional role [40, 54] of healthcare providers based on their qualifications, competence, technical skills [19, 22, 23, 46, 53], attitudes, and beliefs . Patient’s trust in expertise is built upon the foundation of the knowledge and training [24, 41] of a healthcare provider as well as the validation by multidisciplinary healthcare team . Finally, patients expect that their privacy should be fully respected before, during and after receiving health services [23, 48].
Mechanisms of collecting patient experience
While efforts have been made to collect and measure information about the patient experience using qualitative studies or surveys, actions and strategies on systematically improving quality of care and promoting patient-centered care according to patient-reported experience measures have not yet been fully undertaken . Considering the positive correlation between the patient experience and clinical outcomes, it needs to be considered as a tool to refine the quality of care and enhance the implementation of the concept of patient-centeredness [18, 64, 68]. In a recent study evaluating key drivers of the patient experience in pediatric population with heart disorders, cheerfulness during practice, the cohesiveness of staff, and explanation of problems and conditions from the providers were identified as predictive of overall satisfaction . Furthermore, it has also been reported in a study evaluating interview narratives who had been hospitalized that, medication management, physical comfort, and emotional security were what matter most .
Strengths and weaknesses of the study
One of the strengths of this overview of reviews is that a comprehensive search was conducted for studies relating to the patient experience. We provided evidence from different perspectives of the patient-healthcare provider relationship and summarized ten themes about the patient experience. Providers working in healthcare settings treating patients with musculoskeletal disorders may find this overview of reviews beneficial to better understand patients’ perceptions when using healthcare services, value of effective interpersonal skills, and need to simplify the process of access to quality healthcare. A few limitations of this overview of reviews included the unfeasibility of performing a meta-analysis (due to the heterogeneity among the study designs and population of included reviews) and lack of analysis of overlapping between the reviews. This means that one original study might have been included in more than one review. As we did not review all different musculoskeletal disorders, it may not necessarily be applicable to all health settings.
Unanswered questions and future research
Further investigation of the patient experience should focus on patients with neurological disorders or other chronic conditions that require intensive healthcare services. It is also worth discussing issues on cultural differences/impacts that are relevant/different in various countries or geographical regions. To bridge the evidence to clinical practice, it is healthcare providers’ responsibility to try to understand the patient experience when delivering services. When acknowledging the relational and functional aspects of patient experience, healthcare providers would value the importance of communication and strive to comprehend what truly matters to their patients, which could be their individual information needs, preferences of treatment, or expectations of a supportive healthcare environment. Collecting patients’ feedbacks will assist healthcare providers better evaluate their services and ensure the voices of service users are heard .
Patient experience alongside safety and clinical effectiveness serve as the three pillars that enhance quality of healthcare and influence patients’ perspectives when receiving healthcare services. In healthcare settings, which currently treat musculoskeletal conditions, efforts on measuring and capturing patient experience could help guide improvement in healthcare providers’ interpersonal aspects, and patient’s expectations on how healthcare should be delivered. This overview of reviews identified constructs regarding patient experience of healthcare providers and health services and proposed ways to enhance healthcare experience of patients with musculoskeletal disorders. By adjusting healthcare providers’ professional attitudes and behaviors when interacting with patients, as well as changing environmental factors in healthcare facilities, an improvement in patient adherence to medical advice and regimens promoting health and well-being would be reasonably expected. Our findings suggested that healthcare providers understand the importance of patient information needs and expectations via effective communication. It is also recommended that patients be treated individually with personalized intervention plans in a supportive, comforting environment.
Availability of data and materials
all data generated or analyzed during this study are included in this published article and its supplementary information files.
A MeaSurement Tool to Assess systematic Reviews
Patient-reported experience measures
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Prospective Register of Systematic Reviews
Hoy DG, Smith E, Cross M, Sanchez-Riera L, Buchbinder R, Blyth FM, et al. The global burden of musculoskeletal conditions for 2010: an overview of methods. Ann Rheum Dis. 2014;73(6):982–9.
March L, Smith EU, Hoy DG, Cross MJ, Sanchez-Riera L, Blyth F, et al. Burden of disability due to musculoskeletal (MSK) disorders. Best Pract Res Clin Rheumatol. 2014;28(3):353–66.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2095–128.
Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333.
Larranaga I, Soto-Gordoa M, Arrospide A, Jauregi ML, Millas J, San Vicente R, et al. Evaluation of the implementation of an integrated program for musculoskeletal system care. Reumatol Clin. 2017;13(4):189–96.
Carlson H, Carlson N. An overview of the management of persistent musculoskeletal pain. Ther Adv Musculoskelet Dis. 2011;3(2):91–9.
Duffield SJ, Ellis BM, Goodson N, Walker-Bone K, Conaghan PG, Margham T, et al. The contribution of musculoskeletal disorders in multimorbidity: implications for practice and policy. Best Pract Res Clin Rheumatol. 2017;31(2):129–44.
Boudreaux ED, O'Hea EL. Patient satisfaction in the emergency department: a review of the literature and implications for practice. J Emerg Med. 2004;26(1):13–26.
Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2019;54(2):79–86.
Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3(1):1–18.
Roberts L. Improving quality, service delivery and patient experience in a musculoskeletal service. Man Ther. 2013;18(1):77–82.
Guastello S, Jay K. Improving the patient experience through a comprehensive performance framework to evaluate excellence in person-centred care. BMJ Open Qual. 2019;8(4):e000737.
Institute of Medicine Committee on Quality of Health Care in A. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001.
Medina-Mirapeix F, Jimeno-Serrano FJ, Escolar-Reina P, Del Bano-Aledo ME. Is patient satisfaction and perceived service quality with musculoskeletal rehabilitation determined by patient experiences? Clin Rehabil. 2013;27(6):555–64.
Kingsley C, Patel S. Patient-reported outcome measures and patient-reported experience measures. BJA Educ. 2017;17(4):137–44.
Anhang Price R, Elliott MN, Zaslavsky AM, Hays RD, Lehrman WG, Rybowski L, et al. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev. 2014;71(5):522–54.
Black N, Jenkinson C. Measuring patients' experiences and outcomes. Brit Med J. 2009;339:2495.
Black N, Varaganum M, Hutchings A. Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery. BMJ Qual Saf. 2014;23(7):534–42.
Chou L, Ranger TA, Peiris W, Cicuttini FM, Urquhart DM, Sullivan K, et al. Patients' perceived needs of health care providers for low back pain management: a systematic scoping review. Spine J. 2018;18(4):691–711.
Chou L, Ranger TA, Peiris W, Cicuttini FM, Urquhart DM, Sullivan K, et al. Patients' perceived needs for medical services for non-specific low back pain: a systematic scoping review. PLoS One. 2018;13(11):e0204885.
Chou L, Shamdasani P, Briggs AM, Cicuttini FM, Sullivan K, Seneviwickrama K, et al. Systematic scoping review of patients' perceived needs of health services for osteoporosis. Osteoporos Int. 2017;28(11):3077–98.
Papandony MC, Chou L, Seneviwickrama M, Cicuttini FM, Lasserre K, Teichtahl AJ, et al. Patients' perceived health service needs for osteoarthritis (OA) care: a scoping systematic review. Osteoarthr Cartil. 2017;25(7):1010–25.
Slade SC, Keating JL. Measurement of participant experience and satisfaction of exercise programs for low back pain: a structured literature review. Pain Med. 2010;11(10):1489–99.
Wijma AJ, Bletterman AN, Clark JR, Vervoort S, Beetsma A, Keizer D, et al. Patient-centeredness in physiotherapy: what does it entail? A systematic review of qualitative studies. Physiother Theory Pract. 2017;33(11):825–40.
Chou L, Ellis L, Papandony M, Seneviwickrama K, Cicuttini FM, Sullivan K, et al. Patients' perceived needs of osteoarthritis health information: a systematic scoping review. PLoS One. 2018;13(4):e0195489.
Segan JD, Briggs AM, Chou L, Connelly KL, Seneviwickrama M, Sullivan K, et al. Patient-perceived health service needs in inflammatory arthritis: a systematic scoping review. Semin Arthritis Rheum. 2018;47(6):765–77.
Hunt H, Pollock A, Campbell P, Estcourt L, Brunton G. An introduction to overviews of reviews: planning a relevant research question and objective for an overview. Syst Rev. 2018;7(1):39.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions: Wiley; 2011..
Beattie M, Murphy DJ, Atherton I, Lauder W. Instruments to measure patient experience of healthcare quality in hospitals: a systematic review. Syst Rev. 2015;4:97.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.
Fleiss JL, Cohen J. The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas. 1973;33(3):613–9.
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR Checklist [Available from: https://amstar.ca/Amstar_Checklist.php].
Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143.
Lim YZ, Chou L, Au RT, Seneviwickrama KMD, Cicuttini FM, Briggs AM, et al. People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review. Aust J Phys. 2019;65(3):124–35.
Fu Y, McNichol E, Marczewski K, Closs SJ. Patient-professional partnerships and chronic back pain self-management: a qualitative systematic review and synthesis. Health Soc Care Community. 2016;24(3):247–59.
Zuidema RM, Repping-Wuts H, Evers AW, Van Gaal BG, Van Achterberg T. What do we know about rheumatoid arthritis patients' support needs for self-management? A scoping review. Int J Nurs Stud. 2015;52(10):1617–24.
Rothmann MJ, Jakobsen PR, Jensen CM, Hermann AP, Smith AC, Clemensen J. Experiences of being diagnosed with osteoporosis: a meta-synthesis. Arch Osteoporos. 2018;13(1):21.
O'Neill T, Jinks C, Ong BN. Decision-making regarding total knee replacement surgery: a qualitative meta-synthesis. BMC Health Serv Res. 2007;7:52.
O'Keeffe M, Cullinane P, Hurley J, Leahy I, Bunzli S, O'Sullivan PB, et al. What influences patient-therapist interactions in musculoskeletal physical therapy? Qualitative systematic review and meta-synthesis. Phys Ther. 2016;96(5):609–22.
Connelly K, Segan J, Lu A, Saini M, Cicuttini FM, Chou L, et al. Patients' perceived health information needs in inflammatory arthritis: a systematic review. Semin Arthritis Rheum. 2019;48(5):900–10.
Hulen E, Ervin A, Schue A, Evans-Young G, Saha S, Yelin EH, et al. Patient goals in rheumatoid arthritis care: a systematic review and qualitative synthesis. Musculoskeletal Care. 2017;15(4):295–303.
Campbell P, Wynne-Jones G, Dunn KM. The influence of informal social support on risk and prognosis in spinal pain: a systematic review. Eur J Pain. 2011;15(5):444 e1–14.
Raybould G, Babatunde O, Evans AL, Jordan JL, Paskins Z. Expressed information needs of patients with osteoporosis and/or fragility fractures: a systematic review. Arch Osteoporos. 2018;13(1):55.
Gillespie H, Kelly M, Duggan S, Dornan T. How do patients experience caring? Scoping review. Patient Educ Couns. 2017;100(9):1622–33.
Hopayian K, Notley C. A systematic review of low back pain and sciatica patients' expectations and experiences of health care. Spine J. 2014;14(8):1769–80.
McMurray J, McNeil H, Lafortune C, Black S, Prorok J, Stolee P. Measuring Patients' experience of rehabilitation services across the care continuum. Part II: key dimensions. Arch Phys Med Rehabil. 2016;97(1):121–30.
Slade SC, Patel S, Underwood M, Keating JL. What are patient beliefs and perceptions about exercise for nonspecific chronic low back pain? A systematic review of qualitative studies. Clin J Pain. 2014;30(11):995–1005.
Verbeek J, Sengers MJ, Riemens L, Haafkens J. Patient expectations of treatment for back pain: a systematic review of qualitative and quantitative studies. Spine (Phila Pa 1976). 2004;29(20):2309–18.
Hush JM, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;91(1):25–36.
Chou L, Ranger TA, Peiris W, Cicuttini FM, Urquhart DM, Briggs AM, et al. Patients' perceived needs for allied health, and complementary and alternative medicines for low back pain: a systematic scoping review. Health Expect. 2018;21(5):824–47.
Rossettini G, Latini TM, Palese A, Jack SM, Ristori D, Gonzatto S, et al. Determinants of patient satisfaction in outpatient musculoskeletal physiotherapy: a systematic, qualitative meta-summary, and meta-synthesis. Disabil Rehabil. 2018;42(4):1–13.
Wluka A, Chou L, Briggs AM, Cicuttini F. Understanding the needs of consumers with musculoskeletal conditions: consumers’ perceived needs of health information, health services and other non-medical services: a systematic scoping review. Melbourne Victoria: MOVE muscle, bone & joint health; 2016.
Asif M, Cadel L, Kuluski K, Everall AC, Guilcher SJT. Patient and caregiver experiences on care transitions for adults with a hip fracture: a scoping review. Disabil Rehabil. 2019:1–10.
Davenport S, Dickinson A, Minns LC. Therapy-based exercise from the perspective of adult patients: a qualitative systematic review conducted using an ethnographic approach. Clin Rehabil. 2019;33(12):1963–77.
Amalraj S, Starkweather C, Nguyen C, Naeim A. Health literacy, communication, and treatment decision-making in older cancer patients. Oncology (Williston Park). 2009;23(4):369–75.
Tousignant-Laflamme Y, Martel MO, Joshi AB, Cook CE. Rehabilitation management of low back pain - it's time to pull it all together! J Pain Res. 2017;10:2373–85.
Robertson K. Active listening: more than just paying attention. Aust Fam Physician. 2005;34(12):1053–5.
Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361–7.
Murray A, Hall AM, Williams GC, McDonough SM, Ntoumanis N, Taylor IM, et al. Effect of a self-determination theory-based communication skills training program on physiotherapists' psychological support for their patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil. 2015;96(5):809–16.
Svedmark A, Djupsjobacka M, Hager C, Jull G, Bjorklund M. Is tailored treatment superior to non-tailored treatment for pain and disability in women with non-specific neck pain? A randomized controlled trial. BMC Musculoskelet Disord. 2016;17(1):408.
Fregly BJ, Boninger ML, Reinkensmeyer DJ. Personalized neuromusculoskeletal modeling to improve treatment of mobility impairments: a perspective from European research sites. J Neuroeng Rehabil. 2012;9:18.
Ahern M, Dean CM, Dear BF, Willcock SM, Hush JM. The experiences and needs of people seeking primary care for low-back pain in Australia. Pain Rep. 2019;4(4):e756.
Murphy DR, Hurwitz EL. A theoretical model for the development of a diagnosis-based clinical decision rule for the management of patients with spinal pain. BMC Musculoskelet Disord. 2007;8:75.
Gerteis M, Edgman-Levitan S, Daley J, Delbanco TL. Through the Patient's eyes: understanding and promoting patient-centered care. San Francisco: Wiley; 2002.
Groene O, Arah OA, Klazinga NS, Wagner C, Bartels PD, Kristensen S, et al. Patient experience shows little relationship with hospital quality management strategies. PLoS One. 2015;10(7):e0131805.
Christalle E, Zeh S, Hahlweg P, Kriston L, Harter M, Scholl I. Assessment of patient centredness through patient-reported experience measures (ASPIRED): protocol of a mixed-methods study. BMJ Open. 2018;8(10):e025896.
Allam SD, Mehta M, Ben Khallouq B, Burrows JF, Rosen P. Key drivers of patient experience in ambulatory paediatric cardiology. Cardiol Young. 2017;27(8):1585–90.
Edwards KJ, Duff J, Walker K. What really matters? A multi-view perspective of one patient's hospital experience. Contemp Nurse. 2014;49:122–36.
Greenhalgh J. The applications of PROs in clinical practice: what are they, do they work, and why? Qual Life Res. 2009;18(1):115–23.
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Chi-Lun-Chiao, A., Chehata, M., Broeker, K. et al. Patients’ perceptions with musculoskeletal disorders regarding their experience with healthcare providers and health services: an overview of reviews. Arch Physiother 10, 17 (2020). https://0-doi-org.brum.beds.ac.uk/10.1186/s40945-020-00088-6
- Musculoskeletal disorder
- Patient experience
- Systematic review