How Is Health Equity Assessed in Cochrane Musculoskeletal Reviews?

Objective To evaluate the extent to which Cochrane Musculoskeletal systematic reviews assess and analyze health equity considerations.

Methods We included Cochrane Musculoskeletal systematic reviews that included trials with participants aged ≥ 50 years and that were published from 2015 to 2020. We assessed the extent to which reviews considered health equity in the description of the population in the PICO (Patient/Population – Intervention – Comparison/Comparator – Outcome) framework, data analysis (planned and conducted), description of participant characteristics, summary of findings, and applicability of results using the PROGRESS-Plus framework. The PROGRESS acronym stands for place of residence (rural or urban), race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital, and Plus represents age, disability, relationship features, time-dependent relationships, comorbidities, and health literacy.

Results In total, 52 systematic reviews met our inclusion criteria. At least 1 element of PROGRESS-Plus was considered in 90% (47/52) of the reviews regarding the description of participants and in 85% (44/52) of reviews regarding question formulation. For participant description, the most reported factors were age (47/52, 90%) and sex (45/52, 87%). In total, 8 (15%) reviews planned to analyze outcomes by sex, age, and comorbidities. Only 1 had sufficient data to carry this out. In total, 19 (37%) reviews discussed the applicability of the results to 1 or more PROGRESS-Plus factor, most frequently across sex (12/52, 23%) and age (9/52, 17%).

Conclusion Sex and age were the most reported PROGRESS-Plus factors in any sections of the Cochrane Musculoskeletal reviews. We suggest a template for reporting participant characteristics that authors of reviews believe may influence outcomes. This could help patients and practitioners make judgments about applicability.