Author(s): VASCONCELOS, G., THUANY, M., MACHADO, E., LYNG, K., ANDRADE, D., YAMATO, T., RATHLEFF M., Institution: FEDERAL UNIVERSITY OF GOIAS, Country: BRAZIL, Abstract-ID: 1930

INTRODUCTION:
Musculoskeletal (MSK) conditions are a leading cause of disability worldwide and frequently progress to chronic pain. Although the burden, affecting approximately 1.63 billion people, is disproportionately higher in low- and middle–sociodemographic index (SDI) regions, global MSK research production remains uneven. Little is known about how research agendas reflect the realities of populations most affected. This study examines how MSK research is structured globally through a critical narrative synthesis.
METHODS:
The primary empirical basis of this analysis was a systematic review of long-term (>12 months) psychosocial prognostic outcomes in patellofemoral pain (PFP), which is currently under submission. Searches were conducted in MEDLINE, OVID, CENTRAL, Web of Science, OpenGrey, and the abstract books of the International Patellofemoral Research Retreat. Eligible studies were prospective investigations of clinically diagnosed PFP in individuals under 40 years of age with long-term follow-up. No date restrictions were applied, and only articles written in English were included. PFP was selected as a theoretically informative case within MSK research due to its high prevalence, multifactorial nature, and frequent chronicity. Rather than considering PFP as an isolated condition, the review examined broader research practices, including geographical distribution, study design, and the psychosocial outcomes assessed. These characteristics were analysed as indicators of how social and psychosocial dimensions are prioritised or neglected within MSK research more broadly.
RESULTS:
Among the 42 included studies, the evidence base was overwhelmingly derived from high-SDI countries (38 studies; 90.5%), with limited representation from middle-SDI regions (4 studies; 9.5%), and no studies were conducted in low-SDI settings. Study designs reflected the substantial resource demands, including the capacity to conduct large-scale and long-term studies, with six prospective cohorts (14.3%), 13 interventional studies (30.9%), and 23 randomised controlled clinical trials (54.8%). Psychosocial outcomes were rarely assessed, with kinesiophobia, anxiety/depression, and self-efficacy appearing in only one study (2.4%), while quality of life was included in five studies (11.9%), consistently as a secondary outcome. Notably, all studies from middle-SDI regions were conducted in Brazil and comprised three randomised controlled trials and one prospective cohort; none assessed psychosocial outcomes. These studies were also characterised by small sample sizes, highlighting a misalignment between disease burden and research production.
CONCLUSION:
The global MSK research agenda continues to prioritise high-SDI issues, perpetuating inequities and reducing its relevance to the Global South. However, strengthening MSK research in Brazil could provide an opportunity to develop context-sensitive models with broader applicability to low- and middle-income countries.