Gap analyses

A gap analysis system is under development by the group.  While that is being created, below is a list of research gaps already identified by projects undertaken with our group:

  1. Space agencies are advised to ensure that information on relevant spacecraft constraints is readily available to research communities in an accessible published documentation rather than as grey literature
    A systematic review published in Feb 2020 found a lack of publicly available data specifying constraints of new human space vehicles that are medically relevant, e.g. constraints for exercise countermeasures.  The publicly available evidence base at the time consisted almost entirely of expert testimony and anecdotal evidence.  This means that technical constraints that were reported lacked clear and details information as how they might impact medical operational decision making and provide little information for researchers to develop and test medical interventions for use in future space craft.  To enable the research community to provide informed recommendations, space agencies should ensure that information on relevant spacecraft constraints is clearly available.  This information should be accessible in officially published documents.  Until this is done, the published, peer-reviewed, systematic provides the most comprehensive synthesis of data that is already publicly available and can be accessed here
  2. Systematic reviews required to synthesise data on how cardiovascular and bone outcomes decondition over time in spaceflight/bed rest with no countermeasures
    A systematic review was conducted in 2019 that quantitatively synthesise all available data to show the rate of expected muscle decline, with no countermeasures.  This was to done to inform operational decisions linking to need of exercise countermeasures for Lunar transit, to inform potential use of "countermeasure holidays" on Martian missions and inform decisions around managing astronauts that could become unable to exercise on exploration class missions.  Additional reviews need to be conducted to perform the same analysis for the bone and cardiovascular systems to enable to over arching operational medical guide to be written.  You can read the peer reviewed systematic review here
  3. Data is lacking on expected muscle changes during spaceflight for some key muscles and outcome measures need to be standardised and use some patient reported assessments
    The systematic review mentioned in gap 2 also found limited data for Gluteal and Hip flexor muscles for several outcome measures including contractile work capacity, muscle thickness and power outcomes.  No patient reported outcome measures were found to have been used in any of the studies included in the review, making it unclear how the muscles changes reported will relate to patient (in this case astronaut) experience.  There was also a lack of standardised time points at which outcome measures had been reported and the outcome measures themselves were heterogeneous.  It is recommended space agencies and bed rest study researchers try and agree standardised outcome measures and testing time points that are most relevant to stakeholders and future space mission success.  The Core Outcome Measures in Effectiveness Trials (COMET) is an example initiative that facilitates development and application of core outcome sets and how to reach consensus and is one example of an exercise that could aid in achieving enhanced standardisation of testing.  You can read the peer reviewed systematic review here
  4. Countermeasures for minimising risk of injury to the lumbopelvic area following long-term microgravity.
    Only six distinct human trial populations existed in 2017 in which countermeasures for this body region were tested.  None of the countermeasures trialled were able to fully protect against all the physiological changes known to occur in the lumbopelvic region.  In addition none of the countermeasures trialled were those currently used in actual spaceflight, therefore the effect of current operational countermeasures is unknown.  The evidence base in this area is therefore lacking and further research into effective countermeasures is needed.  In addition the outcome measures used in the current trials are heterogeneous, it is therefore recommended that outcomes be standardised.  A list of currently used outcome measures is included in the systematic review and could be used inform future selection of relevant outcome measures.  The AMSRG also advocates the use of participant reported outcome measures as these were not widely used in the studies included in the review.  You can access the full text peer reviewed systematic review here
  5. Human physiological effects of various g-loading to inform medical considerations of Lunar and Martian missions.
    Several outcome data were missing from when the evidence base was reviewed in 2017. This included morphological parameters such as fibre type composition, muscle fibre length, physiological and anatomical cross sectional areas, muscle pennation angles and tendon function.  In addition data on bone mineral density is missing which is an important outcome for human spaceflight medical operations.  You can access the full text peer reviewed systematic review here  

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