. 2023 Mar 17;18(3):e0281308.

doi: 10.1371/journal.pone.0281308. eCollection 2023.

Which clinical research questions are the most important? Development and preliminary validation of the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network Research Question Importance Tool (ANZMUSC-RQIT)

William J Taylor^{1

2

3}, Robin Willink¹, Denise A O'Connor^{4

5}, Vinay Patel¹, Allison Bourne^{4

5}, Ian A Harris^{6

7

8}, Samuel L Whittle^{4

9}, Bethan Richards^{7

8}, Ornella Clavisi¹⁰, Sally Green¹¹, Rana S Hinman¹², Chris G Maher^{13

14}, Ainslie Cahill¹⁵, Annie McPherson¹⁶, Charlotte Hewson¹⁶, Suzie E May¹⁶, Bruce Walker¹⁷, Philip C Robinson¹⁸, Davina Ghersi¹⁹, Jane Fitzpatrick²⁰, Tania Winzenberg²¹, Kieran Fallon²², Paul Glasziou²³, Laurent Billot²⁴, Rachelle Buchbinder^{4

5}

Affiliations

¹ University of Otago, Wellington, New Zealand.
² Hutt Valley District Health Board, Lower Hutt, New Zealand.
³ Hauora Tairawhiti, Gisborne, New Zealand.
⁴ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
⁵ Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Victoria, Australia.
⁶ Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia.
⁷ School of Clinical Medicine, UNSW Sydney, Liverpool, NSW, Australia.
⁸ Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁹ The Queen Elizabeth Hospital, Adelaide, SA, Australia.
¹⁰ Musculoskeletal Australia, Melbourne, VIC, Australia.
¹¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
¹² Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
¹³ Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
¹⁴ Institute for Musculoskeletal Health, Sydney, NSW, Australia.
¹⁵ Arthritis Australia, Sydney, NSW, Australia.
¹⁶ Consumer Partner, ANZMUSC, Melbourne, Australia.
¹⁷ Emeritus Professor in the College of Science, Health, Engineering and Education (SHEE), Murdoch University, Murdoch, WA, Australia.
¹⁸ University of Queensland School of Medicine, Brisbane, QLD, Australia.
¹⁹ National Health and Medical Research Council of Australia, Canberra, ACT, Australia.
²⁰ University of Melbourne, Melbourne, VIC, Australia.
²¹ Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
²² ANU College of Health and Medicine, Australian National University, Garran, ACT, Australia.
²³ Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia.
²⁴ The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.

PMID: 36930668
PMCID: PMC10022765
DOI: 10.1371/journal.pone.0281308

Which clinical research questions are the most important? Development and preliminary validation of the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network Research Question Importance Tool (ANZMUSC-RQIT)

William J Taylor et al. PLoS One. 2023.

. 2023 Mar 17;18(3):e0281308.

doi: 10.1371/journal.pone.0281308. eCollection 2023.

Authors

Affiliations

¹ University of Otago, Wellington, New Zealand.
² Hutt Valley District Health Board, Lower Hutt, New Zealand.
³ Hauora Tairawhiti, Gisborne, New Zealand.
⁴ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
⁵ Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Victoria, Australia.
⁶ Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia.
⁷ School of Clinical Medicine, UNSW Sydney, Liverpool, NSW, Australia.
⁸ Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁹ The Queen Elizabeth Hospital, Adelaide, SA, Australia.
¹⁰ Musculoskeletal Australia, Melbourne, VIC, Australia.
¹¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
¹² Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
¹³ Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
¹⁴ Institute for Musculoskeletal Health, Sydney, NSW, Australia.
¹⁵ Arthritis Australia, Sydney, NSW, Australia.
¹⁶ Consumer Partner, ANZMUSC, Melbourne, Australia.
¹⁷ Emeritus Professor in the College of Science, Health, Engineering and Education (SHEE), Murdoch University, Murdoch, WA, Australia.
¹⁸ University of Queensland School of Medicine, Brisbane, QLD, Australia.
¹⁹ National Health and Medical Research Council of Australia, Canberra, ACT, Australia.
²⁰ University of Melbourne, Melbourne, VIC, Australia.
²¹ Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
²² ANU College of Health and Medicine, Australian National University, Garran, ACT, Australia.
²³ Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia.
²⁴ The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.

PMID: 36930668
PMCID: PMC10022765
DOI: 10.1371/journal.pone.0281308

Abstract

Background and aims: High quality clinical research that addresses important questions requires significant resources. In resource-constrained environments, projects will therefore need to be prioritized. The Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network aimed to develop a stakeholder-based, transparent, easily implementable tool that provides a score for the 'importance' of a research question which could be used to rank research projects in order of importance.

Methods: Using a mixed-methods, multi-stage approach that included a Delphi survey, consensus workshop, inter-rater reliability testing, validity testing and calibration using a discrete-choice methodology, the Research Question Importance Tool (ANZMUSC-RQIT) was developed. The tool incorporated broad stakeholder opinion, including consumers, at each stage and is designed for scoring by committee consensus.

Results: The ANZMUSC-RQIT tool consists of 5 dimensions (compared to 6 dimensions for an earlier version of RQIT): (1) extent of stakeholder consensus, (2) social burden of health condition, (3) patient burden of health condition, (4) anticipated effectiveness of proposed intervention, and (5) extent to which health equity is addressed by the research. Each dimension is assessed by defining ordered levels of a relevant attribute and by assigning a score to each level. The scores for the dimensions are then summed to obtain an overall ANZMUSC-RQIT score, which represents the importance of the research question. The result is a score on an interval scale with an arbitrary unit, ranging from 0 (minimal importance) to 1000. The ANZMUSC-RQIT dimensions can be reliably ordered by committee consensus (ICC 0.73-0.93) and the overall score is positively associated with citation count (standardised regression coefficient 0.33, p<0.001) and journal impact factor group (OR 6.78, 95% CI 3.17 to 14.50 for 3rd tertile compared to 1st tertile of ANZMUSC-RQIT scores) for 200 published musculoskeletal clinical trials.

Conclusion: We propose that the ANZMUSC-RQIT is a useful tool for prioritising the importance of a research question.

Copyright: © 2023 Taylor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

**Fig 1. A schematic of the overall study structure.**

**Fig 2. Distribution of rankings and importance grade of 30 research questions relevant to MSK clinical trials.**
Each research question is labelled as an Australian wildflower and are displayed in order of most highly ranked to least highly ranked. The blue line shows the mean ranking (left axis) and the green line shows the importance grade nominated by the source of the research question (right axis). Each data symbol represents a workshop participant.

**Fig 3. The level of association between dimensions of RQIT shown as counts of publications by journal impact factor (low, high) and by categories of the RQIT assessment.**
The Phi (also known as Cramer’s V) statistic can be interpreted in a similar way as a correlation coefficient.

See this image and copyright information in PMC

References

1. Safiri S, Kolahi AA, Cross M, Hill C, Smith E, Carson, et al. Burden of musculoskeletal disorders in 195 countries and territories, 1990–2017: findings from the Global Burden of Disease Study 2017. Arthritis Rheum. 2021; 73(4):702–14. - PubMed
1. Australian Institute of Health and Welfare. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2018.; 2021. Contract No.: Cat. no. BOD 29.
1. Buchbinder R, Maher C, Harris I. Setting the research agenda for improving health care in musculoskeletal disorders. Nature Rev Rheum. 2015;11:597–605. - PubMed
1. Buchbinder R, Bourne A, Latimer J, Harris I, Whittle S, Richards B, et al. Early development of the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network. Intern Med J. 2020;50(1):17–23. - PubMed
1. Gilbert SE, Buchbinder R, Harris IA, Maher CG. A comparison of the distribution of Medical Research Future Fund grants with disease burden in Australia. The Medical Journal of Australia. 2021;214(3):111–3. - PubMed

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Which clinical research questions are the most important? Development and preliminary validation of the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network Research Question Importance Tool (ANZMUSC-RQIT)

Affiliations

Which clinical research questions are the most important? Development and preliminary validation of the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network Research Question Importance Tool (ANZMUSC-RQIT)

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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Associated data

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