What does high value care for musculoskeletal conditions mean and how do you apply it in practice? A consensus statement from a research network of physiotherapists in New South Wales, Australia.

OBJECTIVES: To develop a physiotherapist-led consensus statement on the definition and provision of high-value care for people with musculoskeletal conditions. DESIGN: We performed a three-stage study using Research And Development/University of California Los Angeles Appropriateness Method methodology. We reviewed evidence about current definitions through a rapid literature review and then performed a survey and interviews with network members to gather consensus. Consensus was finalised in a face-to-face meeting. SETTING: Australian primary care. PARTICIPANTS: Registered physiotherapists who are members of a practice-based research network (n=31). RESULTS: The rapid review revealed two definitions, four domains of high value care and seven themes of high-quality care. Online survey responses (n=26) and interviews (n=9) generated two additional high-quality care themes, a definition of low-value care, and 21 statements on the application of high value care. Consensus was reached for three working definitions (high value, high-quality and low value care), a final model of four high value care domains (high-quality care, patient values, cost-effectiveness, reducing waste), nine high-quality care themes and 15 statements on application. CONCLUSION: High value care for musculoskeletal conditions delivers most value for the patient, and the clinical benefits outweigh the costs to the individual or system providing the care. High-quality care is evidence based, effective and safe care that is patient-centred, consistent, accountable, timely, equitable and allows easy interaction with healthcare providers and healthcare systems.

Hippotherapy in adults with acquired brain injury: A systematic review.

BACKGROUND: Hippotherapy is used to supplement conventional therapy in neurological conditions with evidence supporting its use in pediatric patients. However, evaluation of its merit in adults with acquired brain injury (ABI) is lacking. The aim of this study was to determine if hippotherapy can improve motor function in adults with ABI. Methods: A systematic review of all available controlled studies investigating the use of hippotherapy, in adults with ABI, was conducted. The primary outcome of interest was movement related function and secondary outcomes included impairment, quality of life, and adverse events. Results: Nine studies with 256 participants were included, of which six studies with 204 participants were included for meta-analysis. When the data were pooled, hippotherapy did not produce statistically significant improvements in balance (SMD = 0.24, 95% CI -0.05, 0.54, p = 0.1) or gait parameters (SMD = -0.04, 95% CI -0.79, 0.72 p = 0.92) when compared to control and measured immediately after the intervention. Long-term effects remain unknown due to lack of follow-up evaluation. Conclusions: This review suggests that hippotherapy is safe and well tolerated by adults with ABI. Short-term functional benefits were not associated with the use of hippotherapy. Further high-quality research is required before hippotherapy can be endorsed as a modality in adult neurological rehabilitation.