P119 The Alliance - a framework for conceptualising patient and public involvement in rheumatic and musculoskeletal guidelines implementation
Authors: Babatunde Opeyemi O , Dawson Shoba , Brammar June , Dziedzic Krysia , Adebajo Adewale O 
Published: April 2022

Abstract

Background/Aims
Over the last two decades, patient and public involvement (PPI) have improved the relevance, appropriateness, quality, and acceptability of rheumatic and musculoskeletal (MSK) research. This has in turn been successfully curated into widely endorsed evidence-based recommendations and guidelines. However, uptake and applicability of guideline recommendations is less than optimal, significant variation exist in care, and health and socio-economic burdens attributed to MSK continues to rise, suggesting an implementation challenge. We conducted a rapid review to investigate the role of PPI in rheumatic/MSK guideline implementation.

Methods
A comprehensive search was used to identify relevant literature in three databases (Medline, Embase, Cinahl) and two large repositories (WHO, G-IN). A priori eligibility criteria and systematic review-based methods were used to identify primary studies with explicit reference to PPI involvement in a rheumatic/MSK guideline implementation activity. Extracted data from included studies was interrogated by authors for details regarding activities, contexts, outcomes, and impact of PPI in implementation of MSK guidelines and further discussed in review project meetings. Findings were brought together in a narrative synthesis. Recommendations for future research and practice, and a conceptual framework for PPI in rheumatic and musculoskeletal guidelines implementation were co-developed with research team including a public contributor.

Results
Ten papers were included, only one from the global south. A prevalence of consultative PPI activities in rheumatic/MSK guideline dissemination (e.g., language translations, patient versions of guidelines) was found. Few studies explicitly report high-level PPI engagement in relation to care pathway adjustments, care commissioning, institutional operations and policy with a view to MSK guideline implementations. Training, development, and practice of PPI in MSK guideline implementation were not evidenced to have spread much beyond Europe, though it is acknowledged that these activities may be occurring at low levels but are not yet well reported in literature nor rightly accrued as PPI activities in guideline implementation. The Alliance framework highlighting an iterative process of “creative thinking/co-production” and “strategic doing” was developed to address the challenge of PPI in MSK guideline implementation. The framework guides knowledge translation from guidelines to ensure real world benefits and drive quality improvement for MSK care with patients and for patients, across and within care settings in the global North and South.

Conclusion
Despite success of PPI in rheumatic/MSK research, oversight or ineffective PPI in guideline implementation may hamper translation of novel advances in MSK care into real world practice and therefore patient benefit. The Alliance framework prioritises effective PPI in MSK guideline implementation design, delivery, and evaluation, ideally applied in parallel with the development of evidence-based guidance recommendations. It highlights continuous application of innovative thinking, dynamic, and impactful collaborations for bridging the evidence-practice gap and improving quality of care for MSK patients globally through novel partnerships.

Disclosure
O.O. Babatunde: None. S. Dawson: None. J. Brammar: None. K. Dziedzic: None. A.O. Adebajo: None.