Burden of disability due to musculoskeletal (MSK) disorders

doi:10.1016/j.berh.2014.08.002

Best Practice & Research Clinical Rheumatology

Volume 28, Issue 3, June 2014, Pages 353-366

https://doi.org/10.1016/j.berh.2014.08.002 Get rights and content

Abstract

This chapter summarises the global and regional prevalence, disability (Years Lived with Disability (YLDs)) and overall burden (Disability Adjusted Life Years (DALYs)) and costs for the common musculoskeletal disorders including low back and neck pain, hip and knee osteoarthritis, rheumatoid arthritis, gout, and a remaining combined group of other MSK conditions. The contribution of the role of pain in disability burden is introduced. Trends over time and predictions of increasing MSK disability with demographic changes are addressed and the particular challenges facing the developing world are highlighted.

Section snippets

Prevalence of musculoskeletal disorders

The prevalence and incidence of a series of MSK disorders reported in population-based epidemiological studies were systematically reviewed and published [12], [13], [14], [15], [16], [17], [18], [19]. In the GBD 2010 Study, extensive systematic reviews of the prevalence of each of the MSK disorders (knee and hip OA, RA, LPB, NP, gout and other MSK disorders) were conducted from the years 1980 to 2009 ∗[3], ∗[4], ∗[5], ∗[6], ∗[9], ∗[10]. Searches were carried out in MEDLINE, EMBASE, CINAHL, CAB

Disability related to MSK disorders

DALY is the standard metric used to measure the overall burden of diseases [31]. DALY consists of fatal and non-fatal components, namely years of life lost due to premature mortality (YLLs) and YLDs, respectively. Disability weights (DWs) are required to derive the YLDs. Together with the description of disability related to all MSK disorders, these interrelated units of measurement used to quantify the disability are briefly explained.

Role of pain in disability

The experience of episodes of site-specific pain, defined by the average duration (number of hours per episode) and average frequency (number of days per week that these episodes were experienced), was used in the MSK health-state descriptions that were used to derive DWs and calculate YLDs for all of the common MSK conditions identified by systematic reviews of the epidemiological literature. There was significant variability in population studies in defining and characterising the course of

Contribution of low BMD to falls and fractures

In the GBD 2010 Study, low BMD was defined as a risk factor and grouped within the MSK disorders. The contribution of low BMD to the burden of fractures due to falls was limited to populations aged 50 years or older, as osteoporotic fractures have little burden at younger ages in the general population [7]. Fractures due to osteoporosis formed a proportion of the global burden from falls. This proportion, however, was likely to be significantly underestimated, influenced by a number of aspects

Costs associated with MSK disorders

MSK disorders have a great cost to individuals and society through the associated disability as well as health-care needs. Most costs are associated with their impact on activities of daily living, in particular on productive work along with the need for social support rather than health-care costs. The costs of support may be borne by the welfare system or by family and carers depending on systems of social care. The costs are easiest to quantify when the health and social costs are borne by

Predictions of increasing MSK disability with demographic changes and socio-economic impact

From 1990 to 2010, the burden attributable to MSK disorders increased by 46%. This increase in DALYs was relatively consistent across MSK conditions (range: 41–64%), except for ‘other MSK conditions’, which increased by 13%.

Summary of the increase in the burden (no. of years lived with disabilities YLDs) of MSK disorders in developing countries and in developed countries, from 1990 to 2010.

Empty Cell	1990	2010	% increase	1990	2010	% increase	1990	2010	% increase
Empty Cell	Global			Developing countries			Developed countries

References (61)

R. Lozano et al.
Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2013 Dec 15)
C.J. Murray et al.
Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2013 Dec 15)
T. Vos et al.
Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2013 Dec 15)
D.G. Hoy et al.
The epidemiology of low back pain
Best Pract Res Clin Rheumatol
(2010)
D.G. Hoy et al.
The epidemiology of neck pain
Best Pract Res Clin Rheumatol
(2010)
L. Busija et al.
Osteoarthritis
Best Pract Res Clin Rheumatol
(2010)
L. Carmona et al.
Rheumatoid arthritis
Best Pract Res Clin Rheumatol
(2010)
A.F. Mourao et al.
Generalised musculoskeletal pain syndromes
Best Pract Res Clin Rheumatol
(2010)
L. Sanchez-Riera et al.
Osteoporosis and fragility fractures
Best Pract Res Clin Rheumatol
(2010)
E.U. Smith et al.
Epidemiology of gout: an update
Best Pract Res Clin Rheumatol
(2010)

The World Bank Group. Population projections. [cited 2014]; Available from:...

Geere JA, Hunter PR, P J. Domestic water carrying and its implications for health: a review and mixed methods pilot...

C.E. Dionne et al.

A consensus approach toward the standardization of back pain definitions for use in prevalence studies

Spine

(2008)

J. Guzman et al.

A new conceptual model of neck pain: linking onset, course, and care: the bone and joint decade 2000-2010 task force on neck pain and its associated disorders

Spine

(2008)

F.C. Arnett et al.

The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis

Arthritis Rheum

(1988)

J.H. Kellgren et al.

Radiological assessment of osteo-arthrosis

Ann Rheum Dis

(1957)

Cited by (370)

Genicular artery embolization for knee osteoarthritis: Results of the LipioJoint-1 trial
2024, Diagnostic and Interventional Imaging
The purpose of this study was to evaluate the safety and efficacy of transient genicular artery embolization (GAE) using an ethiodized oil-based emulsion for the treatment of knee osteoarthritis (KOA).
This prospective, single-arm, open-label, multicenter, first-in-human cohort trial was registered on ClinicalTrials.gov (NCT04733092). The main inclusion criterion was diagnosis of KOA according to a visual analogue scale (VAS) pain score ≥ 40 mm (score range: 0–100 mm), despite conservative treatment for at least three months. Treatment efficacy was assessed using changes in VAS pain score, Mean Western Ontario & McMaster Universities osteoarthritis (WOMAC) function score (normalized to 100; score ranging from 0 to100) and outcome measures in rheumatoid arthritis clinical trials (OMERACT)-Osteoarthritis Research Society (OARSI) set of responder criteria.
Twenty-two consecutive participants (13 women; mean age, 66 ± 9 [standard deviation (SD)]) were included and underwent GAE. Emulsion consisted in a mixture of ioversol and ethiodized oil (ratio 1:3, respectively) prepared extemporaneously. The rate of serious adverse events attributed to GAE within one month was 5% (1/22), corresponding to reversible worsening of renal function. Immediate technical success rate was 100%. Mean VAS pain score dropped from 74.4 ± 16.5 (SD) mm at baseline to 37.2 ± 26.7 (SD) mm at three months (P < 0.001). Mean WOMAC function score (normalized to 100: score ranging from 0 to 100) decreased from 57.3 ± 17.1 (SD) at baseline to 33.5 ± 25.9 (SD) at three months (P < 0.001). At three months, 16 out of 22 participants (73%) were considered responders according to the OMERACT-OARSI set of responder criteria, including high improvement in either pain or WOMAC function, or improvement in both pain and WOMAC function.
GAE using an ethiodized oil-based emulsion is safe and improves pain and function in participants with KOA for at least three months.
Sit-to-stand power predicts functional performance and patient-reported outcomes in patients with advanced knee osteoarthritis. A cross-sectional study
2024, Musculoskeletal Science and Practice
Lower limb muscle power is positively associated with functional performance and patient-reported outcomes (PROMs) and suggested as an important variable to evaluate in patients with advanced knee osteoarthritis (OA).
To explore the association between muscle power derived from the 30-sec sit-to-stand test (STS power) with functional performance and PROMs compared to maximal isometric knee extensor strength (KE MVC) in male- and female patients with advanced OA.
Cross-sectional design.
Eighty-six patients (66.6 [64.9–67.7]years) with advanced knee OA were included. Dependent variables were STS power and KE MVC. Independent variables were Timed Up&Go (TUG), 40-m fast-paced walk test (40mFWT), Knee injury and Osteoarthritis Outcome Score (KOOS) subscales.
Age.
Simple linear- and multiple regression analyses with and without adjusting for age. Pitman's test was used to evaluate differences in correlation strength among dependent variables.
STS power demonstrated a statistical relationship with TUG and 40mFWT for both sexes (β coefficients −1.11 to −4.36 (p < 0.05), r2 = 0.47–0.55 (p < 0.05)), and with KOOS Pain, ADL, and Sport for male patients (β coefficients 6.53 to 7.17 (p < 0.05), r2 = 0.29–0.33 (p < 0.05)). Knee extensor MVC demonstrated no relationship with any outcomes for male patients or female patients. STS power displayed statistically stronger correlation to functional performance.
STS power was associated with functional performance in both male patients and female patients suffering from advanced knee OA. Moreover, STS power was associated with KOOS Pain, Sport, and ADLin male patients. The assessment of STS power should be considered in the evaluation of patients with advanced knee OA.
NCT04081493.
Do key measurement parameters derived from specific cervical vertebral segments differ between lordotic and non-lordotic cervical spine alignments? A study of asymptomatic young adults
2024, Journal of Bodywork and Movement Therapies
Measurement parameters derived from specific cervical vertebral segments (e.g., C2 slope) can provide clinicians with important information on cervical sagittal balance and guide pre- and post-surgical decision-making processes. It is unclear however, what constitutes typical values for these types of measurements in an asymptomatic population of young adults, whether values change depending upon the classification of the cervical spine's global alignment, and if any non-lordotic cervical subtypes display values that are comparable to those reported for pre-surgery patients.
Neutral lateral cervical radiographs of 150 asymptomatic participants (18–30 years) were taken. Global cervical alignment was classified as lordotic or one of four non-lordotic subtypes using a multi-method subtyping protocol. Four key measurement parameters - the anterior translation of the head measure (ATHM), C0–C2 angle, C2 slope, and C7 slope – were derived from specific cervical segments. Independent samples t-tests were used to compare lordotic and non-lordotic groups.
There was considerable variation in the four key measurement parameters amongst this asymptomatic population of young adults. Thirty-four percent of the sample were classified as lordotic and 66% were classified as non-lordotic. There was a significant difference (p ≤ 0.0125) between lordotic and non-lordotic groups for the C0–C2 angle, C2 slope and C7 slope. There was no difference between groups for the ATHM (p ≥ 0.0125). Within the non-lordotic group, the global-kyphotic (GK) subtype had the largest mean C2 slope, largest mean C0–C2 angle, and smallest mean C7 slope.
Long term prospective investigations are required to determine whether possible biomarkers (alignment parameters/radiological measurements) for spinal degenerative changes can be identified so that early interventions can be put in place to try and reduce the impact of neck pain on society.
Impact of holistic, patient-centric yoga & naturopathy-based lifestyle modification program in patients with musculoskeletal disorders: A quasi-experimental study
2023, Advances in Integrative Medicine
Musculoskeletal disorders (MSD) are one of the leading causes of disability and decreased well-being globally. This study investigates the role of a 10-day holistic, person-centric yoga & naturopathy based lifestyle intervention model (HOPE-YN) in improving musculoskeletal health, vitality, strength, flexibility, pain, and treatment satisfaction among MSD patients.
This quasi-experimental study included 57 participants with varying MSD, aged between 29 and 65, who underwent a 10-day HOPE-YN program that included interventions like diet, yoga, massage, etc. Additionally, each patient received a holistic consultation focused on holistic dimensions of health and healing. Except for STS and TUG, which were measured at the baseline and 10th day, the Musculoskeletal-related Health Quality (MSK-HQ), the Visual Analog Scale for Health, Vitality, and Pain, weight, sit-to-stand (STS) and time-up-and-go (TUG) tests, and the visit-specific patient satisfaction questionnaire (VSQ-9) were measured at the baseline, 10th day, and 1 month post intervention.
The study was completed by 50 participants (76 % females), with the majority of the participants reporting having osteoarthritis and rheumatoid arthritis. Statistically significant improvement (P < 0.001) was observed in MSK-HQ, health, vitality, pain, STS, and TUG scores at the end of 10 days and one month after the intervention(P < 0.001). Females were found to have higher treatment satisfaction compared to males (P = 0.008). Treatment satisfaction was associated with improvements in vitality (P = 0.02), TUG (P = 0.03) and STS scores (P = 0.04).
HOPE-YN program was found to be beneficial in managing MSD and may improve adherence to lifestyle programs. The findings need to be validated through robust clinical trials.
Chiropractic Day 2023: A Report and Qualitative Analysis of How Thought Leaders Celebrate the Present and Envision the Future of Chiropractic
2023, Journal of Chiropractic Humanities
This study aimed to (1) collect and analyze statements about how to celebrate chiropractic in the present and roles that chiropractors may fulfill in the future, (2) identify if there was congruence among the themes between present and future statements, and (3) offer a model about the chiropractic profession that captures its complex relationships that encompass its interactions within microsystem, mesosystem, exosystem, and macrosystem levels.
For this qualitative analysis, we used pattern and grounded theory approaches. A purposive sample of thought leaders in the chiropractic profession were invited to answer the following 2 open-ended questions: (1) envision the chiropractor of the future, and (2) recommendations on how to celebrate chiropractic. Information was collected during April 2023 using Survey Monkey. The information was entered into a spreadsheet and analyzed for topic clusters, which resulted in matching concepts with social-ecological themes. The themes between the responses to the 2 questions were analyzed for congruence. We used the Standards for Reporting Qualitative Research to report our findings.
Of the 54 experts invited, 32 (59%) participated. Authors represented 7 countries and have a median of 32 years of chiropractic experience, with a range of 5 to 51 years. Nineteen major topics in the future statements and 23 major topics in statements about celebrating chiropractic were combined in a model. The topics were presented using the 4 levels of the social-ecological framework. Individual (microsystem): chiropractors are competent, well-educated experts in spine and musculoskeletal care who apply evidence-based practices, which is a combination of the best available evidence, clinical expertise, and patient values. Interpersonal relationships (mesosystem): chiropractors serve the best interests of their patients, provide person-centered care, embrace diversity, equity, and inclusion, consider specific health needs and the health of the whole person. Community (exosystem): chiropractors provide care within integrated health care environments and in private practices, serve the best interests of the public through participation in their communities, participate through multidisciplinary collaboration with and within the health care system, and work together as a profession with a strong professional identity. Societal (macrosystem): chiropractors contribute to the greater good of society and participate on a global level in policy, leadership, and research. There was concordance between both the future envisioning statements and the present celebration recommendations, which suggest logical validity based on the congruence of these concepts.
A sample of independent views, including the perceptions from a broad range of chiropractic thought leaders from various backgrounds, philosophies, diversity characteristics, and world regions, were assembled to create a comprehensive model of the chiropractic profession. The resulting model shows an array of intrinsic values and provides the roles that chiropractors may provide to serve patients and the public. This study offers insights into the roles that future chiropractors may fulfill and how these are congruent with present-day values. These core concepts and this novel model may have utility during dialogs about identity, applications regarding chiropractic in policy, practice, education, and research, and building positive relationships and collaborations.
Posterior oblique technique for sacroiliac joint fusion leads to greater pain relief and similar improvement in function compared to the lateral technique: A retrospective, comparative study
2023, North American Spine Society Journal
Management of chronic sacroiliac joint (SIJ) pain among patients who do not respond to nonsurgical treatment is increasingly turning toward minimally invasive SIJ fusion. There are different techniques available to perform this procedure, with the lateral technique being more commonly studied than the posterior oblique technique. This study examined the effects of these techniques on pain relief and functional improvement, both preoperatively and at a 12-month follow-up.
This retrospective cohort study analyzed data from 45 patients who underwent SIJ fusion. Included patients were ≥50 years old, nonresponsive to conservative treatment. Subjects were divided into 2 cohorts based on the SIJ fusion technique. Primary outcomes were pain relief, measured by Visual Analog Scale (VAS), and functional improvement, determined by the Oswestry Disability Index (ODI); both were recorded and assessed at baseline, postoperative, and the change from pre- to postoperative. Additionally, data regarding patient demographics, previous lumbar fusion, operative time, and duration of hospital stay were collected and analyzed.
Baseline demographic and clinical variables exhibited no significant differences in distribution between groups. The posterior oblique cohort demonstrated a substantial reduction in operative time (over 50%) and duration of hospital stay compared to lateral cohort. Pain relief (postoperative VAS: lateral 3.5±1.7 vs. posterior oblique 2.4±1.5 [p=.02]) and functional improvement (postoperative ODI: lateral 29.6±7.3 vs. posterior oblique 21±5.7 [p≤.001]) were significantly better in the posterior oblique group. Pre- to postoperative improvement analysis indicated greater reduction in pain (VAS: lateral −4.4±1.9 vs. posterior oblique −6.1±1.5 [p=.002]) in the posterior oblique group.
Compared to the lateral technique group, patients undergoing minimally invasive SIJ fusion through the posterior oblique technique experienced greater pain relief and demonstrated a trend toward better functional improvement, with shorter operative times and duration of hospital stay. The posterior oblique technique may be more efficient and beneficial to manage patients suffering from chronic SIJ pain through joint fusion.

View all citing articles on Scopus

View full text

1Burden of disability due to musculoskeletal (MSK) disorders

Abstract

Section snippets

Prevalence of musculoskeletal disorders

Disability related to MSK disorders

Role of pain in disability

Contribution of low BMD to falls and fractures

Costs associated with MSK disorders

Predictions of increasing MSK disability with demographic changes and socio-economic impact

Lancet

Lancet

Lancet

Best Pract Res Clin Rheumatol

Best Pract Res Clin Rheumatol

Best Pract Res Clin Rheumatol

Best Pract Res Clin Rheumatol

Best Pract Res Clin Rheumatol

Best Pract Res Clin Rheumatol

Best Pract Res Clin Rheumatol

Lancet

Lancet

J Physiother

Lancet

The global burden of rheumatoid arthritis: estimates from the Global Burden of Disease 2010 Study

Ann Rheum Dis

The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 Study

Ann Rheum Dis

The global burden of low back pain: estimates from the Global Burden of Disease 2010 Study

Ann Rheum Dis

The global burden of neck pain: estimates from the Global Burden of Disease 2010 Study

Ann Rheum Dis

The global burden of musculoskeletal conditions for 2010: an overview of methods

Ann Rheum Dis

Global burden attributable to low bone mineral density

Ann Rheum Dis

The global burden of gout: estimates from the Global Burden of Disease 2010 Study

Ann Rheum Dis

The global burden of other musculoskeletal disorders: estimates from the Global Burden of Disease 2010 Study

Ann Rheum Dis

A systematic review of the global prevalence of low back pain

Arthritis Rheum

Menopause, postmenopausal hormone use and risk of incident gout

Ann Rheum Dis

A consensus approach toward the standardization of back pain definitions for use in prevalence studies

Spine

A new conceptual model of neck pain: linking onset, course, and care: the bone and joint decade 2000-2010 task force on neck pain and its associated disorders

Spine

The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis

Arthritis Rheum

Radiological assessment of osteo-arthrosis

Ann Rheum Dis

1
Burden of disability due to musculoskeletal (MSK) disorders