A time for action: Opportunities for preventing the growing burden and disability from musculoskeletal conditions in low- and middle-income countries

South African Chiropractic Students' Intentions, Motivations, and Considerations for Emigration: A Cross-Sectional Study

Objective

The purpose of this study was to investigate the emigration intentions of South African senior chiropractic students upon graduation, emphasizing motivations and considerations guiding migration decisions.

Methods

A cross-sectional, quantitative, and exploratory approach was employed, utilizing an anonymous and adapted online survey administered to chiropractic students at 2 South African institutions (n = 177) between March 15 and May 19, 2021. Data were analyzed using frequencies, descriptions, and cross-tabulations to identify trends and interrelationships related to students' intentions to emigrate postqualification.

Results

Findings indicate that 75.5% of South African chiropractic senior students intend to emigrate. Motivations for emigration include improved quality of life and seeking of opportunities. Economic instability in South Africa (SA) (82.7%) and concern for the National Health Insurance implementation (57.7%) serve as a significant push factor, whereas economic stability abroad (85.7%) emerged as a key pull factor. Preferred emigration destinations are primarily developed countries with established chiropractic communities.

Conclusion

High emigration intentions among students were driven by diverse push factors in SA, including economic decline, socio-political climates, and safety concerns, contrasting with pull factors abroad, such as better opportunities, living conditions, and economic stability. Concerns regarding healthcare reforms, particularly the National Health Insurance, are also highlighted. Destinations in order of preference such as the United Kingdom, Canada, and Australia offer valuable insights for policy interventions. Understanding these dynamics is crucial for developing effective retention strategies and addressing socio-economic challenges.

Water fetching and musculoskeletal health across the life-course in Sub-Saharan Africa: A scoping review

The world is experiencing a global water crisis and Sub-Saharan Africa (SSA) is expected to be a hotspot for increasing global water scarcity in years to come. Water is quintessentially a gendered issue; indeed, sociocultural norms hold women responsible for household water collection, requiring them to travel far distances while carrying water. This paper reports the findings of a scoping review of peer-reviewed and grey literature that examines the relationship between water fetching and the musculoskeletal (MSK) health of women in SSA. The work is informed by a gendered life-course perspective, and the authors follow the PRISMA-ScR guidelines. Results indicate a bidirectional relationship between water fetching and poor MSK health as chronic and acute incidences of water carrying are highly related to MSK pain and dysfunction. This has negative implications for the overall health and wellbeing of women and their households. Gaps in the literature are identified, including the experiences of elderly people and people with various vulnerabilities. Recommendations from the literature are compiled to outline potential avenues of future research and innovation to better support the MSK health of water fetchers in SSA.

Development and internal validation of a multivariable prognostic model to predict chronic pain after a new episode of non-specific idiopathic, non-traumatic neck pain in physiotherapy primary care practice

OBJECTIVE

To develop and internally validate a prognostic model to predict chronic pain after a new episode of acute or subacute non-specific idiopathic, non-traumatic neck pain in patients presenting to physiotherapy primary care, emphasising modifiable biomedical, psychological and social factors.

DESIGN

A prospective cohort study with a 6-month follow-up between January 2020 and March 2023.

SETTING

30 physiotherapy primary care practices.

PARTICIPANTS

Patients with a new presentation of non-specific idiopathic, non-traumatic neck pain, with a duration lasting no longer than 12 weeks from onset.

BASELINE MEASURES

Candidate prognostic variables collected from participants included age and sex, neck pain symptoms, work-related factors, general factors, psychological and behavioural factors and the remaining factors: therapeutic relation and healthcare provider attitude.

OUTCOME MEASURES

Pain intensity at 6 weeks, 3 months and 6 months on a Numeric Pain Rating Scale (NPRS) after inclusion. An NPRS score of ≥3 at each time point was used to define chronic neck pain.

RESULTS

62 (10%) of the 603 participants developed chronic neck pain. The prognostic factors in the final model were sex, pain intensity, reported pain in different body regions, headache since and before the neck pain, posture during work, employment status, illness beliefs about pain identity and recovery, treatment beliefs, distress and self-efficacy. The model demonstrated an optimism-corrected area under the curve of 0.83 and a corrected R2 of 0.24. Calibration was deemed acceptable to good, as indicated by the calibration curve. The Hosmer-Lemeshow test yielded a p-value of 0.7167, indicating a good model fit.

CONCLUSION

This model has the potential to obtain a valid prognosis for developing chronic pain after a new episode of acute and subacute non-specific idiopathic, non-traumatic neck pain. It includes mostly potentially modifiable factors for physiotherapy practice. External validation of this model is recommended.

The impact of musculoskeletal ill health on quality of life and function after critical care: a multicentre prospective cohort study

Physical disability is a common component of post-intensive care syndrome, but the importance of musculoskeletal health in this population is currently unknown. We aimed to determine the musculoskeletal health state of intensive care unit survivors and assess its relationship with health-related quality of life; employment; and psychological and physical function. We conducted a multicentre prospective cohort study of adults admitted to intensive care for > 48 h without musculoskeletal trauma or neurological insult. Patients were followed up 6 months after admission where musculoskeletal health state was measured using the validated Musculoskeletal Health Questionnaire score. Of the 254 participants, 150 (59%) had a musculoskeletal problem and only 60 (24%) had received physiotherapy after discharge. Functional Comorbidity Index, Clinical Frailty Scale, duration of intensive care unit stay and prone positioning were all independently associated with worse musculoskeletal health. Musculoskeletal health state moderately correlated with quality of life, rs = 0.499 (95%CI 0.392-0.589); anxiety, rs = -0.433 (95%CI -0.538 to -0.315); and depression, rs = -0.537 (95%CI -0.631 to -0.434) (all p < 0.001). Patients with a musculoskeletal problem were less physically active than those without a problem (median (IQR [range]) number of 30 min physical activity sessions per week 1 (0-3.25 [0-7]) vs. 4 (1-7 [0-7]), p < 0.001, respectively). This study found that musculoskeletal health problems were common after intensive care unit stay. However, we observed that < 25% of patients received physical rehabilitation after discharge home. Our work has identified potential high-risk groups to target in future interventional studies.

Interprofessional education interventions in undergraduate students of musculoskeletal healthcare professions: a scoping review protocol

INTRODUCTION

Enhancing interprofessional education (IPE) fosters collaborative efforts among healthcare professionals specializing in musculoskeletal (MSK) care. This approach presents a valuable opportunity to address the pressing MSK disease burden in developing countries, with high prevalence rates and limited resources. While an abundance of literature on the various elements of IPE among healthcare students and professionals exists, shared contexts of practice of South African MSK disciplines are not currently developed through IPE at higher education level, establishing a need for South African formalised curricular IPE interventions with an explicit focus on undergraduate students of MSK healthcare professions.

METHODS AND ANALYSIS

The intended scoping review protocol is guided by the framework set out by Arksey and O'Malley, where the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will guide the process of reporting. English sources (qualitative and quantitative methodological studies, conference papers and proceedings, systematic reviews, grey literature, unpublished materials, theses and dissertations) from the electronic databases PubMed, Scopus, ERIC and ProQuest with no date restriction will be included. A researcher, an independent reviewer and research librarian will search and extract data from abstracts and full texts for this scoping review, where any arising disagreements will be resolved by discussion. Reference lists of relevant literature will be scrutinised. Relevant literature will be recorded on a referencing software and deduplicated. The data collection will take place between May and October 2023. The findings will be reported narratively with the use of tables.

ETHICS AND DISSEMINATION

This scoping review does not require ethical approval as all literature used already exists in the public domain with no involvement of human participants. The findings from this planned review will be submitted to peer-reviewed journals and will be presented at higher education conferences. This scoping review protocol was registered on Open Science Framework with the registration osf.io/c27n4.

Global, Regional, and National Change Patterns in the Incidence of Low Back Pain From 1990 to 2019 and Its Predicted Level in the Next Decade

Objectives: To analyze and describe the spatiotemporal trends of Low back pain (LBP) burdens from 1990 to 2019 and anticipate the following decade's incidence. Methods: Using data from the Global Burden of Disease (GBD) 2019 Study, we described net drifts, local drifts, age effects, and period cohort effects in incidence and forecasted incidence rates and cases by sex from 2020 to 2029 using the Nordpred R package. Results: LBP remained the leading cause of the musculoskeletal disease burden globally and across all socio-demographic index (SDI) regions. China is the top country. For recent periods, high-SDI countries faced unfavorable or worsening risks. The relative risk of incidence showed improving trends over time and in successively younger birth cohorts amongst low-middle-, middle- and high-middle-SDI countries. Additionally, the age-standardized incidence rates (ASIR) of LBP in both sexes globally showed a decreasing trend, but the incident cases would increase from 223 to 253 million overall in the next decade. Conclusion: As the population ages, incident cases will rise but ASIR will fall. To minimise LBP, public awareness and disease prevention and control are needed.

The association between morphological characteristics of paraspinal muscle and spinal disorders

BACKGROUND

Spinal disorders affect millions of people worldwide, and can cause significant disability and pain. The paraspinal muscles, located on either side of the spinal column, play a crucial role in the movement, support, and stabilization of the spine. Many spinal disorders can affect paraspinal muscles, as evidenced by changes in their morphology, including hypertrophy, atrophy, and degeneration.

OBJECTIVES

The objectives of this review were to examine the current literature on the relationship between the paraspinal muscles and spinal disorders, summarize the methods used in previous studies, and identify areas for future research.

METHODS

We reviewed studies on the morphological characteristics of the paravertebral muscle and discussed their relationship with spinal disorders, as well as the current limitations and future research directions.

RESULTS

The paraspinal muscles play a critical role in spinal disorders and are important targets for the treatment and prevention of spinal disorders. Clinicians should consider the role of the paraspinal muscles in the development and progression of spinal disorders and incorporate assessments of the paraspinal muscle function in clinical practice.

CONCLUSION

The findings of this review highlight the need for further research to better understand the relationship between the paraspinal muscles and spinal disorders, and to develop effective interventions to improve spinal health and reduce the burden of spinal disorders.

The combined role of diabetes and obesity in susceptibility to musculoskeletal disorders and its subtypes in older men and women in India

Background and aims

In later life, diabetes and obesity can cause a change in musculoskeletal systems that can lead to aching joints and a myriad of other musculoskeletal disorders such as arthritis, osteoporosis, rheumatism, bone fractures etc., resulting in significant morbidity including pain and disability. There is a paucity of research to know how comorbidity of diabetes and obesity increase musculoskeletal disorders among older people. Therefore, the present study used nationally representative data to examine the interaction of diabetes and obesity on musculoskeletal disorders and its subtypes including arthritis, osteoporosis, and rheumatism among older men and women in India.

Methods

Data were extracted from the first wave of the nationally representative survey Longitudinal Aging Study in India (LASI) conducted in 2017-18. The final sample includes 31,464 people aged 60 years or above. Primary outcome variable was any listed musculoskeletal disorders and secondary outcomes were its subtypes including arthritis, osteoporosis, and rheumatism based on self-reported questions. Diabetes and obesity based on anthropometric index of weight and height (i.e., body mass index (BMI) with a standard cut-off of 30 kg/m2 or over) were considered as explanatory variables of interest. Logistic regression was used to assess the relationship between diabetes and musculoskeletal disorders. Interaction analysis was performed by both additive and multiplicative scales.

Results

Comparing older people without diabetes, the prevalence of musculoskeletal disorders and its subtypes were higher among those with diabetes, particularly arthritis disorders in older women. Diabetes was significantly correlated with the risk of musculoskeletal disorders and its subtypes including arthritis and osteoporosis even after controlling potential factors. The combination of diabetes and obesity was significantly and positively associated with musculoskeletal disorders (aOR: 4.14; p-value < 0.0001; 95% CI: 1.96 to 8.74) and its subtype only arthritis (aOR: 4.36; p-value < 0.0001; 95% CI: 1.76 to 10.8) comparing to those without both the conditions. However, the association was strong for older women as compared to older men. Notwithstanding, multiplicative scale interaction showed statistically significant for musculoskeletal disorders and its three subtypes among older women, however it was not significant for osteoporosis and rheumatism disorders among older men. When we analyzed interaction on additive scale, we found it only for arthritis disorder among older women suggesting the risk from obesity (relative excess risk due to interaction (RERI): -0.83, 95% CI: -1.44 to -0.22, attributable proportion due to interaction (AP): -0.54, 95% CI: -1.05 to -0.03, synergy index (S): 0.39, 95% CI: 0.16 to 0.93) was additive to the risk from diabetes.

Conclusions

This study suggests an elevated risk of musculoskeletal disorders among Indian older adults with diabetes. The result of this study also suggests an interactive association of diabetes and obesity with musculoskeletal disorders, particularly with arthritis disorder. There is a need to pay attention to the BMI level while treating diabetes in Indian older population.

The burden of musculoskeletal disorders in the Middle East and North Africa (MENA) region: a longitudinal analysis from the global burden of disease dataset 1990-2019

BACKGROUND

Musculoskeletal (MSK) disorders are one of the main causes of disability among adults globally. The burden of MSK disorders varies greatly between different regions and is the highest in low- and middle income- countries. This study sought to investigate trends in the burden of MSK disorders across the MENA region, utilizing the GBD 2019 dataset.

METHODS

This ecological study utilized data from the Global Burden of Disease (GBD) to report on the burden of musculoskeletal (MSK) disorders in The Middle East and North Africa (MENA) region between 1990 and 2019. Our analysis involved descriptive statistics and sociodemographic trends and did not employ any specific statistical analyses. Using age-standardized rates of prevalence and disability-adjusted life-years (DALYs), we reported trends in the burden of MSK disorders, as well as national variation between different countries. Furthermore, we analyzed trends in risk factors contributing to MSK disorders by age and gender.

RESULTS

The longitudinal analysis from 1990 to 2019 showed an increase in the age-standardized rate for prevalence and DALYs of MSK disorders by 5% and 4.80%, respectively. Low back pain continued to be the most prevalent MSK condition, while RA and other MSK disorders had the largest percentage increase for DALYs between 1990 and 2019. The study found that Afghanistan had the lowest age standardized DALYs rate attributed to MSK disorders, while Iran, Turkey, and Jordan had the highest. Further, Syria showed the most dramatic decrease while Saudi Arabia had the most notable increase in age standardized DALY rates from 1990 to 2019. In 2019, occupational risks, high body mass index, and tobacco smoking were the main risk factors for MSK disorders, with occupational risks being the largest contributor, and between 1990 and 2019, there was a decrease in the contribution of occupational risks but an increase in the contribution of high body mass index as a risk factor.

CONCLUSION

This study highlights the significant burden of MSK disorders in the MENA region, with various risk factors contributing to its increasing prevalence in recent decades. Further research is needed to better understand the underlying factors and potential interventions that could improve health outcomes. Addressing MSK disorders should be a public health priority in the region, and efforts should be made to develop effective strategies to prevent and manage this debilitating condition.

Association between inequalities in human resources for health and all cause and cause specific mortality in 172 countries and territories, 1990-2019: observational study

OBJECTIVE

To explore inequalities in human resources for health (HRH) in relation to all cause and cause specific mortality globally in 1990-2019.

DESIGN

Observational study.

SETTING

172 countries and territories.

DATA SOURCES

Databases of the Global Burden of Disease Study 2019, United Nations Statistics, and Our World in Data.

MAIN OUTCOME MEASURES

The main outcome was age standardized all cause mortality per 100 000 population in relation to HRH density per 10 000 population, and secondary outcome was age standardized cause specific mortality. The Lorenz curve and the concentration index (CCI) were used to assess trends and inequalities in HRH.

RESULTS

Globally, the total HRH density per 10 000 population increased, from 56.0 in 1990 to 142.5 in 2019, whereas age standardized all cause mortality per 100 000 population decreased, from 995.5 in 1990 to 743.8 in 2019. The Lorenz curve lay below the equality line and CCI was 0.43 (P<0.05), indicating that the health workforce was more concentrated among countries and territories ranked high on the human development index. The CCI for HRH was stable, at about 0.42-0.43 between 1990 and 2001 and continued to decline (narrowed inequality), from 0.43 in 2001 to 0.38 in 2019 (P<0.001). In the multivariable generalized estimating equation model, a negative association was found between total HRH level and all cause mortality, with the highest levels of HRH as reference (low: incidence risk ratio 1.15, 95% confidence interval 1.00 to 1.32; middle: 1.14, 1.01 to 1.29; high: 1.18, 1.08 to 1.28). A negative association between total HRH density and mortality rate was more pronounced for some types of cause specific mortality, including neglected tropical diseases and malaria, enteric infections, maternal and neonatal disorders, and diabetes and kidney diseases. The risk of death was more likely to be higher in people from countries and territories with a lower density of doctors, dentistry staff, pharmaceutical staff, aides and emergency medical workers, optometrists, psychologists, personal care workers, physiotherapists, and radiographers.

CONCLUSIONS

Inequalities in HRH have been decreasing over the past 30 years globally but persist. All cause mortality and most types of cause specific mortality were relatively higher in countries and territories with a limited health workforce, especially for several specific HRH types among priority diseases. The findings highlight the importance of strengthening political commitment to develop equity oriented health workforce policies, expanding health financing, and implementing targeted measures to reduce deaths related to inadequate HRH to achieve universal health coverage by 2030.

Context and priorities for health systems strengthening for pain and disability in low- and middle-income countries: a secondary qualitative study and content analysis of health policies

Musculoskeletal (MSK) health impairments contribute substantially to the pain and disability burden in low- and middle-income countries (LMICs), yet health systems strengthening (HSS) responses are nascent in these settings. We aimed to explore the contemporary context, framed as challenges and opportunities, for improving population-level prevention and management of MSK health in LMICs using secondary qualitative data from a previous study exploring HSS priorities for MSK health globally and (2) to contextualize these findings through a primary analysis of health policies for integrated management of non-communicable diseases (NCDs) in select LMICs. Part 1: 12 transcripts of interviews with LMIC-based key informants (KIs) were inductively analysed. Part 2: systematic content analysis of health policies for integrated care of NCDs where KIs were resident (Argentina, Bangladesh, Brazil, Ethiopia, India, Kenya, Malaysia, Philippines and South Africa). A thematic framework of LMIC-relevant challenges and opportunities was empirically derived and organized around five meta-themes: (1) MSK health is a low priority; (2) social determinants adversely affect MSK health; (3) healthcare system issues de-prioritize MSK health; (4) economic constraints restrict system capacity to direct and mobilize resources to MSK health; and (5) build research capacity. Twelve policy documents were included, describing explicit foci on cardiovascular disease (100%), diabetes (100%), respiratory conditions (100%) and cancer (89%); none explicitly focused on MSK health. Policy strategies were coded into three categories: (1) general principles for people-centred NCD care, (2) service delivery and (3) system strengthening. Four policies described strategies to address MSK health in some way, mostly related to injury care. Priorities and opportunities for HSS for MSK health identified by KIs aligned with broader strategies targeting NCDs identified in the policies. MSK health is not currently prioritized in NCD health policies among selected LMICs. However, opportunities to address the MSK-attributed disability burden exist through integrating MSK-specific HSS initiatives with initiatives targeting NCDs generally and injury and trauma care.

[Comparative analysis of the use of symptomatic slow acting drugs for osteoarthritis containing chondroitin sulfate or affecting its biosynthesis in patients with non-specific low back pain]

OBJECTIVE

Retrospective comparative analysis of the use of SYSADOA preparations containing chondroitin sulfate (Chondroguard, 2 ml, 25 amp., glycosaminoglycan-peptide complex, 1 ml 25 amp., bioactive concentrate of small marine fish, 2 ml, 10 amp.) in patients with chronic non-specific low back pain (LBP) of lumbar and sacral localization caused by spondylosis and osteochondrosis of the lumbar spine, at the stage of outpatient care.

MATERIAL AND METHODS

Data of medical records of patients (n=120; men - 32, women - 88, age - 54.1±7.6 years, duration of disease exacerbation 4.0±1.7 months) with nonspecific LBP were systematized according to the inclusion/exclusion criteria. All patients were divided into 4 groups: Group 1 (n=30) received Chondroguard im., 2 ml every other day, the course of treatment was 25 injections, 25 days; Group 2 (n=30) received glycosaminoglycan-peptide complex on the 1st day - 0.3 ml, on the 2nd day - 0.5 ml, and then 3 times a week for 1 ml, course of treatment - 25 injections, 25 days; Group 3 (n=30) received bioactive concentrate of small marine fish, 2 ml im., every other day, the course of treatment was 10 injections; repeated courses of treatment - after 6 months; Group 4 (n=30) received Amelotex (meloxicam) at a dose of 15 mg once a day for 15 days. All patients of the first 3 groups received Amelotex at a dose of 15 mg with the possibility of reducing the dose to 7.5 mg or completely discontinuing the drug if necessary. Retrospectively, dynamic monitoring was performed in the medical records of outpatients after 50 days and 6 months from the start of therapy according to the following parameters: intensity of pain according to VAS, short form of the McGill pain questionnaire, vital signs of patients (Oswestry Disability Index, version 2.1a [Oswestry Disability Index], and Roland-Morris questionnaire), propensity to chronic pain syndrome according to the STarT Back Screening Tool questionnaire, the presence and severity of comorbid fibromyalgia according to the Fibromyalgia Rapid Screening Tool questionnaire, the level of pain catastrophization according to the Pain Catastrophizing Scale, the severity of comorbid anxiety and depression according to the Hospital Anxiety and Depression Scale, the severity comorbid insomnia (Insomnia Severity Index), quality of life according to the SF-36 scale, the effectiveness of drugs according to the patient on a 5-point scale, the need to take NSAIDs and analgesics, tolerability on a 4-point system. The safety of therapy was monitored using the WHO and Naranjo scales.

RESULTS

In patients with nonspecific LBP, a greater degree of reduction in the intensity of the pain syndrome, a smaller number of exacerbations of the pain syndrome over 6 months of observation, an improvement in the functional status and life activity, a tendency to a decrease in the severity of anxiety and depression, sleep disturbances and comorbid fibromyalgia, limiting the risk of chronicity and catastrophization of pain, the presence of a structure-modifying effect on IVD and degenerative changes in the facet joints, a significant improvement in the physical and mental components of health, high satisfaction and safety of therapy, which included taking Chondroguard with meloxicam, with a decrease in the need to take the latter by the 50th day observation period compared to other regimens. The effects of Chondroguard and meloxicam turned out to be long-term and were recorded by the 6th month in the absence of Chondroguard, which indicated the preservation of the influence of highly purified cholesterol on the pathogenetic mechanisms of the formation of LBP.

CONCLUSION

The study allows us to recommend the use of a parenteral form of cholesterol (Chondroguard, CJSC «PharmFirma «Sotex», Russia) for the treatment of nonspecific LBP with moderate or severe pain, chronic relapsing or persistent course, in combination with NSAIDs and their subsequent cancellation or administration on demand.

Prevalence of spinal pain in a population of Bosnia and Herzegovina

Objectives

To determine the prevalence and risk factors of spinal pain in the population of Bosnia and Herzegovina (BiH).

Methods

This was a cross-sectional survey conducted online in November/December 2018. Participants were inhabitants of BiH of both sexes, aged ≥ 16 years. The sample was stratified based on region and demographic characteristics. Current pain was analyzed; point prevalence was measured.

Results

We received 1048 responses, of which data from 1017 could be used. The prevalence of spinal pain in BiH was 70.9%: 75.5% in women (n = 440) and 64.7% in men (n = 281). Low back pain (LBP) was more common compared to neck pain (NP) and thoracic pain (TP) in both sexes and all age groups. Significant associations with spinal pain in the bivariate analysis were found for the following groups: women, aged from 30 to 50 years, with high school education, employed persons and retirees, spinal pain in parents, smoking, irregular physical activity, longer use of TV or computer/mobile phone per day.

Conclusion

To our knowledge, this is the first study of the prevalence of spinal pain in BiH. Some factors associated with spinal pain are modifiable. Therefore, public health interventions should target those factors to reduce the burden of spinal pain in BiH.

Prevalence and biopsychosocial factors associated with chronic low back pain in urban and rural communities in Western Africa: a population-based door-to-door survey in Benin

PURPOSE

This study aimed to assess the prevalence of chronic low back pain (CLBP) and related biopsychosocial factors in urban and rural communities in Benin.

METHODS

This is a population-based observational cross-sectional survey. An interviewer-administered electronic questionnaire was used to collect information on demographic, socio-economic, behavioral, and psychological factors relating to CLBP risk factors and medical history of participants. The numeric pain rating scale and the Beck Depression Inventory were used to assess pain intensity and the level of depression, respectively. Bivariate analyses were performed to investigate the association between sociodemographic, behavioral, and psychological factors and CLBP. Sequential multiple regression analyses were subsequently performed to predict the occurrence of CLBP.

RESULTS

A total of 4320 participants, with a mean age ± SD of 32.9 ± 13.1 years, of which 40.7% were females and 50.1% from an urban area, were enrolled in the study. We found a global prevalence rate of CLBP of 35.5% [95% CI 34.1-36.9%]. The prevalence in urban areas was 30.68% [95% CI 28.9-32.8%]) while 40.2% was found in rural areas [95% CI 38.1-42.2%]). Age (p < 0.001), level of education (p = 0.046), marital status (p < 0.001), working status (p < 0.003), tobacco use (p < 0.016) and regular physical activity (p < 0.011) were associated with CLBP. In urban areas, only the level of education was able to predict the prevalence of CLBP (R2 = 61%). In rural areas, CLBP was predicted by age, marital and working status (R2 = 89%).

CONCLUSIONS

This study showed a high prevalence of CLBP among urban and rural communities in Benin. Age, level of education, marital status, and working status were significantly associated with CLBP in Benin.

Digital pain extent is associated with pain intensity but not with pain-related cognitions and disability in people with chronic musculoskeletal pain: a cross-sectional study

Background

To evaluate whether digital pain extent is associated with an array of psychological factors such as optimism, pessimism, expectations of recovery, pain acceptance, and pain self-efficacy beliefs as well as to analyse the association between digital pain extent and pain intensity and pain-related disability in people with chronic musculoskeletal pain.

Methods

A descriptive cross-sectional study conducted in a primary health care setting was carried out including 186 individuals with chronic musculoskeletal pain. Patient-reported outcomes were used to assess psychological factors, pain intensity, and pain-related disability. Digital pain extent was obtained from pain drawings shaded using a tablet and analysed using novel customized software. Multiple linear regression models were conducted to evaluate the association between digital pain extent and the aforementioned variables.

Results

Digital pain extent was statistically significantly associated with pain intensity. However, digital pain extent was not associated with any psychological measure nor with pain-related disability.

Discussion

The results did not support an association between digital pain extent and psychological measures.

Water carrying in hills of Nepal–associations with women’s musculoskeletal disorders, uterine prolapse, and spontaneous abortions

More than a third of women in Nepal have to carry water from source to home to satisfy their families’ daily needs. A cross-sectional study was carried out in a hilly area in Nepal to assess water-carrying practices and their association with women’s health. Quantitative interviews were conducted with 1001 women of reproductive age and were complemented with health surveys carried out by health professionals and structured observations of water carrying. Multivariate mixed logistic regression models were used to assess the associations between water-carrying-related risk factors and health issues for women. Around 46% of women faced considerably increased to excessive physical stress due to water carrying during the dry season. Women suffered from a disproportionately high prevalence of back pain (61%), with about 18% of this pain being horrible to excruciating; pain in the knees (34%); uterine prolapse (11.3%); and at least one spontaneous abortion (9%). The risk category of water carrying was significantly associated with uterine prolapse (OR = 1.44, 95%CI = 1.12–1.85, p = 0.031) and pain in the hips (OR = 1.69, 95%CI = 1.27–2.26, p<0.001). Receiving help with water carrying during pregnancy and during the first three months after delivery was associated with reduced odds ratios for uterine prolapse (OR = 0.10, 95% CI = 0.01–0.87, p = 0.037), and strong back pain (OR = 0.32, 95% CI = 0.12–0.87, p = 0.026). Improvements to water supply infrastructure and the promotion of social support for carrying water during pregnancy and after delivery are recommended to reduce water-carrying-related health risks.

Musculoskeletal disorders among the population in Northwest Ethiopia

Objective:

This study aimed to assess the magnitude and patterns of chronic musculoskeletal disorders among the population in East Gojjam zone, Northwest Ethiopia.

Methods:

A community-based cross-sectional study with 846 recruited study participants was done using a multistage sampling technique in conjunction with a simple and systematic random sampling technique. Face-to-face interviews, physical examinations, a semi-structured questionnaire adapted from the Community Oriented Program for Control of Rheumatic Diseases, and other literature were used to collect data. EpiData 3.1 was used to enter the data, which were then exported to STATA 14.0 for analysis.

Result:

The study had a response rate of 98.8%, with about 836 people out of a total of 846 expected to take part. The magnitude of musculoskeletal disorders was found to be 40.1%. Back pain was the most common musculoskeletal condition (16%) of the population, followed by osteoarthritis (10%) and other forms of arthritis (rheumatoid arthritis (8%), gout arthritis (6%)). The most common comorbidity (multimorbidity) patterns were hypertension (9.8%), diabetes (5.6%), obesity (3.9%), and others (2.2%).

Conclusion:

Almost one in four participants have at least one musculoskeletal disorder in Northwest Ethiopia. Rheumatoid arthritis, osteoarthritis, low back pain, and gout arthritis were the most common musculoskeletal disorders. The most common comorbidity patterns were hypertension, diabetes, obesity, and others. An in-depth investigation of the musculoskeletal burden at the national level will be critical for implementing evidence-based strategies, as well as early detection and screening, linking to health institutions, and direct interventions.

Physiotherapists' knowledge, attitude and practice behavior to prevent chronification in patients with non-specific, non-traumatic, acute- and subacute neck pain: A qualitative study

BACKGROUND

The purpose of this study was to explore physiotherapists' knowledge, attitude, and practice behavior in assessing and managing patients with non-specific, non-traumatic, acute- and subacute neck pain, with a focus on prognostic factors for chronification.

METHOD

A qualitative study using in-depth semi-structured interviews was conducted with 13 physiotherapists working in primary care. A purposive sampling method served to seek the broadest perspectives. The knowledge-attitude and practice framework was used as an analytic lens throughout the process. Textual data were analyzed using qualitative content analysis with an inductive approach and constant comparison.

RESULTS

Seven main themes emerged from the data; physiotherapists self-estimated knowledge and attitude, role clarity, therapeutic relationship, internal- and external barriers to practice behavior, physiotherapists' practice behaviors, and self-reflection. These findings are presented in an adjusted knowledge-attitude and practice behavior framework.

CONCLUSION

A complex relationship was found between a physiotherapist's knowledge about, attitude, and practice behavior concerning the diagnostic process and interventions for non-specific, non-traumatic, acute, and subacute neck pain. Overall, physiotherapists used a biopsychosocial view of patients with non-specific neck pain. Physiotherapists' practice behaviors was influenced by individual attitudes towards their professional role and therapeutic relationship with the patient, and individual knowledge and skills, personal routines and habits, the feeling of powerlessness to modify patients' external factors, and patients' lack of willingness to a biopsychosocial approach influenced physiotherapists' clinical decisions. In addition, we found self-reflection to have an essential role in developing self-estimated knowledge and change in attitude towards their therapeutic role and therapist-patient relationship.

Workplace Musculoskeletal Disorder Prevention Practices and Experiences

Introduction. Musculoskeletal disorders (MSD) remain a substantial burden to society and to workplaces worldwide. Evidence-based practice approaches may be helpful; however, current research evidence is not consistently strong. Workplaces must address MSD regardless of the state of the research evidence. The study objective was to describe workplace MSD prevention practices experiences and perspectives of workers, managers, and occupational health and safety practitioners. Methods. This descriptive study used a convenience sample from Newfoundland and Labrador workplaces. Data were collected via survey and interviews. The survey data was analyzed using descriptive statistics and the interview data was analyzed using thematic analysis. Results. Results were examined from 645 survey respondents and 17 interviewees. Survey findings revealed that about half of respondents reported MSD policies existed in their workplace. Many MSD practices (such as ergonomics and force reduction) were considered available by most respondents. Over fifty percent of respondents received some training on MSD. The person most often endorsed as responsible to support workers with MSD was a manager. Interview findings showed that MSD prevention practices related to awareness, training, and hazard reduction are considered important and effective. Facilitators of MSD prevention include practices that are proactive and customized and increase knowledge about MSD prevention. Barriers concerning lack of resources and poor implementation were consistently mentioned. Conclusions. Evidence from current practices may help workplaces reduce MSD burden. However, with only about fifty percent of respondents reporting that MSD policies exist in the workplace, further work to address MSD is required. Future research should examine workplace practices as an important source of evidence. OHS professionals can use the study findings and adapt it to their context(s) to guide their design and implementation of MSD prevention practices. Improved MSD prevention practices and interventions can lead to decreases in MSD in workplaces across all industrial sectors.

Health systems strengthening to arrest the global disability burden: empirical development of prioritised components for a global strategy for improving musculoskeletal health

INTRODUCTION

Despite the profound burden of disease, a strategic global response to optimise musculoskeletal (MSK) health and guide national-level health systems strengthening priorities remains absent. Auspiced by the Global Alliance for Musculoskeletal Health (G-MUSC), we aimed to empirically derive requisite priorities and components of a strategic response to guide global and national-level action on MSK health.

METHODS

Design: mixed-methods, three-phase design.Phase 1: qualitative study with international key informants (KIs), including patient representatives and people with lived experience. KIs characterised the contemporary landscape for MSK health and priorities for a global strategic response.Phase 2: scoping review of national health policies to identify contemporary MSK policy trends and foci.Phase 3: informed by phases 1-2, was a global eDelphi where multisectoral panellists rated and iterated a framework of priorities and detailed components/actions.

RESULTS

Phase 1: 31 KIs representing 25 organisations were sampled from 20 countries (40% low and middle income (LMIC)). Inductively derived themes were used to construct a logic model to underpin latter phases, consisting of five guiding principles, eight strategic priority areas and seven accelerators for action.Phase 2: of the 165 documents identified, 41 (24.8%) from 22 countries (88% high-income countries) and 2 regions met the inclusion criteria. Eight overarching policy themes, supported by 47 subthemes, were derived, aligning closely with the logic model.Phase 3: 674 panellists from 72 countries (46% LMICs) participated in round 1 and 439 (65%) in round 2 of the eDelphi. Fifty-nine components were retained with 10 (17%) identified as essential for health systems. 97.6% and 94.8% agreed or strongly agreed the framework was valuable and credible, respectively, for health systems strengthening.

CONCLUSION

An empirically derived framework, co-designed and strongly supported by multisectoral stakeholders, can now be used as a blueprint for global and country-level responses to improve MSK health and prioritise system strengthening initiatives.

The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants

BACKGROUND

Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. We aimed to explore contemporary context, challenges and opportunities at a global level and relevant to health systems strengthening for MSK health, as identified by international key informants (KIs) to inform a global MSK health strategic response.

METHODS

An in-depth qualitative study was undertaken with international KIs, purposively sampled across high-income and low and middle-income countries (LMICs). KIs identified as representatives of peak global and international organisations (clinical/professional, advocacy, national government and the World Health Organization), thought leaders, and people with lived experience in advocacy roles. Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method. Data were organised into categories describing 1) contemporary context; 2) goals; 3) guiding principles; 4) accelerators for action; and 5) strategic priority areas (pillars), to build a data-driven logic model. Here, we report on categories 1-4 of the logic model.

RESULTS

Thirty-one KIs from 20 countries (40% LMICs) affiliated with 25 organisations participated. Six themes described contemporary context (category 1): 1) MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised; 2) improving MSK health is more than just healthcare; 3) global guidance for country-level system strengthening is needed; 4) impact of COVID-19 on MSK health; 5) multiple inequities associated with MSK health; and 6) complexity in health service delivery for MSK health. Five guiding principles (category 3) focussed on adaptability; inclusiveness through co-design; prevention and reducing disability; a lifecourse approach; and equity and value-based care. Goals (category 2) and seven accelerators for action (category 4) were also derived.

CONCLUSION

KIs strongly supported the creation of an adaptable global strategy to catalyse and steward country-level health systems strengthening responses for MSK health. The data-driven logic model provides a blueprint for global agencies and countries to initiate appropriate whole-of-health system reforms to improve population-level prevention and management of MSK health. Contextual considerations about MSK health and accelerators for action should be considered in reform activities.

What Are Models of Care? A Systematic Search and Narrative Review to Guide Development of Care Models for Premature Ovarian Insufficiency

No specific model of care (MoC) is recommended for premature ovarian insufficiency (POI), despite awareness that POI is associated with comorbidities requiring multidisciplinary care. This article aims to explore the definitions and central components of MoC in health settings, so that care models for POI can be developed. A systematic search was performed on Ovid Medline and Embase, and including gray literature. Unique definitions of MoC were identified, and thematic analysis was used to summarize the key component of MoC. Of 2,477 articles identified, 8 provided unique definitions of MoC, and 11 described components of MoC. Definitions differ in scope, focusing on disease, service, or system level, but a key feature is that MoC is operational, describing how care is delivered, as well as what that care is. Thematic analysis identified 42 components of MoC, summarized into 6 themes-stakeholder engagement, supporting integrated care, evidence-based care, defined outcomes and evaluation, behavior change methodology, and adaptability. Stakeholder engagement was central to all other themes. MoCs operationalize how best practice care can be delivered at a disease, service, or systems level. Specific MoC should be developed for POI, to improve clinical and process outcomes, translate evidence into practice, and use resources more efficiently.

Musculoskeletal health - The case for action

Musculoskeletal health is critical for human function, enabling mobility, dexterity and the ability to work and actively participate in all aspects of life. It is essential for maintaining economic, social and functional independence as well as human capital across the life course. Action is needed and the Global Alliance for Musculoskeletal Health (G-MUSC) is working with the entire musculoskeletal community to develop a global consensus on the important components of a global strategy. This will serve to influence and accelerate the priorities and actions of countries and international agencies such as the WHO. This issue aims to provide a background for developing such a global strategy for improving musculoskeletal health.

In pursuit of 'safe' water: the burden of personal injury from water fetching in 21 low-income and middle-income countries

INTRODUCTION

Water fetching for household needs can cause injury, but documentation of the burden of harm globally has been limited. We described the frequency, characteristics and correlates of water-fetching injuries in 24 sites in 21 low-income and middle-income countries in Asia, Africa and Latin America and the Caribbean.

METHODS

In a survey of 6291 randomly selected households, respondents reported whether and how they had experienced water-fetching injuries. Responses were coded for injury type, mechanism, bodily location and physical context. We then identified correlates of injury using a multilevel, mixed-effects logistic regression model.

RESULTS

Thirteen per cent of respondents reported at least one water-fetching injury. Of 879 injuries, fractures and dislocations were the most commonly specified type (29.2%), and falls were the most commonly specified mechanism (76.4%). Where specified, 61.1% of injuries occurred to the lower limbs, and dangerous terrain (69.4%) was the most frequently reported context. Significant correlates included being female (aOR=1.50, 95% CI 1.15 to 1.96); rural (aOR=4.80, 95% CI 2.83 to 8.15) or periurban residence (aOR=2.75, 95% CI 1.64 to 4.60); higher household water insecurity scores (aOR=1.09, 95% CI 1.07 to 1.10) and reliance on surface water (aOR=1.97, 95% CI 1.21 to 3.22) or off-premise water sources that required queueing (aOR=1.72, 95% CI 1.19 to 2.49).

CONCLUSION

These data suggest that water-fetching injuries are an underappreciated and largely unmeasured public health challenge. We offer guidelines for comprehensive data collection on injuries to better capture the true burden of inadequate water access. Such data can guide the design of interventions to reduce injury risk and promote equitable water access solutions.

Improving musculoskeletal health for children and young people - A 'call to action'

This chapter describes the musculoskeletal (MSK) context in children and young people as an important contributor to the global non-communicable disease burden. Through selected MSK conditions, we describe the impact on patients, families and communities and highlight the challenges that need to be addressed. We focus on opportunities for better working together and describe exemplar initiatives to raise awareness, workforce capacity building, models of care and research agendas to have a greater global context.

Implementing models of care for musculoskeletal conditions in health systems to support value-based care

Models of Care (MoCs), and their local Models of Service Delivery, for people with musculoskeletal conditions are becoming an acceptable way of supporting effective implementation of value-based care. MoCs can support the quadruple aim of value-based care through providing people with musculoskeletal disease improved access to health services, better health outcomes and satisfactory experience of their healthcare; ensure the health professionals involved are experiencing satisfaction in delivering such care and health system resources are better utilised. Implementation of MoCs is relevant at the levels of clinical practice (micro), service delivery organisations (meso) and health system (macro) levels. The development, implementation and evaluation of MoCs has evolved over the last decade to more purposively engage people with lived experience of their condition, to operationalise the Chronic Care Model and to employ innovative solutions. This paper explores how MoCs have evolved and are supporting the delivery of value-based care in health systems.

Global health policy in the 21st century: Challenges and opportunities to arrest the global disability burden from musculoskeletal health conditions

The profound burden of disease associated with musculoskeletal health conditions is well established. Despite the unequivocal disability burden and personal and societal consequences, relative to other non-communicable diseases (NCDs), system-level responses for musculoskeletal conditions that are commensurate with their burden have been lacking nationally and globally. Health policy priorities and responses in the 21st century have evolved significantly from the 20th century, with health systems now challenged by an increasing prevalence and impact of NCDs and an unprecedented rate of global population ageing. Further, health policy priorities are now strongly aligned to the 2030 Sustainable Development Goals. With this background, what are the challenges and opportunities available to influence global health policy to support high-value care for musculoskeletal health conditions and persistent pain? This paper explores these issues by considering the current global health policy landscape, the role of global health networks, and progress and opportunities since the 2000-2010 Bone and Joint Decade for health policy to support improved musculoskeletal health and high-value musculoskeletal health care.

The burden of low back pain in Brazil: estimates from the Global Burden of Disease 2017 Study

BACKGROUND

The prevalence and burden of musculoskeletal (MSK) conditions are growing around the world, and low back pain (LBP) is the most significant of the five defined MSK disorders in the Global Burden of Disease (GBD) study. LBP has been the leading cause of non-fatal health loss for the last three decades. The objective of this study is to describe the current status and trends of the burden due to LBP in Brazil based on information drawn from the GBD 2017 study.

METHODS

We estimated prevalence and years lived with disability (YLDs) for LBP by Brazilian federative units, sex, age group, and age-standardized between 1990 and 2017 and conducted a decomposition analysis of changes in age- and sex-specific YLD rates attributable to total population growth and population ageing for the purpose of understanding the drivers of changes in LBP YLDs rates in Brazil. Furthermore, we analyzed the changes in disability-adjusted life years (DALYs) rankings for this disease over the period.

RESULTS

The results show high prevalence and burden of LBP in Brazil. LBP prevalence increased 26.83% (95% UI 23.08 to 30.41) from 1990 to 2017. This MSK condition represents the most important cause of YLDs in Brazil, where the increase in burden is mainly related to increase in population size and ageing. The LBP age-standardized YLDs rate are similar among Brazilian federative units. LBP ranks in the top three causes of DALYs in Brazil, even though it does not contribute to mortality.

CONCLUSIONS

Findings from this study show LBP to be the most important cause of YLDs and the 3rd leading cause of DALYs in Brazil. The Brazilian population is ageing, and the country has been experiencing a rapid epidemiological transition, which generates an increasing number of people who need chronic care. In this scenario, more attention should be paid to the burden of non-fatal health conditions.

Validation of the Musculoskeletal Health Questionnaire (MSK-HQ) in primary care patients with musculoskeletal pain

OBJECTIVE

To evaluate the responsiveness, and concurrent validity of the Musculoskeletal Health Questionnaire (MSK-HQ) in UK primary care patients with common musculoskeletal (MSK) pain presentations.

METHODS

A secondary analysis of a primary care pilot randomised trial (STarT MSK) was performed. In 524 people consulting with back, neck, shoulder, knee, or multi-site pain, the following were recorded at 0/6 months: MSK-HQ, EQ-5D-5L, Roland-Morris Disability Questionnaire (RMDQ; back pain), Neck Disability Index (NDI), Shoulder Pain and Disability Index (SPADI), Knee Injury and Outcome Score (KOOS), Short-Form-12 (SF-12; multisite pain). At 6-months, patients self-rated their global change in MSK condition, from -5 ("very much worse") to +5 ("completely recovered"). Receiver operating characteristic curves evaluated abilities of 6-month changes in each patient reported outcome measure (PROM) to discriminate between patients improving/not improving on global change scores, with Minimal Clinically Important Differences (MCID) calculated.

RESULTS

The MSK-HQ had a good ability to discriminate between MSK pain patients reporting global improvement vs. no improvement (area under the curve [AUC] 0.81; 95% CI 0.78, 0.85). Its discriminative ability was higher than the EQ-5D-5L (AUC 0.68; 95% CI 0.62, 0.73) and similar to site-specific PROMs. The MCID for the 6-month change in MSK-HQ was 5.5. The MSK-HQ had strong correlations with all PROMs, except SF-12 scores.

CONCLUSION

In primary care patients with common MSK pain presentations, the MSK-HQ was as good as existing pain-site specific PROMs at identifying people reporting global improvements in their MSK condition, and was better than the EQ-5D-5L.

Burden of musculoskeletal disorders in Iran during 1990-2017: estimates from the Global Burden of Disease Study 2017

Musculoskeletal diseases (MSDs) are the leading cause of disability and facing them demands updated reports on their burden for efficient policymaking. We showed Iran had the highest female-to-male ratio and highest increase in the burden of musculoskeletal diseases, in the past three decades, worldwide. We further confirmed the role of population aging as the main cause.

PURPOSE

MSDs comprise most of the top causes of years lived with disability (YLDs) worldwide and are rapidly increasing in lower- and middle-income countries. Here, we present disability and mortality due to MSDs in Iran at the national level from 1990 to 2017.

METHODS

We used Global Burden of Disease (GBD) 2017 Study data and standard methodology and presented the burden of MSDs in rates of years of life lost (YLLs), YLDs, and disability-adjusted life years (DALYs) during 1990-2017, for population aged ≥ 5 years old. We further explored attributable risk factors and decomposed the changing trend in DALYs to assess underlying causes.

RESULTS

In Iran, MSDs were responsible for 1.82 million (95%uncertainty interval [UI] 1.3-2.4) DALYs, in 2017. During the past 28 years, with 1.75% annualized percentage change (APC), Iran had the highest percentage increase in the all-ages MSD DALYs rate worldwide, while the age-standardized DALYs APC was negligible. Low back pain was the greatest contributor to DALYs and caused 4.5% of total DALYs. The female population is experiencing considerably higher burden of MSDs, with 115% and 48% higher all-ages YLLs and YLDs rates per 100,000, respectively (YLLs 28.7; YLDs 2629.1), than males (YLLs 13.2; YLDs 1766.1). However, due to wide UIs, difference was not significant. Only 17.6% of MSD YLDs are attributable to assessed risk factors.

CONCLUSION

Despite that MSDs are rising as an important cause of disability in Iran, these conditions are not sufficiently addressed in health policies. There is urgent need for cross-sectoral engagement, especially addressing the MSDs in females.

Incidence trend of five common musculoskeletal disorders from 1990 to 2017 at the global, regional and national level: results from the global burden of disease study 2017

OBJECTIVE

To assess cause-specific incidence and its trend of musculoskeletal (MSK) disorders at global, regional and national levels.

METHODS

Data on MSK disorders were downloaded from the Global Burden of Disease 2017 study website. Estimated annual percentage change (EAPC) was calculated to quantify the temporal trend in age-standardised incidence rate (ASR) of MSK disorders, by age, sex, region and cause.

RESULTS

Between 1990 and 2017 incident cases of MSK disorders increased globally by 58% from 211.80 million to 334.74 million, with a decreasing ASR of 0.18% annually (95% CI -0.21% to -0.15%). The ASR decreased for low back pain (LBP), remained stable for neck pain (NP), and increased for rheumatoid arthritis (RA), osteoarthritis (OA) and gout, with EAPCs (95% CI) of -0.24 (-0.29 to -0.20), -0.09 (-0.13 to -0.05), 0.36 (0.28 to 0.43), 0.32 (0.28 to 0.36) and 0.22 (0.21 to 0.23), respectively. It appears women have higher increase in EAPC than men for RA (1.3 times) and gout (1.6 times). The absolute EAPC was strikingly high in high or high-middle sociodemographic index (SDI) regions for overall, LBP and gout, and in low SDI regions for NP. EAPC was significantly associated with baseline ASR for LBP (nonlinear), RA (ρ=-0.41) and gout (ρ=-0.42), also with 2017 human development index for LBP (ρ=-0.53) and gout (ρ=0.15).

CONCLUSIONS

Globally, MSK disorders remain a public health burden. The ASR is decreasing for MSK disorders overall, mainly in high-middle SDI regions, but increasing for RA, OA and gout.

Pain assessment for chronic lower back pain: performance of the PAL-S and PAL-I patient-reported measures for symptoms and impacts

Objective: The Patient Assessment for Low Back Pain-Symptoms (PAL-S) and the Patient Assessment for Low Back Pain-Impacts (PAL-I) were developed to incorporate patient perspective of treatment benefit in chronic low back pain (cLBP) trials. This study documents psychometric measurement properties of the PAL-S and PAL-I.Methods: In this multicenter, observational study, eligible participants clinically diagnosed with cLBP provided sociodemographic information and completed PAL measures and other patient-reported outcome measures of pain and/or disability. Confirmatory factor analyses (CFA), construct validity, and reliability were assessed.Results: The 104 participants were 61% female, 89% white, and mean age of 55 years; mean cLBP duration was 11.4 (range 0-47) years. Using painDETECT scores, 36.5% reported small likelihood of neuropathic pain, 30.8% reported unclear likelihood, and 32.7% reported definite likelihood. Persistent pain with pain attacks was reported by 38.5% of participants. CFA confirmed single components with adequate fit indices. Cronbach's alpha was 0.83 (PAL-S) and 0.87 (PAL-I), indicating reliable scales. Intraclass correlation coefficients (test-retest reproducibility, n = 44) were 0.81 (PAL-S) and 0.85 (PAL-I). PAL-S score correlation was 0.49 with Roland-Morris Disability Questionnaire (RMDQ) and 0.77 with Neuropathic Pain Symptom Inventory (NPSI). PAL-I correlated at 0.73 with RMDQ and -0.60 with Medical Outcomes Study (MOS)-36 Bodily Pain. Both measures significantly differentiated between pain intensity levels (based on numeric response scale) and painDETECT groups.Conclusion: The PAL-S and PAL-I generated highly reliable scores with substantial evidence of construct validity. Routine use of these measures in treatment trials will enhance comparability of LBP-related symptom and impact results, including patient perspective of treatment benefit.

Association between childhood conditions and arthritis among middle-aged and older adults in China: the China Health and Retirement Longitudinal Study

This study examined the association between childhood conditions and arthritis among middle-aged and older adults in China. The data were derived from the 2015 wave and the life-history module of the China Health and Retirement Longitudinal Study. Face-to-face interviews were conducted with respondents age 45 and over across China. Multiple imputation was used to handle the missing data, generating a final analytic sample of 19,800. Doctor-diagnosed arthritis was the main outcome variable. Random-effects logistic regression models were used to test the proposed models. Approximately 8 per cent of the respondents had better family financial status in childhood than their neighbours. Close to 8 per cent had been hospitalised or encountered similar conditions (e.g. confined to bed or home) for at least one month in childhood. Around one-third reported better subjective health in childhood than their peers. The majority of the respondents (80%) reported that they had stable health resources, and that their mothers were illiterate during their childhood. Childhood family financial status, subjective health, mother's education, access to health care and medical catastrophic events were found to be significant factors associated with arthritis in later life, after controlling for adulthood and older-age conditions (family financial status: odds ratio (OR) = 0.885, 95 per cent confidence interval (95% CI) = 0.848–0.924; subjective health: OR = 0.924, 95% CI = 0.889–0.960; mother's education: OR = 0.863, 95% CI = 0.750–0.992; access to health care: OR = 0.729, 95% CI = 0.552–0.964; medical catastrophic events: OR = 1.266, 95% CI = 1.108–1.446). The study results highlight an important role that childhood conditions play in affecting the onset of arthritis in late life in China. Health-care providers may consider childhood conditions as a valuable screening criterion to identify risk populations, which could be used to guide health promotion and prevention programmes, and promote healthy ageing.

Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017

Background

Low back pain (LBP) is a common musculoskeletal problem globally. Updating the prevalence and burden of LBP is important for researchers and policy makers. This paper presents, compares and contextualizes the global prevalence and years lived with disability (YLDs) of LBP by age, sex and region, from 1990 to 2017.

Methods

Data were extracted from the GBD (the Global Burden of Disease, Injuries, and Risk Factors Study) 2017 Study. Age, sex and region-specific analyses were conducted to estimate the global prevalence and YLDs of LBP, with the uncertainty intervals (UIs).

Results

The age-standardized point prevalence of LBP was 8.20% (95% UI: 7.31–9.10%) in 1990 and decreased slightly to 7.50% (95% UI: 6.75–8.27%) in 2017. The prevalent numbers of people with LBP at any one point in time in 1990 was 377.5 million, and this increased to 577.0 million in 2017. Age-standardized prevalence of LBP was higher in females than males. LBP prevalence increased with age, and peaked around the ages of 80 to 89 years, and then decreased slightly. Global YLDs were 42.5 million (95% UI: 30.2 million–57.2 million) in 1990 and increased by 52.7% to 64.9 million (95% UI: 46.5 million–87.4 million) in 2017. YLDs were also higher in females than males and increased initially with age; they peaked at 35–39 years of age in 1990, before decreasing, whereas in 2017, they peaked at 45–49 years of age, before decreasing. Western Europe had the highest number of LBP YLDs.

Conclusions

Globally, LBP is the leading global cause of YLDs. Greater attention is urgently needed to mitigate this increasing burden and the impact it is having on health and social systems.

Role of Metabolic Stress and Exercise in Regulating Fibro/Adipogenic Progenitors

Obesity is a major public health concern and is associated with decreased muscle quality (i.e., strength, metabolism). Muscle from obese adults is characterized by increases in fatty, fibrotic tissue that decreases the force producing capacity of muscle and impairs glucose disposal. Fibro/adipogenic progenitors (FAPs) are muscle resident, multipotent stromal cells that are responsible for muscle fibro/fatty tissue accumulation. Additionally, they are indirectly involved in muscle adaptation through their promotion of myogenic (muscle-forming) satellite cell proliferation and differentiation. In conditions similar to obesity that are characterized by chronic muscle degeneration, FAP dysfunction has been shown to be responsible for increased fibro/fatty tissue accumulation in skeletal muscle, and impaired satellite cell function. The role of metabolic stress in regulating FAP differentiation and paracrine function in skeletal muscle is just beginning to be unraveled. Thus, the present review aims to summarize the recent literature on the role of metabolic stress in regulating FAP differentiation and paracrine function in skeletal muscle, and the mechanisms responsible for these effects. Furthermore, we will review the role of physical activity in reversing or ameliorating the detrimental effects of obesity on FAP function.

Functional Measures of Sarcopenia: Prevalence, and Associations with Functional Disability in 10,892 Adults Aged 65 Years and Over from Six Lower- and Middle-Income Countries

Identification of sarcopenia in lower- and middle-income countries (LMICs) is limited by access to technologies that assess muscle mass. We investigated associations between two functional measures of sarcopenia, grip strength and gait speed (GS), with functional disability in adults from six LMICs. Data were extracted from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007-2010) for adults (≥ 65 years) from China, Mexico, Ghana, India, Russia and South Africa (n = 10,892, 52.8% women). We calculated country-specific prevalence of low grip strength, slow GS (≤ 0.8 m/s), and both measures combined. Using multivariable negative binomial regression, we separately assessed associations between low grip strength, slow GS, and both measures combined, with the WHO Disability Assessment Schedule 2.0, accounting for selected socioeconomic factors. In women, low grip strength ranged from 7 in South Africa to 51% in India; in men, it ranged from 17 in Russia to 51% in Mexico. Country-specific proportions of slow GS ranged from 77 in Russia, to 33% in China. The concomitant presence of both was the lowest in South Africa and the highest in India (12.3% vs. 33%). Independent of age, those with both low grip strength and slow GS had between 1.2- and 1.5-fold worse functional disability scores, independent of comorbidities, low education, and low wealth (all country-dependent). Low grip strength, slow GS, and the combination of both, were all associated with higher levels of functional disability, thus indicating these objective measures offer a reasonably robust estimate for potential poor health outcomes.

A case-control study of musculoskeletal impairment: association with socio-economic status, time use and quality of life in post-conflict Myanmar

Background

Musculoskeletal impairments (MSI) are a major global contributor to disability. Evidence suggests entrenched cyclical links between disability and poverty, although few data are available on the link of poverty with MSI specifically. More data are needed on the association of MSI with functioning, socio-economic status and quality of life, particularly in resource-poor settings where MSI is common.

Methods

We undertook a case-control study of the association between MSI and poverty, time use and quality of life in post-conflict Myanmar. Cases were recruited from two physical rehabilitation service-centres, prior to the receipt of any services. One age- (+/− 5 years of case’s age) and sex- matched control was recruited per case, from their home community. 108 cases and 104 controls were recruited between July – December 2015. Cases and controls underwent in-depth structured interviews and functional performance tests at multiple time points over a twelve-month period. The baseline characteristics of cases and controls are reported in this manuscript, using multivariate logistic regression analysis and various tests of association.

Results

89% of cases were male, 93% were lower limb amputees, and the vast majority had acquired MSI in adulthood. 69% were not working compared with 6% of controls (Odds Ratio 27.4, 95% Confidence Interval 10.6–70.7). Overall income, expenditure and assets were similar between cases and controls, with three-quarters of both living below the international LMIC poverty line. However, cases’ health expenditure was significantly higher than controls’ and associated with catastrophic health expenditure and an income gap for one fifth and two thirds of cases respectively. Quality of life scores were lower for cases than controls overall and in each sub-category of quality of life, and cases were far less likely to have participated in productive work the previous day than controls.

Conclusion

Adults with MSI in Myanmar who are not in receipt of rehabilitative services may be at increased risk of poverty and lower quality of life in relation to increased health needs and limited opportunities to participate in productive work. This study highlights the need for more comprehensive and appropriate support to persons with physical impairments in Myanmar.

Guggulipid ameliorates adjuvant-induced arthritis and liver oxidative damage by suppressing inflammatory and oxidative stress mediators

BACKGROUND

Arthritis is a common degenerative joint disease characterized by deterioration of articular cartilage, subchondral bone, and associated with immobility, pain and inflammation. The incessant action of reactive oxygen species (ROS) during progressive arthritis causes severe oxidative damage to vital organs and circulatory system.

PURPOSE

In this study we investigated the ability of guggulipid (GL), a lipid rich extract from the gum resin of the plant Commiphora whighitii to suppress the progressive arthritis and associated liver oxidative stress both in vivo and in vitro.

STUDY DESIGN/METHODS

The anti-arthritic ability of GL was demonstrated in vitro using IL-1β stimulated bovine nasal cartilage model and in vivo Freund's complete adjuvant-induced arthritic rat model. Collagen/proteoglycan degradation and pro-inflammatory mediators were monitored in the harvested culture medium of nasal cartilage by estimating the levels of matrix metalloproteinases (MMPs), hydroxy proline, glycosaminoglycans and inflammatory mediators. Further, anti-arthritic ability of GL was evaluated in vivo by measuring enzymatic and non-enzymatic mediators of cartilage degradation, inflammation and oxidative stress markers.

RESULTS

GL significantly inhibited the IL-1β stimulated cartilage degradation in vitro by mitigating the MMPs activity, collagen degradation and secretion of pro-inflammatory mediators. Further, GL significantly reduced the adjuvant-induced paw swelling and body weight loss in vivo. GL remarkably reduced the MMPs and hyaluronidases activities in serum and bone homogenate along with altered hematological parameters. GL also mitigated the elevated bone resorbing enzymes cathepsins, exoglycosidases and phosphatases. Additionally, GL effectively mitigated ROS and oxidative stress-mediators recuperating the altered serum/liver oxidative stress and liver damage incurred during arthritic progression.

CONCLUSION

In summary, the study clearly demonstrates the protective efficacy of GL against arthritis and its associated oxidative stress, particularly, liver oxidative damage. Hence, GL could be a potential alternative and complementary medicine to treat inflammatory joint diseases.

Musculoskeletal Injuries and Outcomes Pre- and Post- Emergency Medicine Training Program

Introduction

Musculoskeletal injuries (MSI) comprise a large portion of the trauma burden in low- and middle-income countries (LMIC). Rwanda recently launched its first emergency medicine training program (EMTP) at the University Teaching Hospital-Kigali (UTH-K), which may help to treat such injuries; yet no current epidemiological data is available on MSI in Rwanda.

Methods

We conducted this pre-post study during two data collection periods at the UTH-K from November 2012 to July 2016. Data collection for MSI is limited and thus is specific to fractures. We included all patients with open, closed, or mixed fractures, hereafter referred to as MSI. Gathered information included demographics and outcomes including death, traumatic complications, and length of hospital stay, before and after the implementation of the EMTP.

Results

We collected data from 3609 patients. Of those records, 691 patients were treated for fractures, and 674 of them had sufficient EMTP data measured for inclusion in the analysis of results (279 from pre-EMTP and 375 from post-EMTP). Patient demographics demonstrate that a majority of MSI cases are male (71.6% male vs 28.4% female) and young (64.3% below 35 years of age). Among mechanisms of injury, major causes included road traffic accidents (48.1%), falls (34.2%), and assault (6.0%). There was also an observed association between EMTP and trends of the three primary outcomes: a reduction of death in the emergency department (ED) from those with MSI by 89.9%, from 2.51% to 0.25% (p = 0.0077); a reduction in traumatic complications for MSI patients by 71.7%, from 3.58% to 1.01% (p = 0.0211); and a reduction in duration of stay in the ED among those with MSI by 52.7% or 2.81 days on average, from 5.33 to 2.52 days (p = 0.0437).

Conclusion

This study reveals the current epidemiology of MSI morbidity and mortality for a major Rwandan teaching hospital and the potential impacts of EM training implementation among those with MSI. Residency training programs such as EMTP appear capable of reducing mortality, complications, and ED length of stay among those with MSI caused by fractures. Such findings underscore the efficacy and importance of investments in educating the next generation of health professionals to combat prevalent MSI within their communities.

Integrated prevention and management of non-communicable diseases, including musculoskeletal health: a systematic policy analysis among OECD countries

Introduction

Development and implementation of appropriate health policy is essential to address the rising global burden of non-communicable diseases (NCDs). The aim of this study was to evaluate existing health policies for integrated prevention/management of NCDs among Member States of the Organisation for Economic Co-operation and Development (OECD). We sought to describe policies' aims and strategies to achieve those aims, and evaluate extent of integration of musculoskeletal conditions as a leading cause of global morbidity.

Methods

Policies submitted by OECD Member States in response to a World Health Organization (WHO) NCD Capacity Survey were extracted from the WHO document clearing-house and analysed following a standard protocol. Policies were eligible for inclusion when they described an integrated approach to prevention/management of NCDs. Internal validity was evaluated using a standard instrument (sum score: 0-14; higher scores indicate better quality). Quantitative data were expressed as frequencies, while text data were content-analysed and meta-synthesised using standardised methods.

Results

After removal of duplicates and screening, 44 policies from 30 OECD Member States were included. Three key themes emerged to describe the general aims of included policies: system strengthening approaches; improved service delivery; and better population health. Whereas the policies of most countries covered cancer (83.3%), cardiovascular disease (76.6%), diabetes/endocrine disorders (76.6%), respiratory conditions (63.3%) and mental health conditions (63.3%), only half the countries included musculoskeletal health and pain (50.0%) as explicit foci. General strategies were outlined in 42 (95.5%) policies-all were relevant to musculoskeletal health in 12 policies, some relevant in 27 policies and none relevant in three policies. Three key themes described the strategies: general principles for people-centred NCD prevention/management; enhanced service delivery; and system strengthening approaches. Internal validity sum scores ranged from 0 to 13; mean: 7.6 (95% CI 6.5 to 8.7).

Conclusion

Relative to other NCDs, musculoskeletal health did not feature as prominently, although many general prevention/management strategies were relevant to musculoskeletal health improvement.

Prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: A systematic review

BACKGROUND

Prognosis of acute idiopathic neck pain is poor. An overview of modifiable and non-modifiable prognostic factors for the development of chronic musculoskeletal neck pain after an episode of idiopathic, non-traumatic neck pain is needed.

OBJECTIVE

Identify prognostic factors for pain intensity and perceived non-recovery at three, six and 12 months after a first episode of idiopathic, non-traumatic neck pain.

STUDY DESIGN

Systematic review METHODS: Systematic literature search up to October 21, 2017 for prospective prognostic studies with main outcomes perceived non-recovery and pain intensity. The QUIPS was used for quality assessment.

RESULTS

Out of 2737 screened articles six prospective studies with high-risk-of-bias were identified, analyzing 47 and 43 factors for the outcome variables 'pain intensity' and 'perceived non-recovery', respectively. Based on univariate- and multivariate analyses we found moderate evidence for 'age> 40 years' and 'concomitant back pain' to be prognostic for 'pain intensity'. For the outcome 'perceived non-recovery' at 12 months, we found moderate evidence for both 'a previous period of neck pain' and 'accompanying headache' as prognostic variables for persistent pain, based on univariate analysis. No prognostic factor was found which was retained in more than one multivariate analysis for the outcome variable 'perceived non-recovery'. However, the quality of the evidence for these prognostic factors was low to very low.

CONCLUSION

This review identifies prognostic factors for neck pain, of which only a few are modifiable. Further research is needed before drawing definite conclusions about the prognostic value of these factors.