What healthcare programs have been developed for the management of musculoskeletal pain in Indigenous populations? A scoping review

Objective There is a current knowledge gap and need for a comprehensive summary of literature about the management of musculoskeletal pain for Indigenous people internationally. We aimed to summarise and appraise cultural and methodological quality of studies describing programs developed to support Indigenous peoples manage musculoskeletal pain. Design Scoping review. Data sources Systematic literature search of Medline, Embase, CINAHL, Proquest Central and Scopus from January 1993 to November 2023. Eligibility criteria Scientific literature published in English; conducted in Canada, United States of America, Australia and New Zealand; describing the development and/or implementation of programs or components of programs for Indigenous patients with musculoskeletal pain or health staff working with Indigenous patients with pain musculoskeletal pain were included.

23 articles met the inclusion criteria. Articles were classified into two categories: programs for patients (n=16) and programs for health staff working with Indigenous peoples (n=7). Overall methodological quality of studies was moderate-high, overall cultural quality of studies was moderate. Most programs had positive outcomes and were well received by participants. Multiple strategies, including culturally appropriate models of care and locations, were incorporated into the programs and most studies considered cultural components for the development and delivery of the programs.

Although there has been a recent increase in research for the management of musculoskeletal pain amongst Indigenous peoples it is still limited. Cultural considerations are critical for research methodology and the development and delivery of new health programs focussed on improving the health and wellbeing of Indigenous peoples with musculoskeletal pain. What is already known in this topic Indigenous peoples internationally experience an inequitable burden due to musculoskeletal pain and have reduced access to culturally safe and appropriate health programs for musculoskeletal pain. Culturally safe and appropriate healthcare programs have demonstrated positive outcomes for Indigenous peoples with other chronic disease conditions. Little is known about the western methodological or cultural rigour of research, features, or outcomes of musculoskeletal programs for Indigenous peoples. What are the new findings Programs have been developed to improve the management of musculoskeletal pain for Indigenous peoples, by providing interventions for Indigenous peoples and education training for health staff working with Indigenous peoples with musculoskeletal pain conditions. A comprehensive summary of the programs can inform Indigenous Community members, clinicians and researchers in the future development of culturally safe, appropriate and accessible programs for Indigenous peoples. Strategies for the development and delivery of health programs, such as the co-design of programs with Indigenous peoples and the implementation of programs in culturally safe locations, have resulted in positive outcomes for Indigenous peoples with musculoskeletal pain conditions. Musculoskeletal health research with Indigenous peoples needs to be of a high quality from both methodological and cultural perspective. Examples of how to conduct or appraise future studies are demonstrated. Competing Interest Statement The authors have declared no competing interest. Funding Statement JL was supported by a Centre for Research Excellence-STRIDE scholarship funded by the National Medical Research Council of Australia. CMW receives funding for salary from the National Medical Research Council of Australia. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present work are contained in the manuscript