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Vaucher P, Carnes D, Hohenschurz-Schmidt D, Thomson O, Vogel S, Arienti C, Bright P, Alvarez Bustins G, Esteves J, Koch Esteves N, Fawkes C, Rinne S, Roura S, Treffel L, Wagner A, Draper-Rodi J. European research Priorities for Osteopathic Care (PROCare): a sequential exploratory investigation and survey. BMJ Open 2025;15:e100757

🔗 https://bmjopen.bmj.com/content/15/10/e100757

Key details relevant to your letter:

• PROCare is a comprehensive international survey project engaging practitioners, patients, students, educators, researchers, and policymakers to establish a research agenda for the osteopathic profession for 2024–2030 — the largest multi-stakeholder consultation of its kind. Hsu
  
  
• The study engaged 2,229 respondents from 42 countries, including patients (7.4%), practitioners (42.1%), students (17.4%), educators (13.5%), researchers (5.0%), and policymakers (4.3%). nih
  
  
• "Patient safety" was nominated as a top priority by 82% of relevant countries, and "digital health" ranked lowest of all 28 subdomains. PubMed
  
  
• The PROCare Eye is a hierarchical model comprising seven principal domains (inner circle), 28 subdomains (middle circle), and 96 research topics (outer circle), with domain clustering reflecting thematic relationships identified through principal component analysis.

• In October 2025, an international team of researchers published the PROCare study in BMJ Open - the largest ever consultation on osteopathic research priorities, drawing on over 2,200 voices from 42 countries. It is a landmark piece of work that will shape what the profession studies, funds, and prioritises globally for years to come.

  But something important was missing.

  The framework ranked "social justice" last among its domains, and topics related to culture and Indigenous health were among the least prioritised across all stakeholder groups. For most of the world, that might read as a minor limitation. For Aotearoa New Zealand, it is a significant gap.

As osteopaths practising under Te Tiriti o Waitangi, we operate within a legal and ethical framework that places Māori health equity, cultural safety, and Indigenous self-determination at the heart of quality care - not at the margins of it. New Zealand legislation including the Health Practitioners Competence Assurance Act and the Pae Ora (Healthy Futures) Act makes this explicit: culturally safe practice is patient safety.

For Māori and Pacific communities, safety is not simply clinical. It is relational, spiritual, and whānau-centred. When those dimensions are overlooked, care is incomplete - regardless of technical competence.

We wrote to the editors to respectfully and constructively call for:

• Integration of Indigenous and culturally grounded health within the core of the PROCare framework - not as an add-on
  
  
• Methodological guidance informed by Indigenous research frameworks such as CONSIDER and CREDES
  
  
• Intentional inclusion of Indigenous and diverse communities in future priority-setting processes
  
  
• Collaboration with stakeholders in Aotearoa New Zealand to test and adapt the framework in our context

A global research framework that does not centre Indigenous health equity will inevitably reproduce the same disparities it aims to address. If the osteopathic profession is serious about research that serves all communities, the framework must reflect the realities of all communities - including those whose definitions of safety, wellbeing, and care look different from the Western clinical default.

This letter is an invitation. We hope the PROCare team will accept it.

Read it here