Swedish musculoskeletal researchers view on a collaborative network and future research priorities in Swedish healthcare

Background: Musculoskeletal disorders (MSK) are a global burden causing significant suffering and economic impact. Systematic identification and targeting of research questions of highest interest for stakeholders can aid in improving MSK disorder knowledge and management. Objective: To obtain Swedish MSK researchers' opinions and views on a collaborative Swedish MSK network (SweMSK) and identify future research areas of importance for Swedish MSK research. Methods: A web ‐ based survey was conducted July to September 2021 to collect data from 354 Swedish MSK researchers. The survey focused on the need, objectives, and structure of a SweMSK network and identified prioritised areas for future MSK research. Results: The study included 141 respondents, of which 82 were associate professors or professors. The majority (68%) supported the creation of a new musculoskeletal network. The most supported element was increased collaboration regarding nationwide and multicenter studies. Respondents recommended the creation of a homepage and the establishment of national work groups with different specific interests as the primary elements of a new network. Conclusion: The results demonstrated a need and desire for increased national research collaboration and the creation of a new musculoskeletal network. The high academic experience and active research participation of the respondents suggest the need for MSK

public, health practitioners, policy makers and healthcare managers, and research funders.Research questions should arise from multiple sources and stakeholders, as it is likely that no single source would produce all the research questions of importance (Bourne et al., 2014;Buchbinder et al., 2020).This study aimed to obtain Swedish MSK researchers' opinions and views on a collaborative Swedish MSK network (SweMSK) and to identify future research areas of importance for Swedish MSK researchers.

| Study design and sampling
This national collaborative network study utilised a web-survey to gather data from researchers affiliated with Swedish research institutions.Data were gathered between July and September 2021.
Based on the data gathered, views on a collaborative SweMSK network were identified as well as key research areas of importance to the study population.All Swedish affiliated authors included in the initial scoping study, who had published research between 2017 and 2020, were included in the questionnaire (Diarbakerli et al., 2022).A total of 354 researchers were included in the study group.

| Questionnaire development and administration
The questionnaire used in this study was based on questionnaire items used by the Australian and New Zealand Musculoskeletal Clinical Trials Network (ANZMUSC) (Buchbinder et al., 2020) and a Delphi-survey on research priorities conducted by the Global Alliance for Musculoskeletal Health (Briggs et al., 2021).The original questionnaire items were translated from English to Swedish, reviewed by an expert group, pilot-tested, and then reviewed by the expert group a second time.The final questionnaire was structured, and content approved when consensus was reached.The questionnaire was distributed electronically to 354 participants between 2021-07-08 and 2021-09-17.Each participant was assigned a unique password to access the questionnaire.Participants were sent email reminders every other week (a total of 5 reminders) and a confirmation email when the questionnaire was answered.The questionnaire consisted of three parts: the first part was about the respondents' background, the second part was about their views on a potential research network, and the third part was about future research areas.The web-survey was initially submitted to the targeted participants with reminders every 2 weeks in case of nonresponse.Each question required an answer for the questionnaire to be completed, which prevented missing data.

| Data analysis
The respondents were asked to rate statements on a scale from 1 to 9, where one indicated 'do not agree at all' and nine indicated 'fully agree,' with five indicating a neutral position.Data are presented as median (25th, 75th percentiles) and number (%) of respondents agreeing with the statements given.A responder was considered to agree with a given statement if their response was six or higher, while a response of four or below was considered as not agreeing and 5 as neutral.Additionally, respondents were asked to rank the five most important topics in need of future research.The available topics were public health, equality in MSK-care, risk assessments/risk factors, primary prevention, secondary prevention, diagnostics (investigation), pharmacological treatment, non-operative interventions, surgical interventions, occupational health, cost-effectiveness of procedures, implementation of research, international collaboration, and innovation.

| Participant characteristics
Of the 354 individuals who were invited to participate in the survey, 141 completed the survey (response rate 40%).Table 1 and Table 2 present the demographic and professional characteristics of the respondents.Of the respondents, 46% were female, and the majority were orthopaedic surgeons (28%) or physical therapists (24%).No occupational therapists responded to the survey.
In terms of academic titles, 33% of respondents were professors and 26% were associate professors, indicating a high level of academic competence among the participants.A further 28% had a PhD as their highest academic title.Table 2 shows that pain disorders were the most common area of research (45%), followed by joint, tendon, and muscle disorders (36%) and degenerative joint disorders (35%).

| Perceptions on potential research network
The majority of respondents (67%) indicated a positive perception of the need for a Swedish musculoskeletal network, with 25% being indecisive and 8% negative.These results were consistent across all research areas.The respondents strongly supported the network's focus on increased research cooperation and facilitation of collaborative projects such as multi-centre trials (Table 3).The creation of research work groups and establishment of a website were identified as the most important topics to address (Figure 1).

| Future research areas
The respondents generally agreed that there is a lack of evidence regarding diagnostic procedures, prevention, rehabilitation, activity of daily living adjustments, physiotherapeutic interventions, pharmacological, and surgical interventions within their scientific area of interest.There was also agreement among the subgroups regarding the need for epidemiological and population health research, public health research, and research on health policy, with median responses ranging from 6 to 8.However, some discrepancies were noted among the subgroups.
Researchers in pain disorders had the highest response medians in the category of health policy and systems, with a median of 8 for the separate statements regarding the implementation of MSK health T A B L E 1 Data on gender and profession for the respondents.Regarding the need for clinical and basic research, all groups had a response median of ≥8 for every separate statement, while researchers in degenerative joint disorders had a median of 7 for the statement regarding exploring new biomarkers, analyses, and diagnostics (Figure 2).

| Respondents' views on important future research topics
The top 5 ranked areas of importance for future research were the implementation of research (69%), non-operative interventions (62%), primary prevention (58%), cost-effectiveness of procedures (45%), and risk assessment/risk factors (45%).When the respondents were stratified by research area, the implementation of research in clinical practice was of highest importance to researchers in the fields of pain (75%), joint/muscle/tendon (75%), and degenerative joint disorders (69%).Risk assessment/risk factors were of highest importance to researchers in the fields of rheumatology (67%) and bone health/osteoporosis (69%).For researchers in the field of fractures, non-operative treatment was ranked highest (64%).

| DISCUSSION
This study aims to consolidate and present the views on a collaborative SweMSK-network based on data gathered from Swedish MSK clinical researchers.The majority of the respondents were in agreement that current evidence, research, and knowledge are lacking in terms of diagnostics, prevention, and interventions of physiotherapeutic, pharmacological, and surgical nature within the field of MSK.
The results of this study indicate that researchers and clinicians in Sweden have similar needs as those in Australia and New Zealand, as highlighted in a recently published scoping review from our group (Diarbakerli et al., 2022).
The current study identified specific areas within the field of MSK in need of further research.The implementation of evidence and new research was a top priority for many respondents.For example, in the area of non-specific low back pain, there is a continued over-treatment and over-diagnosis despite the lack of evidence (Foster et al., 2018).Conversely, there is an underutilisation of non-pharmacological modalities and lifestyle interventions in the field of degenerative joint disorders (Brand et al., 2014).Respondents highlighted the need for clinical and basic science research, health economic research, and innovation research.
To address these issues, a collaborative nationwide network aims to enhance and facilitate high-quality research.
The ANZMUSC initiative aimed to better align MSK research and its implementation, focusing on the most important research topics to reduce research waste and ultimately attract funding to highquality projects (Buchbinder et al., 2020).The initiative has been proven successful, resulting in endorsements and funding for a number of trials backed by ANZMUSC (Buchbinder et al., 2020;Day et al., 2017;Machado et al., 2018).In light of this success, we aim to establish a SweMSK network with the same objectives.Based on the data from this study, there is a large interest in such an initiative. There

| Strengths and limitations
The material of this study was derived from an earlier scoping review that included Swedish affiliated musculoskeletal researchers that were published during 2017-2020 (Diarbakerli et al., 2022).The -5 of 8 Global Alliance for Musculoskeletal Health (Briggs et al., 2021).The questionnaire was in digital format to provide easy access to both respondents and researchers.The response rate was 40%, which was considered good since it was mailed to the respondents.The Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/msc.1865by E-resursteam HiG -Gavle University College , Wiley Online Library on [19/02/2024].See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions)on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License questionnaire was based on earlier English questionnaires regarding the creation of musculoskeletal networks in Australia and New Zealand, ANZMUSC, and the priority setting questionnaire from F I G U R E 2 Respondents' answers on the statements regarding research priorities.Data are presented as median (25th, 75th percentile) or number (%).DIARBAKERLI ET AL.
potential bias could be invalid or unused e-mail addresses or that the survey was conducted during the summer months where many researchers may have missed the invitation to answer the questionnaire while on work leave.

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of high academic competence and active researchers.The results displayed a need and desire for increased national research collaboration, the need for the SweMSK network, and researchers' ratings of future priority areas of research.This study highlights specific areas within the field of MSK that require further research, including non-specific low back pain and degenerative joint disorders.SweMSK aims to enhance and facilitate highquality research by aligning MSK research and its implementation

= 141)
Data on academic title and area of research.
Note: Data are presented as number and percentage.T A B L E 2a Nine level value: 1 (disagree completely) −3 (partly disagree) −5 (neutral) −7 (partly agree) −9 (agree completely).DIARBAKERLI ET AL. -3 of 8 15570681, 2024, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/msc.1865by E-resursteam HiG -Gavle University College , Wiley Online Library on [19/02/2024].See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions)on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License service models, how health service models can reduce inequalities in MSK care, and the effectiveness and acceptability of digital technologies supporting health care.In contrast, researchers in the fracture and other disorder groups had the lowest response median in the same category for the statement on how health service models can reduce inequalities in MSK care (median 6).
was a general agreement on the lack of evidence in MSK research regarding mainly diagnostics, prevention, and interventions.Network establishment priorities.Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/msc.1865by E-resursteam HiG -Gavle University College , Wiley Online Library on [19/02/2024].See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions)on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 15570681, 2024, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/msc.1865by E-resursteam HiG -Gavle University College , Wiley Online Library on [19/02/2024].See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions)on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License