A Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of musculoskeletal trauma care assessment tools and frameworks in low- and middle-income countries: A narrative review

Musculoskeletal (MSK) trauma is a leading cause of global injury-related mortality and disability, particularly affecting low- and middle-income countries (LMICs). Despite the crucial role of trauma care systems in emergency and surgical care, LMICs face significant challenges in developing robust MSK trauma care. The lack of international consensus on evaluation tools and frameworks hinders practical assessment and improvement. This study aims to review and synthesise current evidence on quality evaluation tools for MSK trauma care in LMICs. A narrative review was conducted using PubMed, Embase, MEDLINE, and Internet databases from 2014 to 2024, employing keywords related to orthopaedics, assessment, tool, framework, and LMICs. The review included all study types addressing MSK trauma care tools/assessments in LMICs. Independent screening was performed with team discussions, and data extraction covered study characteristics and tool specifications. Three reviewers conducted a strengths, weakness, opportunities, and threats (SWOT) analysis of identified tools, following stages of familiarisation, theme identification, indexing, charting, and interpretation. The review identified 26 studies. Key tools include SOSAS, G-TSET, PIPES, INTACT, the WHO Tool for Situational Analysis, Guidelines for Essential Trauma Care, G-MUSC, the Modified Donabedian model, the Four Delays Framework, and WHO Monitoring the building blocks of health systems. A thematic analysis of the SWOT analyses identified five themes for strengths, three for weaknesses, five for opportunities, and three for threats, providing recommendations for future MSK trauma care tools in LMICs. This review identified tools and frameworks for MSK trauma care in LMICs. SWOT analysis revealed their strengths and weaknesses, highlighting the need for MSK trauma specific tools can support long-term system evaluation, and tailored to the unique challenges in LMICs. Careful consideration is needed to choose the appropriate tool, and developing a specialised evaluation framework is crucial to advance orthopaedic trauma care in these settings.