Equity, evidence and indigenous knowledges in PROMs in Australian injury research: a systematic review

PURPOSE: Patient-reported outcome measures (PROMs) are widely used in trauma and injury research to assess health-related quality of life (HRQoL), mental health and functional recovery. However, PROMs are rarely adapted to reflect the lived experiences, cultural values and determinants of health for priority populations, particularly Aboriginal and Torres Strait Islander peoples, who experience a disproportionate burden of injury in Australia. This systematic review addressed the inclusion of health equity indicators and Indigenous knowledges for PROMs used in observational Australian trauma and injury studies for adults (≥ 18 years). METHODS: A systematic search of Medline (OVID), CINAHL (EBSCO) and Scopus was performed including prospective cohort or longitudinal designs, focused on trauma-related injuries conducted in Australia. Data were extracted and appraised using the CREATE and PROGRESS-PLUS tools to assess Indigenous engagement and equity-sensitive reporting. RESULTS: Across the 11 included studies, 17 different PROMs were used with SF-36 and PCL-C being the most common. Physical and mental health outcomes were consistently impaired post-injury, with long-term impacts. Equity considerations were largely absent; none of the studies met all PROGRESS-PLUS criteria and Indigenous knowledges were not incorporated. Priority populations, including Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse (CALD) communities, people with disabilities and women, were frequently underrepresented or excluded. CONCLUSION: These findings highlight significant gaps in equity-sensitive PROM use and the urgent need for culturally safe and inclusive PROM development that reflects diverse recovery experiences thereby supporting equitable trauma care and follow-up.