Decolonising the commissioning of Indigenous health and wellbeing program evaluations in Australia

Background

Significant financial investments have been made to improve the life expectancy gap between Indigenous people and other Australians over the last 10 years. Despite the investment, few evaluations have been commissioned to assess program effectiveness. Indigenous leaders have been calling for a more active role in the commissioning of Indigenous program evaluations. This project aims to identify how government and non-government commissioning practices can better support Indigenous engagement and leadership in the evaluation of health and wellbeing programs in Australia. This presentation reports on the different commissioning models that support Indigenous program evaluations, from the perspectives of commissioners, evaluators and program providers.

Methods

Semi-structured interviews were conducted with 20 Indigenous and non-Indigenous commissioners, evaluators and program providers. A mixed coding procedure was used. Interviews were coded using deductively derived codes reflecting best practice principles in Indigenous evaluation and inductively derived codes from participant stories. Interviews were analysed using NVivo qualitative software. A collaborative group-based approach to data analysis was used guided by Indigenous Standpoint Theory.

Results

The commissioning of Indigenous-specific program evaluations in Australia reflects top-down, participatory, co-design and Indigenous-led approaches. Top-down approaches were considered 'extractive' and had limited or token Indigenous input. Indigenous models were more strongly aligned with best practice and reflected authentic Indigenous engagement. There was agreement across the stakeholder groups on the value of Indigenous engagement in the commissioning process. The presentation will elaborate on the different approaches, their characteristics, strengths/ limitations.

Conclusions

Diverse approaches to commissioning are used and reflect different levels of Indigenous engagement and leadership.

Key messages

In the commissioning of Indigenous evaluations there needs to be governance structures to support Indigenous engagement. In the commissioning of Indigenous evaluations there needs to be greater input by Indigenous people.

The OMERACT Core Domain Set for Clinical Trials of Shoulder Disorders

OBJECTIVE

To reach consensus on the core domains to be included in a core domain set for clinical trials of shoulder disorders using the Outcome Measures in Rheumatology (OMERACT) Filter 2.1 Core Domain Set process.

METHODS

At OMERACT 2018, the OMERACT Shoulder Working Group conducted a workshop that presented the OMERACT 2016 preliminary core domain set and its rationale based upon a systematic review of domains measured in shoulder trials and international Delphi sessions involving patients, clinicians, and researchers, as well as a new systematic review of qualitative studies on the experiences of people with shoulder disorders. After discussions in breakout groups, the OMERACT core domain set for clinical trials of shoulder disorders was presented for endorsement by OMERACT 2018 participants.

RESULTS

The qualitative review (n = 8) identified all domains included in the preliminary core set. An additional domain, cognitive dysfunction, was also identified, but confidence that this represents a core domain was very low. The core domain set that was endorsed by the OMERACT participants, with 71% agreement, includes 4 "mandatory" trial domains: pain, function, patient global - shoulder, and adverse events including death; and 4 "important but optional" domains: participation (recreation/work), sleep, emotional well-being, and condition-specific pathophysiological manifestations. Cognitive dysfunction was voted out of the core domain set.

CONCLUSION

OMERACT 2018 delegates endorsed a core domain set for clinical trials of shoulder disorders. The next step includes identification of a core outcome measurement set that passes the OMERACT 2.1 Filter for measuring each domain.

Conceptualization and assessment of disability in shoulder-specific measures with reference to the International Classification of Functioning, Disability and Health

OBJECTIVE

To expand on a previous systematic review of shoulder-specific outcome measures by investigating how concepts of functioning were conceptualized and measured, using International Classification of Functioning, Disability and Health (ICF) constructs as a reference.

METHODS

The material consisted of the linked content of 17 condition-specific measures. The distribution of the key concepts of functioning was assessed in relation to the 3 ICF levels: body level (body functions and structures), personal level (activities) and societal level (participation). Based on this cate-gorization, the concepts were further explored; body functions as to whether they were informed by any contextual information, and activities and participation as to whether they measured a person's capacity, capability or performance.

RESULTS

Seven measures assessed all 3 levels of functioning, 8 measured 2 levels, and 2 measured a single level. The majority of the 15 measures including body functions assessed a mix of decontextualized and contextualized functions. Of the 13 measures of activities, 7 measured capabilities, 4 performance and 2 used both constructs. In comparison, among the 11 measures of participation, 5 measured capabilities, 2 performance and 4 a mixture of these. No measure used the capacity construct.

CONCLUSION

Shoulder-specific outcome measures differ in their choice of measurement levels and measurement constructs. The inconsistent use of the capability and performance constructs to measure activities and participation, raise important questions about the suitability of the measures for their intended use.

Reliability and validity of the Norwegian version of the Disabilities of the Arm, Shoulder and Hand questionnaire in patients with shoulder impingement syndrome

BACKGROUND

Patient-rated outcome measures (PROMs) are an important part of clinical decision-making in rehabilitation of patients with shoulder pain. The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire was designed to measure physical disability and symptoms in patients with musculoskeletal disorders of the upper extremity and is one the most commonly used outcome measures for patients with shoulder pain. The purpose of this study was to investigate the reliability and validity of the Norwegian version of the DASH in patients with shoulder impingement syndrome.

METHODS

Sixty-three patients diagnosed with shoulder impingement syndrome at an orthopaedic outpatient clinic were included in the study. Internal consistency of the DASH was evaluated by the Cronbach's alpha and item-to-total correlations. Test-retest reliability was analyzed by the intraclass correlation coefficient (ICC) and limits of agreement (LoA) according to the Bland Altman method. Standard error of measurement (SEM) and minimally detectable change (MDC) were calculated for the total DASH score. Construct validity was evaluated by testing six a priori hypotheses for the Pearson's correlation coefficient between the DASH and the Shoulder Pain and Disability Index (SPADI), the 36-item Short Form Health Survey (SF-36) and a Numeric Pain Rating Scale (NPRS).

RESULTS

Reliability: Cronbach's alpha of the DASH was 0.93 and item-to-total correlations ranged from 0.36 to 0.81. ICC was 0.89. The 95 percent LoA was calculated to be between -11.9 and 14.1. SEM was 4.7 and MDC 13.1. Construct validity: Eighty-three percent of the a priori hypotheses of correlation were confirmed. The DASH showed a high positive correlation of 0.75 with the SPADI, a negative moderate correlation of -0.48 to -0.62 with physical functioning, bodily pain and physical component summary of the SF-36 and a moderate positive correlation of 0.58 with the NPRS. DASH correlated higher with the physical component summary than with the mental component summary of the SF-36.

CONCLUSIONS

The Norwegian version of the DASH is a reliable and valid outcome measure for patients with shoulder impingement syndrome.

Identification of relevant International Classification of Functioning, Disability and Health categories in patients with shoulder pain: a cross-sectional study

OBJECTIVE

To identify the most common problems in patients with shoulder pain, using the International Classification of Functioning, Disability and Health (ICF) as a reference.

DESIGN

A cross-sectional study.

SUBJECTS

Outpatients at a hospital with shoulder pain lasting longer than 3 months.

METHODS

Patients were interviewed with an extended version of the ICF Checklist version 2.1a. Patients' problems in functioning, and the magnitude of the problem, were registered separately for each category. Categories identified as a problem in at least 5% of patients were reported. To describe the population, age, diagnosis, work participation and the Shoulder Pain and Disability Index (SPADI) were recorded.

RESULTS

A total of 165 patients with a mean age of 46.5 years (standard deviation 12.5) and a SPADI score of 47.4 (standard deviation 21.1) were included. Of the participants, 92.8% were either employed or students, 35.2% of whom were on sick leave. The primary result was the identification of 61 condition-specific second-level ICF categories: 19 in the body functions and structures component, 34 in activities and participation, and 8 in environmental factors.

CONCLUSION

The findings provide a comprehensive picture from the patient-perspective of the disability associated with shoulder pain. The findings may enhance multidisciplinary communication in clinical settings.