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Improving musculoskeletal health: Global issues

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Musculoskeletal (MSK) disorders are among the leading reasons why patients consult a family or primary health practitioner, take time off work and become disabled. Many of the MSK disorders are more common in the elderly. Thus, as the proportion of the elderly increases all over the world, MSK disorders will make a greater contribution to the global burden of disease. Epidemiological studies have shown that the spectrum of MSK disorders in developing countries is similar to that seen in industrialised countries, but the burden of disease tends to be higher due to a delay in diagnosis or lack of access to adequate health-care facilities for effective treatment. Musculoskeletal pain is very common in the community while fibromyalgia is being recognised as part of a continuum of chronic widespread pain rather than a narrowly defined entity. This will allow research to improve our understanding of pain in a variety of diffuse pain syndromes. The availability of newer more effective therapies has resulted in efforts to initiate therapy at an earlier stage of diseases. The new criteria for rheumatoid arthritis, and the diagnosis of axial and peripheral involvement in spondyloarthritis, permit an earlier diagnosis without having to wait for radiological changes. One of the major health challenges is the global shortage of health workers, and based on current training of health workers and traditional models of care for service delivery, the global situation is unlikely to change in the near future. Thus, new models of care and strategies to train community health-care workers and primary health-care practitioners to detect and initiate the management of patients with MSK disorders at an earlier stage are required. There is also a need for prevention strategies with campaigns to educate and raise awareness among the entire population. Lifestyle interventions such as maintaining an ideal body weight to prevent obesity, regular exercises, avoidance of smoking and alcohol abuse, intake of a balanced diet and nutrients to include adequate calcium and vitamin D, modification of the work environment and avoidance of certain repetitive activities will prevent or ameliorate disorders such as osteoarthritis, osteoporosis, rheumatoid arthritis, gout and MSK pain syndromes including low back pain and work-related pain syndromes. These prevention strategies also contribute to reducing the prevalence and outcome of diseases such as hypertension, cardiovascular diseases, diabetes and respiratory diseases. Thus, prevention strategies require urgent attention globally.

Introduction

Musculoskeletal (MSK) disorders are common in populations all over the world and they are a leading cause of disability and time off work. A wide variety of conditions are included within the spectrum of MSK disorders. They may involve a number of different anatomical structures such as bone, the structures within joints and the periarticular structures which includes muscles, tendons, ligaments or bursae. They may have an acute onset as seen with hip fracture in an elderly osteoporotic patient or multiple bone trauma associated with road traffic injuries, or chronic knee pain associated with osteoarthritis or chronic neck pain associated with cervical spondylosis. The pain may be localised to a single joint area or patients may have chronic widespread pain (CWP). The source of the MSK disorder may be mild and minor as occurs with abnormal posture or overuse, or it may be severe and demand immediate intervention as in patients with suspected septic arthritis or neurological complications after spinal injury.

Measures such as the World Health Organisation (WHO) International Classification of Functioning, Disability and Health (ICF) [1] can be used to determine the impact of a particular problem regardless of the cause. The ICF includes assessment of the body structure and function, activity limitation and any restriction to participation in life situations. The development of any impairment may also be influenced by contextual factors which also include personal and environmental factors.

Section snippets

The burden and impact of MSK disorders

A detailed discussion on the burden of MSK disorders is beyond the scope of this chapter and some of the disorders are discussed in detail in other chapters in this issue. Some of the more common conditions will be discussed briefly. The risk factors and some of the strategies to prevent or limit the consequences of these disorders are also discussed.

  • A)

    MSK pain

MSK pain is one of the leading reasons for primary care consultations in industrialised countries. Community-based studies such as the

Strategies for prevention of MSK disorders

Woolf et al. have provided recommendations for the prevention of MSK conditions in the developing world [59]. The measures to improve MSK health from a public health perspective have been reported by Bergman [60].

Non-communicable diseases such as cardiovascular diseases, respiratory diseases and malignancies, and communicable diseases such as HIV, TB and malaria are the traditional focus of public health initiatives as they are among the leading contributors to mortality. As a result, less

Challenges to improving musculoskeletal health

There many challenges to achieving some of the targets for the prevention, early diagnosis and management of musculoskeletal disorders and they include the following:

  • A)

    Human resources

Over a billion people in the world lack access to quality health-care services. The WHO estimates that there is a global shortage of about 4.3 million health-care workers [69] in the decade 2007–2017. However, there are no global efforts to address this shortage with potential severe consequences for improving health

References (82)

  • L. Sanchez-Riera et al.

    Osteoporosis and fragility fractures

    Best Practice & Research: Clinical Rheumatology

    (2010 Dec)
  • S. Govender et al.

    Impact of HIV on bone and joint surgery

    Best Practice & Research: Clinical Rheumatology

    (2008 Aug)
  • W.J. Harrison et al.

    Open fractures of the tibia in HIV positive patients: a prospective controlled single-blind study

    Injury

    (2004 Sep)
  • A.D. Woolf et al.

    Prevention of musculoskeletal conditions in the developing world

    Best Practice & Research: Clinical Rheumatology

    (2008 Aug)
  • S. Bergman

    Public health perspective–how to improve the musculoskeletal health of the population

    Best Practice & Research: Clinical Rheumatology

    (2007 Feb)
  • WHO

    The international classification of functioning, disability and health (ICF)

    (2001)
  • F. Wolfe et al.

    The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity

    Arthritis Care & Research (Hoboken)

    (2010 May)
  • M. Makela et al.

    Prevalence of primary fibromyalgia in the Finnish population

    British Medical Journal

    (1991 Jul 27)
  • E.R. Senna et al.

    Prevalence of rheumatic diseases in Brazil: a study using the COPCORD approach

    Journal of Rheumatology

    (2004 Mar)
  • S.A. Haq et al.

    Prevalence of rheumatic diseases and associated outcomes in rural and urban communities in Bangladesh: a COPCORD study

    Journal of Rheumatology

    (2005 Feb)
  • P. Cote et al.

    Patterns of sick-leave and health outcomes in injured workers with back pain

    European Spine Journal

    (2008 Apr)
  • W.E. Hoogendoorn et al.

    Systematic review of psychosocial factors at work and private life as risk factors for back pain

    Spine (Philadelphia Pa 1976)

    (2000 Aug 15)
  • H. Matsui et al.

    Risk indicators of low back pain among workers in Japan. Association of familial and physical factors with low back pain

    Spine (Philadelphia Pa 1976)

    (1997 Jun 1)
  • S.A. Haq et al.

    Osteoarthritis of the knees in the COPCORD world

    International Journal of Rheumatic Diseases

    (2011 May)
  • J.M. Jordan et al.

    Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston county osteoarthritis Project

    Journal of Rheumatology

    (2007 Jan)
  • C.F. Dillon et al.

    Prevalence of knee osteoarthritis in the United States: arthritis data from the third national health and Nutrition examination survey 1991-94

    Journal of Rheumatology

    (2006 Nov)
  • K. Lim et al.

    Perception is everything: OA is exciting

    International Journal of Rheumatic Diseases

    (2011 May)
  • D. Aletaha et al.

    2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative

    Annals of Rheumatic Diseases

    (2010 Sep)
  • S.S. Seong et al.

    Incidence of tuberculosis in Korean patients with rheumatoid arthritis (RA): effects of RA itself and of tumor necrosis factor blockers

    Journal of Rheumatology

    (2007 Apr)
  • M. Montgomery

    Gout: tips on diagnosis, treatment, and patient education

    Nurse Practitioner

    (2008 Dec)
  • H.K. Choi et al.

    Independent impact of gout on mortality and risk for coronary heart disease

    Circulation

    (2007 Aug 21)
  • E. Krishnan et al.

    Long-term cardiovascular mortality among middle-aged men with gout

    Archives of Internal Medicine

    (2008 May 26)
  • A. Farooqi et al.

    Prevalence of the major rheumatic disorders in the adult population of north Pakistan

    British Journal of Rheumatology

    (1998 May)
  • C.T. Chou et al.

    Prevalence of rheumatic diseases in Taiwan: a population study of urban, suburban, rural differences

    Journal of Rheumatology

    (1994 Feb)
  • M. Tikly et al.

    Risk factors for gout: a hospital-based study in urban black South Africans

    Revue du Rhumatisme (English ed.)

    (1998 Apr)
  • D.A. Belachew et al.

    Ankylosing spondylitis in sub-Saharan Africa

    Postgraduate Medical Journal

    (2009 Jul)
  • D. Middleton et al.

    New allele frequency database

    Tissue Antigens

    (2003 May)
  • J. Sieper et al.

    The Assessment of Spondylo Arthritis International Society (ASAS) handbook: a guide to assess spondyloarthritis

    Annals of Rheumatic Disease

    (2009 Jun)
  • M. Rudwaleit et al.

    The development of Assessment of Spondylo Arthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection

    Annals of Rheumatic Disease

    (2009 Jun)
  • W. Taylor et al.

    Classification criteria for psoriatic arthritis: development of new criteria from a large international study

    Arthritis & Rheumatism

    (2006 Aug)
  • W.J. Taylor et al.

    Development of diagnostic criteria for psoriatic arthritis: methods and process

    Current Rheumatology Reports

    (2004 Aug)
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