Musculoskeletal comorbidities in cardiovascular disease, diabetes and respiratory disease: the impact on activity limitations; a representative population-based study

Antinociceptive Analysis of Natural Monoterpenes Eugenol, Menthol, Carvacrol and Thymol in a Zebrafish Larval Model

In the last decade, a considerable number of studies have broadened our knowledge of the nociceptive mechanisms of pain, a global health problem in both humans and animals. The use of herbal compounds such as eugenol, menthol, thymol, and carvacrol as analgesic agents has accompanied the growing interest in this area, offering a possible solution for this complex problem. Here, we aimed to explore how these natural substances-at three different concentrations (2, 5 and 10 mg/L)-affect the pain responses in zebrafish (Danio rerio) larvae exposed to 0.05% acetic acid (AA) for 1 min. By analysing the activity of acetylcholinesterase (AChE), 5'-ectonucleotidase and NTPDases, as well as aversion and exploratory behaviours, it was observed that that although all substances were effective in counteracting the pain stimulus, the concentration range within which they do so might be very limited. Eugenol, despite its acknowledged properties in fish anaesthesia, failed to alleviate the pain stimulus at low concentrations. Contrastingly, menthol exhibited the most promising results at the lowest concentrations tested. Overall, it is concluded that menthol might be a good analgesic for this species, qualifying it as a substance of interest for prospective studies.

Pulmonary Diseases in Older Patients: Understanding and Addressing the Challenges

As the global population ages, pulmonary diseases among older people have emerged as a significant and growing public health concern. The increasing incidence of these conditions has led to higher rates of morbidity and mortality among older adults. This perspective study offers a thorough overview of the prevalent pulmonary diseases affecting the elderly demographic. It delves into the challenges encountered during the diagnosis and management of these conditions in older individuals, considering factors such as comorbidities, functional limitations, and medication complexities. Furthermore, innovative strategies and personalized interventions such as precision medicine, advanced therapies, telemedicine solutions, and patient-centered support systems aimed at enhancing the care provided to older individuals grappling with pulmonary disorders are thoroughly explored. By addressing the unique needs and complexities of this vulnerable population, healthcare systems can strive towards improving outcomes and enhancing the quality of life for elderly individuals affected by pulmonary diseases.

Preventative and therapeutic potential of tocotrienols on musculoskeletal diseases in ageing

Musculoskeletal health is paramount in an ageing population susceptible to conditions such as osteoporosis, arthritis and fractures. Age-related changes in bone, muscle, and joint function result in declining musculoskeletal health, reduced mobility, increased risk of falls, and persistent discomfort. Preserving musculoskeletal wellbeing is essential for maintaining independence and enhancing the overall quality of life for the elderly. The global burden of musculoskeletal disorders is significant, impacting 1.71 billion individuals worldwide, with age-related muscle atrophy being a well-established phenomenon. Tocotrienols, a unique type of vitamin E found in various sources, demonstrate exceptional antioxidant capabilities compared to tocopherols. This characteristic positions them as promising candidates for addressing musculoskeletal challenges, particularly in mitigating inflammation and oxidative stress underlying musculoskeletal disorders. This review paper comprehensively examines existing research into the preventive and therapeutic potential of tocotrienols in addressing age-related musculoskeletal issues. It sheds light on the promising role of tocotrienols in enhancing musculoskeletal health and overall wellbeing, emphasizing their significance within the broader context of age-related health concerns.

Investigation of Biopsychosocial Status, Fatigue, Sleep Quality, Alexithymia, Cognitive Functions, and Quality of Life in Behçet's Disease

Objective

The aim of this study was to compare the effects of Behçet's disease in terms of anxiety, biopsychosocial status, fatigue, sleep quality, alexithymia, cognitive level, and quality of life according to major and minor organ involvement.

Methods

The study was planned as a single-centre cohort study. Fifty patients diagnosed with Behçet's (mean age 43±11.96 years) were included in the study. The patients were divided into two groups as major organ involvement (uveitis, neuro-Behçet's, or vascular type Behçet's disease) and minor organ involvement (mucocutaneous type Behçet's disease). Biopsychosocial status was evaluated with Biopsychosocial Questionnaire (BETY-BQ), anxiety with Beck Anxiety Inventory (BAI), fatigue with Multidimensional Assessment of Fatigue (MAF) Scale, sleep quality with Pittsburgh Sleep Quality Index (PSQI), alexithymia with Toronto Alexithymia Scale-20 (TAS-20), cognition level with Mini-Mental State Examination (MMSE), and quality of life with Short Form-36 (SF-36).

Results

In the comparison according to minor and major organ involvement, there was no significant difference between the groups in BETY-BQ, BAI, MAF, PSQI, TAS-20, MMSE and SF-36 (p>0.05).

Conclusion

Behçet's disease negatively effects in parameters such as biopsychosocial status, fatigue, sleep quality, alexithymia and quality of life. The presence of major or minor organ involvement in the patients did not change these negative effects.

A systematic review of genome-wide association studies for pain, nociception, neuropathy, and pain treatment responses

ABSTRACT

Pain is the leading cause of disability worldwide, imposing an enormous burden on personal health and society. Pain is a multifactorial and multidimensional problem. Currently, there is (some) evidence that genetic factors could partially explain individual susceptibility to pain and interpersonal differences in pain treatment response. To better understand the underlying genetic mechanisms of pain, we systematically reviewed and summarized genome-wide association studies (GWASes) investigating the associations between genetic variants and pain/pain-related phenotypes in humans. We reviewed 57 full-text articles and identified 30 loci reported in more than 1 study. To check whether genes described in this review are associated with (other) pain phenotypes, we searched 2 pain genetic databases, Human Pain Genetics Database and Mouse Pain Genetics Database. Six GWAS-identified genes/loci were also reported in those databases, mainly involved in neurological functions and inflammation. These findings demonstrate an important contribution of genetic factors to the risk of pain and pain-related phenotypes. However, replication studies with consistent phenotype definitions and sufficient statistical power are required to validate these pain-associated genes further. Our review also highlights the need for bioinformatic tools to elucidate the function of identified genes/loci. We believe that a better understanding of the genetic background of pain will shed light on the underlying biological mechanisms of pain and benefit patients by improving the clinical management of pain.

Intervertebral disc degeneration and osteoarthritis: a common molecular disease spectrum

Intervertebral disc degeneration (IDD) and osteoarthritis (OA) affecting the facet joint of the spine are biomechanically interdependent, typically occur in tandem, and have considerable epidemiological and pathophysiological overlap. Historically, the distinctions between these degenerative diseases have been emphasized. Therefore, research in the two fields often occurs independently without adequate consideration of the co-dependence of the two sites, which reside within the same functional spinal unit. Emerging evidence from animal models of spine degeneration highlight the interdependence of IDD and facet joint OA, warranting a review of the parallels between these two degenerative phenomena for the benefit of both clinicians and research scientists. This Review discusses the pathophysiological aspects of IDD and OA, with an emphasis on tissue, cellular and molecular pathways of degeneration. Although the intervertebral disc and synovial facet joint are biologically distinct structures that are amenable to reductive scientific consideration, substantial overlap exists between the molecular pathways and processes of degeneration (including cartilage destruction, extracellular matrix degeneration and osteophyte formation) that occur at these sites. Thus, researchers, clinicians, advocates and policy-makers should consider viewing the burden and management of spinal degeneration holistically as part of the OA disease continuum.

Musculoskeletal education in undergraduate medical curricula-A systematic review

Rheumatic and musculoskeletal diseases encompass a vast spectrum of up to 200 conditions that are increasingly prevalent, with significant associated disability and socioeconomic burden. Their impact is pervasive, with musculoskeletal conditions being the second leading cause of years lived with disability worldwide, in addition to the 9th most common cause of disability-adjusted life years. It is therefore imperative that all graduating medical physicians are competent in their management, and that the quality of undergraduate musculoskeletal education is commensurate with patient and societal needs. A systematic literature review was conducted between April 1, 2021 and June 1, 2021 assessing the quality of undergraduate musculoskeletal education in medical schools. Educational interventions in musculoskeletal medicine were also included. Quality assessment appraisal of the studies was done using a Mixed Methods Appraisal Tool. One thousand and thirty-three titles were screened, and 44 studies were included in the final analysis. Our analysis of these studies showed that the quality of undergraduate musculoskeletal education, as determined by the cognitive mastery and clinical confidence of undergraduate medical students remains inadequate. Multiple educational interventions were assessed with mixed results. Despite the prevalence, and burden associated with rheumatic and musculoskeletal diseases, the musculoskeletal education of undergraduate medical students remains inadequate. Urgent international collaboration is required to devise teaching strategies and curriculum initiatives that are globally and reproducibly applicable and effective. Further research into educational interventions and teaching strategies is also required.

Association of musculoskeletal pain with the achievement of treatment targets for type 2 diabetes among primary care patients

AIMS

To assess the association of diagnosed musculoskeletal (MS) pain (low back, neck, shoulder, and knee pain; and the number of pain sites) with the achievement of targets for glycosylated haemoglobin A1c (HbA1c), low-density-lipoprotein cholesterol (LDL), and systolic blood pressure (SBP) among primary care patients with type 2 diabetes (T2D).

METHODS

The cross-sectional study population consisted of 3478 patients with a registry-based T2D diagnosis and available registry-based data on MS pain diagnoses, covariates, and outcomes between 2016 and 2019. Logistic regression analysis was used to evaluate the study aims.

RESULTS

Overall, 22% had at least one of the four types of MS pain, and 73%, 57%, and 51% achieved the treatment targets of HbA1c, LDL, and SBP, respectively. T2D patients with or without MS pain did not differ in their achievement of T2D treatment goals. Of pain locations, low back pain was associated with higher rates of achievement of the LDL target (OR 1.29, 95% CI 1.01-1.65), but the association was attenuated in the adjusted model.

CONCLUSIONS

MS pain was relatively prevalent among primary care patients with T2D, but did not influence the achievement of T2D treatment goals.

A Study on the Correlations between Musculoskeletal Disorders and Work-Related Psychosocial Factors among Nursing Aides in Long-Term Care Facilities

BACKGROUND

Among the nursing aides employed at long-term care facilities (LTCFs), those with musculoskeletal disorders (MSDs) are most likely to experience disability or develop an intention to leave. The purpose of this study was to investigate the association of work-related psychological factors among nursing aides in LTCFs with MSDs in Taiwan.

METHODS

Purposive sampling was used in this cross-sectional study to enrol 308 nursing aides from residential LTCFs in Taiwan as research subjects. A demographic and job background survey, a job content questionnaire (JCQ), and the Nordic musculoskeletal questionnaire (NMQ) were used to collect data.

RESULTS

Lower job control associated with higher psychological job demands, and lower social support was associated with more severe MSDs for the nursing aides (p < 0.001). Among the MSDs reported by nursing aides in LTCFs, lower back pain was the most serious. In addition, nationality, age, exercise habits, chronic diseases, worksite, lack of rest time, lack of assistive devices, low coworker support, and high psychological job demands were significant factors affecting MSDs. In total, 42.1% of the variance in MSDs among nursing aides in LTCFs was explained.

CONCLUSIONS

Work-related psychological factors among nursing aides in LTCFs have an important association with MSDs. For nursing aides, coworker support should be improved, and their psychological demands at work should be reduced.

Complications in the spine associated with type 2 diabetes: The role of advanced glycation end-products

Type 2 diabetes mellitus (T2D) is an increasingly prevalent disease with numerous comorbidities including many in the spine. T2D is strongly linked with vertebral fractures, intervertebral disc (IVD) degeneration, and severe chronic spinal pain. Yet the causative mechanism for these musculoskeletal impairments remains unclear. The chronic hyperglycemic state in T2D promotes the formation of advanced glycation end-products (AGEs) in tissues, and the accumulation of AGEs may play a role in musculoskeletal complications by modifying the extracellular matrix, impairing cellular homeostasis, and perpetuating an inflammatory cascade via its receptor (RAGE). The AGE and RAGE associated alterations in extracellular matrix composition and morphological features of the vertebral bodies and IVDs are likely contributors to the incidence and severity of spinal pathologies in T2D. This review will broadly examine the effects of AGEs on tissues in the spine in the context of T2D, with an emphasis on the changes in the vertebrae and the IVD. Along with the clinical and epidemiological findings, we will provide an overview of preclinical rodent models of T2D that exhibit deficits in the IVD and vertebral bone. Elucidating the role of AGEs and RAGE will be crucial for understanding the disease mechanisms and translation therapies of musculoskeletal pathologies in T2D.

A genome-wide association study finds genetic variants associated with neck or shoulder pain in UK Biobank

Background

Common types of musculoskeletal conditions include pain in the neck and shoulder areas. This study seeks to identify the genetic variants associated with neck or shoulder pain based on a genome-wide association approach using 203 309 subjects from the UK Biobank cohort and look for replication evidence from the Generation Scotland: Scottish Family Health Study (GS:SFHS) and TwinsUK.

Methods

A genome-wide association study was performed adjusting for age, sex, BMI and nine population principal components. Significant and independent genetic variants were then sent to GS:SFHS and TwinsUK for replication.

Results

We identified three genetic loci that were associated with neck or shoulder pain in the UK Biobank samples. The most significant locus was in an intergenic region in chromosome 17, rs12453010, having P = 1.66 × 10⁻¹¹. The second most significant locus was located in the FOXP2 gene in chromosome 7 with P = 2.38 × 10⁻¹⁰ for rs34291892. The third locus was located in the LINC01572 gene in chromosome 16 with P = 4.50 × 10⁻⁸ for rs62053992. In the replication stage, among four significant and independent genetic variants, rs2049604 in the FOXP2 gene and rs62053992 in the LINC01572 gene were weakly replicated in GS:SFHS (P = 0.0240 and P = 0.0202, respectively).

Conclusions

We have identified three loci associated with neck or shoulder pain in the UK Biobank cohort, two of which were weakly supported in a replication cohort. Further evidence is needed to confirm their roles in neck or shoulder pain.

The profile of older adults seeking chiropractic care: a secondary analysis

BACKGROUND

Musculoskeletal conditions are the primary reason older adults seek general medical care, resulting in older adults as the highest consumers of health care services. While there is high use of chiropractic care by older adults, there is no recent, specific data on why older adults seek chiropractic care and how chiropractors manage conditions. Therefore, the purpose of this study was to describe the demographic characteristics of older adults seeking chiropractic care, and to report problems diagnosed by chiropractors and the treatment provided to older adults who seek chiropractic care.

METHODS

A secondary data analysis from two, large cross-sectional observational studies conducted in Australia (COAST) and Canada (O-COAST). Patient encounter and diagnoses were classified using the International Classification of Primary Care, 2nd edition (ICPC-2), using the Australian ICPC-2 PLUS general practice terminology and the ICPC-2 PLUS Chiro terminology. Descriptive statistics were used to summarize chiropractor, patient and encounter characteristics. Encounter and patient characteristics were compared between younger (< 65 years old) and older (≥65 years old) adults using χ² tests or t-tests, accounting for the clustering of patients and encounters within chiropractors.

RESULTS

A total of 6781 chiropractor-adult patient encounters were recorded. Of these, 1067 encounters were for persons aged > 65 years (16%), from 897 unique older patients. The most common diagnosis within older adult encounters was a back problem (56%), followed by neck problems (10%). Soft tissue techniques were most frequently used for older patients (85 in every 100 encounters) and in 29 of every 100 encounters, chiropractors recommended exercise to older patients as a part of their treatment.

CONCLUSIONS

From 6781 chiropractor-adult patient encounters across two countries, one in seven adult chiropractic patients were > 65 years. Of these, nearly 60% presented with a back problem, with neck pain and lower limb problems the next most common presentation to chiropractors. Musculoskeletal conditions have a significant burden in terms of disability in older adults and are the most commonly treated conditions in chiropractic practice. Future research should explore the clinical course of back pain in older patients seeking chiropractic care and compare the provision of care to older adults across healthcare professions.

Distribution of Number, Location of Pain and Comorbidities, and Determinants of Work Limitations among Firefighters

INTRODUCTION

The unique demands of firefighting results in acute, recurrent, or chronic pain complications. We aimed to describe the percentage distribution of number and location of painful sites among FFs and determine whether work limitations differed based on the number or location of painful sites, age, and/or sex.

METHODS

About 325 firefighters completed a work limitation questionnaire (WLQ-26) and a checklist to indicate painful regions of the body using either a paper format or an online survey. A one-way ANOVA was employed to analyze the transformed work limitation scores; this was a two-sided test with a significance level of <0.05, to determine if work limitations differed among firefighters based on the number or location of painful sites, age, and/or sex.

RESULTS

The data analyzed consisted of 325 (men = 216, women = 109) FFs in total. The percentage distribution of the number of painful sites in our study cohort was 43% no pain, 17% one painful site, 19% two painful sites, and 21% three or more painful sites. The percentage distribution of the locations of painful sites was 43% no pain, 41% spine, 9% lower extremity, and 7% upper extremity. An estimated 31% of FFs (n = 102) reported non-MSK comorbidities with 23% (n = 76) reporting at least one non-MSK comorbidity and 8% (n = 26) reported having two or more comorbidities. FFs > 45 years of age experienced more physical work limitations than FFs ≤ 45years (mean difference: 0.74/10; 95% CI .19-1.29; p = 0.008).

CONCLUSIONS

The majority of firefighters reported having at least one painful site and indicated the spine as the most common painful location. Age, the number of painful sites, and location of pain were identified as a potential contributor to physical/mental and work output limitations.

Comorbidity phenotypes and risk of mortality in patients with ischaemic heart disease in the UK

Objectives

The objective of this study is to use latent class analysis of up to 20 comorbidities in patients with a diagnosis of ischaemic heart disease (IHD) to identify clusters of comorbidities and to examine the associations between these clusters and mortality.

Methods

Longitudinal analysis of electronic health records in the health improvement network (THIN), a UK primary care database including 92 186 men and women aged ≥18 years with IHD and a median of 2 (IQR 1–3) comorbidities.

Results

Latent class analysis revealed five clusters with half categorised as a low-burden comorbidity group. After a median follow-up of 3.2 (IQR 1.4–5.8) years, 17 645 patients died. Compared with the low-burden comorbidity group, two groups of patients with a high-burden of comorbidities had the highest adjusted HR for mortality: those with vascular and musculoskeletal conditions, HR 2.38 (95% CI 2.28 to 2.49) and those with respiratory and musculoskeletal conditions, HR 2.62 (95% CI 2.45 to 2.79). Hazards of mortality in two other groups of patients characterised by cardiometabolic and mental health comorbidities were also higher than the low-burden comorbidity group; HR 1.46 (95% CI 1.39 to 1.52) and 1.55 (95% CI 1.46 to 1.64), respectively.

Conclusions

This analysis has identified five distinct comorbidity clusters in patients with IHD that were differentially associated with risk of mortality. These analyses should be replicated in other large datasets, and this may help shape the development of future interventions or health services that take into account the impact of these comorbidity clusters.

Prevalence of Metabolic Syndrome According to Causes of Physical Activity Limitation

PURPOSE

One cause of metabolic syndrome (MetS) is inactivity. This study analyzed the prevalence of MetS due to causes of activity limitation (AL) in adults over 40 years old.

PATICIPANTS AND METHODS

Participants included 2885 people aged 40-79 (1198 men and 1687 women) who completed the Korean National Health and Nutrition Survey (KNHANES) conducted between 2013 and 2017. They were divided into two groups based on age: the middle age group (MA) included 1148 total participants, 515 men and 633 women from 40-59 years old; the older age group (OA) included 1737 total participants, 683 men and 1054 women from 60-79 years old. MetS was diagnosed according to the Third Report of the National Cholesterol Education Program and the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATP III). Logistic regression was conducted to calculate the odds ratio for MetS prevalence.

RESULTS

The prevalence of MetS in people with AL increased 1.432-fold in the MA men group, 1.511-fold in the OA men group, 1.546-fold in the MA women group, and 1.565-fold in the OA women group. There were several causes of AL; people with physical activity for diabetes mellitus and hypertension increased MetS prevalence in both sexes and all age groups: MA men group (OR=3.216, 95% CI=1.852-7.354, P=0.034), MA women group (OR=2.159, 95% CI=1.854-5.346, P=0.032), OA men group (OR=3.200, 95% CI=1.235-7.841, P=0.009), and OA women group (OR=3.444, 95% CI=1.310-6.627, P=0.008). Also, mental problems in the MA men group (OR=2.284, 95% CI=1.591-4.986, P=0.012) and OA men group (OR=1.149, 95% CI=1.017-2.941, P=0.012), and musculoskeletal problems in the MA women group (OR=1.784, 95% CI=1.102-2.902, P=0.021) and OA women group (OR=1.459, 95% CI=1.054-1.993, P=0.004) increased the prevalence.

CONCLUSION

The prevalence of MetS due to activity limitation was increased in MA and OA groups. Activity limitation increased the MetS prevalence from 1.4- to 1.5-times, Therefore, to prevent metabolic syndrome, physical activity should be increased, and guidelines should be presented according to the activity limitation causes, age, and sex.

Identification of physical and psychosocial problems based on symptoms in patients with Behçet's disease

The purpose of this study was to use the International Classification of Functioning, Disability and Health (ICF) to identify physical and psychosocial problems associated with symptoms of Behçet's disease (BD) in Japanese patients. Thirty patients with BD were interviewed in a pilot study using the "ICF Checklist", and a team of medical experts selected categories related to physical and psychosocial aspects of BD. To identify specific physical and psychosocial problems of Japanese patients with BD, 100 new patients were interviewed using the selected categories. Among the 128 categories in the original ICF Checklist, 80 categories were identified as impaired, and another 12 ICF categories were added based on expert discussion of patients input. The number of problem categories was significantly greater in patients with BD with eye involvement and fatigue (eye involvement, 25.7 categories; fatigue, 25.2 categories; both P < 0.001). Specifically, patients with eye involvement had more difficulties with problems in daily life, such as writing (odds ratio 4.2), understanding such nonverbal messages as gestures and facial expressions (13.7), moving (5.7), walking in intense sunlight and bright light (17.6), and patients with fatigue had more difficulties with climate problems such as symptoms getting worse at the turn of the seasons or on cold days (2.5), compared to those without these symptoms. This study demonstrated that support focusing not only on physical symptoms but on other aspects of life as well is necessary for patients with BD, particularly patients with eye involvement and fatigue.

Association of glucose homeostasis and metabolic syndrome with knee cartilage defects and cartilage volume in young adults

OBJECTIVE

To describe the associations of glucose homeostasis and metabolic syndrome (MetS) measures with knee cartilage defects and cartilage volume in young adults.

METHODS

Fasting blood biochemistry, waist circumference and blood pressure measures were collected 4-5 years prior to knee magnetic resonance imaging (MRI) scans. Blood measures included levels of glucose, insulin, triglyceride and high-density lipoprotein cholesterol (HDL-C). Homeostatic model assessment 2-insulin resistance (HOMA2-IR), HOMA2-beta cell function (HOMA2-β), HOMA2-insulin sensitivity (HOMA-S) and MetS were calculated or defined. Knee cartilage defects and cartilage volume were measured from MRI scans. Data were analysed using log binomial or linear regressions.

RESULTS

Among 328 participants (47.3% were females, aged 26-36 years at baseline), 40 (12.7%) had hyperglycaemia and 21 (6.7%) had MetS. Glucose homeostasis measures (except fasting glucose) were associated with tibiofemoral cartilage defects (fasting insulin: relative risk (RR) 1.05, 95% confidence interval (CI) 1.01 to 1.08; HOMA2-IR: 1.44, 1.08 to 1.92; HOMA2-β: 2.59, 1.33 to 5.07; HOMA2-S: 0.36, 0.18 to 0.72), but not patellar cartilage defects. There were no associations between glucose homeostasis measures and knee cartilage volume. High waist circumference (RR 2.32, 95% CI 1.18 to 4.54) and low HDL-C (RR 1.99, 95% CI 1.08 to 3.69) were associated with tibiofemoral cartilage defects, but no other associations were observed between MetS or its components and cartilage defects or volume.

CONCLUSION

Insulin resistance, high waist circumference and low HDL-C were associated with higher risk of tibiofemoral cartilage defects, suggesting glucose homeostasis and some MetS components may affect early cartilage damage in young adults.

Stable prevalence of chronic back disorders across gender, age, residence, and physical activity in Canadian adults from 2007 to 2014

BACKGROUND

Chronic back disorders (CBD) are a global health problem and the leading cause of years lived with disability. The present study aims to examine overall and specific trends in CBD in the Canadian population aged 18 to 65 years.

METHODS

Data from the Canadian Community Health Survey (CCHS), a cross-sectional study, from 2007 to 2014 (8 cycles) were used to calculate CBD prevalence across gender, age, geographical area (urban/rural and ten provinces and northern territories), and physical activity levels. CBD was defined in the CCHS as having back problems, excluding fibromyalgia and arthritis, which have lasted or are expected to last six months or more and that have been diagnosed by a health professional. Prevalence of CBD using survey weights and associated 95% confidence intervals (95% CI) were calculated yearly using balanced repeated replications technique. Trend tests were calculated using joinpoint regressions; ArcGIS software was used for mapping.

RESULTS

Age-standardized CBD prevalence in 2007 and 2014 were 18.9% (95% CI = 18.4;19.5) and 17.8% (95% CI = 17.2,18.4), respectively. CBD prevalence was consistently higher in women, older age groups, rural dwellers, and people classified as inactive. Crude and age-standardized CBD prevalence decreased faster in people classified as physically active compared to those who were inactive (p < 0.006). Although CBD slightly decreased over time, no statistically significant trends were found overall or by gender, area of residence, province or level of physical activity. The prevalence of CBD remained consistently high in the province of Nova Scotia, and consistently low in the province of Quebec over the eight CCHS cycles.

CONCLUSION

Despite prevention efforts, such as the Canadian back pain mass media campaign, CBD prevalence has remained stable between 2007 and 2014. Tailored prevention and management of CBD should consider gender, age, and geographical differences. Further longitudinal studies could elucidate the temporal relationship between potentially modifiable risk factors such as physical activity and CBD.

The impact of a workplace cardiovascular health screening programme 'Farmers Have Hearts' on health behaviour change among Irish farmers

BACKGROUND

Irish farmers are a high-risk group for cardiovascular disease (CVD) which imposes not only a risk to their health but has more far-reaching implications for occupational health and safety.

OBJECTIVE

This study assessed the impact of a workplace health screening and health behaviour change programme among a sub-group of male Irish farmers.

METHODS

Data were collected from male livestock farmers (n = 310) who attended health screenings at livestock marts. Participating farmers also received lifestyle advice to prompt health behaviour change. Health behaviour change was tracked by two phone questionnaires at Week 1 (n = 224) and Week 12 (n = 172). All data were entered into SPSS v22 and analysed using chi-square and regression techniques.

RESULTS

At Week 12, 48% reported having changed at least one health behaviour. The majority of farmers were referred to their GP and by Week 12, 32% had acted on this advice. Participants most in need of health behaviour change based on adverse health screening results were, paradoxically, the least likely to contemplate or engage in health behaviour change.

CONCLUSIONS

Findings demonstrate that whilst workplace health screenings can be a catalyst for behaviour change for some farmers, more follow-up supports are needed to encourage sustainable behaviour change.

Physical activity and chronic back conditions: A population-based pooled study of 60,134 adults

BACKGROUND

Little is known about the association between different types of physical activity (PA) and chronic back conditions (CBCs) at the population level. We investigated the association between levels of total and type-specific PA participation and CBCs.

METHODS

The sample comprised 60,134 adults aged ≥16 years who participated in the Health Survey for England and Scottish Health Survey from 1994 to 2008. Multiple logistic regression models, adjusted for potential confounders, were used to examine the association between total and type-specific PA volume (walking, domestic activity, sport/exercise, cycling, football/rugby, running/jogging, manual work, and housework) and the prevalence of CBCs.

RESULTS

We found an inverse association between total PA volume and prevalence of CBCs. Compared with inactive participants, the fully adjusted odds ratio (OR) for very active participants (≥15 metabolic equivalent h/week) was 0.77 (95% confidence interval (CI): 0.69-0.85). Participants reporting ≥300 min/week of moderate-intensity activity and ≥75 min/week of vigorous-intensity activity had 24% (95%CI: 6%-39%) and 21% (95%CI: 11%-30%) lower odds of CBCs, respectively. Higher odds of CBCs were observed for participation in high-level manual domestic activity (OR = 1.22; 95%CI: 1.00-1.48). Sport/exercise was associated with CBCs in a less consistent manner (e.g., OR = 1.18 (95%CI: 1.06-1.32) for low levels and OR = 0.82 (95%CI: 0.72-0.93) for high levels of sport/exercise).

CONCLUSION

PA volume is inversely associated with the prevalence of CBCs.

Strategies for optimising musculoskeletal health in the 21st century

We live in a world with an ever-increasing ageing population. Studying healthy ageing and reducing the socioeconomic impact of age-related diseases is a key research priority for the industrialised and developing countries, along with a better mechanistic understanding of the physiology and pathophysiology of ageing that occurs in a number of age-related musculoskeletal disorders. Arthritis and musculoskeletal disorders constitute a major cause of disability and morbidity globally and result in enormous costs for our health and social-care systems.By gaining a better understanding of healthy musculoskeletal ageing and the risk factors associated with premature ageing and senescence, we can provide better care and develop new and better-targeted therapies for common musculoskeletal disorders. This review is the outcome of a two-day multidisciplinary, international workshop sponsored by the Institute of Advanced Studies entitled "Musculoskeletal Health in the 21st Century" and held at the University of Surrey from 30th June-1st July 2015.The aim of this narrative review is to summarise current knowledge of musculoskeletal health, ageing and disease and highlight strategies for prevention and reducing the impact of common musculoskeletal diseases.

Is there an association between diabetes and neck and back pain? A systematic review with meta-analyses

Background and objective

Approximately half of the population will experience either low back pain or neck pain, at some point in their lives. Previous studies suggest that people with diabetes are more likely to present with chronic somatic pain, including shoulder, knee and spinal pain. This study aimed to systematically review and appraise the literature to explore the magnitude as well as the nature of the association between diabetes and back, neck, or spinal (back and neck) pain.

Databases and data treatment

A systematic search was performed using the Medline, CINAHL, EMBASE, and Web of Science electronic databases. Studies which assessed the association between diabetes and back or neck pain outcomes, in participants older than 18 years of age were included. Two independent reviewers extracted data on the incidence of pain and reported associations.

Results

Eight studies were included in the meta-analyses. Meta-analyses showed that people with diabetes are more likely to report low back pain [5 studies; n: 131,431; odds ratio (OR): 1.35; 95% Confidence Interval (CI): 1.20 to 1.52; p<0.001] and neck pain (2 studies; n: 6,560; OR: 1.24; 95% CI: 1.05 to 1.47; p = 0.01) compared to those without diabetes. Results from one longitudinal cohort study suggested that diabetes is not associated with the risk of developing future neck, low back or spinal pain.

Conclusions

Diabetes is associated with low back and neck individually, and spinal pain. The longitudinal analysis showed no association between the conditions. Our results suggest that diabetes co-exists with back pain; however, a direct causal link between diabetes and back pain was not established.

Systematic review registration

PROSPERO registration CRD42016050738.

The prevalence of disability among people with cancer, cardiovascular disease, chronic respiratory disease and/or diabetes: a systematic review

BACKGROUND

Cardiovascular disease (CVD), cancer, diabetes and chronic respiratory disease are noncommunicable diseases (NCDs) that cause extensive social and economic burden worldwide, particularly in low-income and middle-income countries. There is growing recognition of the importance of the disabilities that individuals experience as a consequence of these NCDs.

OBJECTIVES

This systematic review examined the prevalence of disabilities associated with cancer, CVD, chronic respiratory disease and diabetes.

METHODS

A comprehensive literature search was conducted in PubMed, CINAHL, Embase, Web of Science, PsycINFO, CIRRIE, WHO database, LILACS and AIM. Studies were included if their samples were representative of people with at least one of these four conditions and if prevalence estimates of disability were provided. As random sampling was not feasible in the majority of cases, studies were included where they offered evidence that their sample was representative of the general population being investigated.

RESULTS

A total of 105 articles were included in the review. Most studies were conducted in high-income countries. The prevalence of difficulties with activities of daily living (i.e. eating, bathing, dressing) was reported to be 10.4-34.5% amongst cancer survivors, 21.1-64.1% in those with CVD, 7.4-49.8% in those with chronic respiratory disease and 12.2-54.5% for those with diabetes. The prevalence of a range of other physical, cognitive and psychological impairments (systemic or structural) was additionally described for each disease.

CONCLUSION

Substantial proportions of people with cancer, CVD, chronic respiratory disease or diabetes experience some form of disability - although there was great variance in prevalence and definitions. The findings of this review support the evidence base of global impact associated with NCD, indicate frequency measures for specific disabilities and inabilities associated with each NCD and provide direction for future systematic reviews.

WHAT IS KNOWN ABOUT THE TOPIC

WHAT THIS ARTICLE ADDS.

The Global Burden of Musculoskeletal Pain-Where to From Here?

To summarize the current understanding of the global burden of musculoskeletal pain-related conditions, consider the process of evidence generation and the steps to generate global pain estimates, identify key gaps in our understanding, and propose an agenda to address these gaps, we performed a narrative review. In the 2010 Global Burden of Disease Study (GBD), which broadened the scope of musculoskeletal conditions that were included over previous rounds, low back pain imposed the highest disability burden of all specific conditions assessed, and subsequent GBD reports further reinforce the size of this burden. Over the past decade, the GBD has produced compelling evidence of the leading contribution of musculoskeletal pain conditions to the global burden of disability, but this has not translated into global health policy initiatives. However, system- and service-level responses to the disease burden persist across high-, middle-, and low-income settings. There is a mismatch between the burden of musculoskeletal pain conditions and appropriate health policy response and planning internationally that can be addressed with an integrated research and policy agenda.

Differences in All-Cause Health Care Utilization and Costs in a Type 2 Diabetes Mellitus Population with and Without a History of Cardiovascular Disease

BACKGROUND

Multiple studies have reported that type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular diseases (CVD), and presence of T2DM and CVD increases risk of death. There is growing interest in examining the effects of antidiabetic treatments on the reduction of cardiovascular events in T2DM adults with a history of CVD and thus at higher risk of cardiovascular events.

OBJECTIVE

To estimate the incremental all-cause health care utilization and costs among adults with T2DM and a history of CVD compared with adults without a history of CVD, using a national linked electronic medical records (EMR) and claims database.

METHODS

Adults aged ≥ 18 years with evidence of at least 1 T2DM-related diagnosis code or antidiabetic medication (date of earliest occurrence was defined as the index date) in calendar year 2012 were identified. The population was divided into 2 cohorts (with and without a history of CVD) and followed until the end of their enrollment coverage, death, or 12 months, whichever came first. Multivariable generalized linear models were used to assess differences in health care utilization and per patient per month (PPPM) total costs (plan- and patient-paid amount for health care services) between the 2 groups during the post-index year, while adjusting for an a priori list of demographic and clinical characteristics.

RESULTS

A total of 138,018 adults with T2DM was identified, of which 16,547 (12%) had a history of CVD. The unadjusted resource utilization (outpatient: 27.5 vs. 17.8; emergency room [ER]: 0.8 vs. 0.4; inpatient: 0.4 vs. 0.2 days; and total unique drug prescriptions: 10.1 vs. 8.3) and PPPM total health care costs ($2,655.1 vs. $1,435.0) were significantly higher in T2DM adults with a history of CVD versus T2DM adults without a history of CVD. The adjusted models revealed that T2DM adults with a history of CVD had a 31% higher number of ER visits (rate ratio [RR] = 1.31, 95% CI = 1.25-1.37); 27% more inpatient visits (RR = 1.27, 95% CI = 1.21-1.34); 15% longer mean inpatient length of stay (RR = 1.15, 95% CI = 1.06-1.25); and 11% more outpatient visits (RR = 1.11, 95% CI = 1.09-1.13) compared with T2DM adults without a history of CVD. Furthermore, the difference in total PPPM health care cost was found to be 16% ($200) higher in adults with a history of CVD (RR = 1.16, 95% CI = 1.13-1.19). PPPM costs associated with outpatient and ER visits were approximately 21% and 19% higher among adults with a history of CVD, respectively (P < 0.0001), while costs for inpatient visits were similar between the 2 groups. In addition, a subgroup analysis revealed that adjusted differences in PPPM total cost was larger in the younger age group (56% higher cost in those aged < 45 years) and diminished in the older age group (only 2% higher in those aged ≥ 65 years).

CONCLUSIONS

Study findings showed that resource utilization and costs remains significantly higher in T2DM patients with a history of CVD compared with patients without a history of CVD even after controlling for significant patient comorbid and demographic characteristics. Also, younger age groups had higher differences in outcomes compared with older age groups. This study underscores the importance of cost-effective interventions that may reduce economic burden in this T2DM population with a history of CVD.

DISCLOSURES

This study was funded by Boehringer Ingelheim. At the time of this study, Mehta and Mountford were employed by IQVIA, which received funding from Boehringer Ingelheim to conduct this study. Mountford is employed by Allergan, which has no connection with this study. Ghosh, Sander, and Kuti are employed by Boehringer Ingelheim. Study concept and design were contributed by Mountford, Mehta, and Ghosh, along with Sander and Kuti. Mountford and Mehta collected the data, and data interpretation was performed by all the authors. The manuscript was written by Sander and Kuti, along with the other authors, and revised by Mehta and Gosh, along with the other authors.

The population impact of rheumatic and musculoskeletal diseases in relation to other non-communicable disorders: comparing two estimation approaches

The aim of this study was to quantify the population impact of rheumatic and musculoskeletal diseases (RMDs) with other non-communicable diseases (NCDs), using two complementary strategies: standard multivariate models based on global burden of disease (GBD)-defined groups vs. empirical mutually exclusive patterns of NCDs. We used cross-sectional data from the Portuguese Fourth National Health Survey (n = 23,752). Six GBD-defined groups were included: RMDs, chronic obstructive pulmonary disease or asthma, cancer, depression, diabetes or renal failure, and stroke or myocardial infarction. The empirical approach comprised the patterns "low disease probability", "cardiometabolic conditions", "respiratory conditions" and "RMDs and depression". As recommended by the outcome measures in rheumatology (OMERACT) initiative, health outcomes included life impact, pathophysiological manifestations, and resource use indicators. Population attributable fractions (PAF) were computed for each outcome and bootstrap confidence intervals (95% CI) were estimated. Among GBD-defined groups, RMDs had the highest impact across all the adverse health outcomes, from frequent healthcare utilization (PAF 7.8%, 95% CI 6.2-9.3) to negative self-rated health (PAF 18.1%, 95% CI 15.4-20.6). In the empirical approach, patterns "cardiometabolic conditions" and "RMDs and depression" had similar PAF estimates across all adverse health outcomes, but "RMDs and depression" showed significantly higher impact on chronic pain (PAF 8.9%, 95% CI 7.6-10.3) than the remaining multimorbidity patterns. RMDs revealed the greatest population impact across all adverse health outcomes tested, using both approaches. Empirical patterns are particularly interesting to evaluate the impact of RMDs in the context of their co-occurrence with other NCDs.

The role of thermal balneotherapy in the treatment of obese patient with knee osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis clinically characterized by joint pain, functional limitation, and reduced quality of life. Several studies have shown a clear link between obesity and higher risk of knee OA. According to the multifactorial OA pathogenesis, the management of this condition requires a multidisciplinary approach. The objective of this study is to evaluate hydrokinesitherapy effects in thermal setting in obese patients with knee OA. Fifty-three patients were assessed for eligibility, of which 33 refused the treatment, while 10 patients dropped out after the enrollment for personal reasons or inability to adhere to the program. Ten patients (8 females, 2 males, mean age of 59.4 years) with obesity (range BMI 30-45 kg/m2) and knee OA (II-III grade of Kellgren-Lawrence scale) treated with hydrokinetic therapy in thermal water (two sessions per week for 8 consecutive weeks) completed the study. Primary outcome measure was pain (VAS). Secondary outcomes were clinical knee evaluation (range of motion-ROM, lower-limb muscle strength), WOMAC, and Lequesne Algofunctional Index. Patellar tendon and peri-articular soft tissue ultrasound evaluation and gait analysis at baseline (T0), at the end of treatment (T1), and at 6 months of follow-up (T2) were performed. Significant decrease on VAS pain during walking on a flat surface and going up/down stairs was reached from baseline at T1 (p = 0.0039; p = 0.0098) and was maintained at T2 (p = 0.00954) exclusively for VAS pain during walking on a flat surface. WOMAC score showed a significant reduction between T0 and T1 (p = 0.0137) and between T0 and T2 (p = 0.006438), as ROM evaluations. Kinematic path assessment did not show significant results in individual gait steps, except for the space-time variables of the average speed and the values of ground reaction force (GRF) obtained with force platforms. Hydrokinesitherapy in thermal environment in obese patients with knee OA may determine pain relief, joint function improvement, and walking speed increase until 6 months of follow-up.

The contribution of musculoskeletal disorders in multimorbidity: Implications for practice and policy

People frequently live for many years with multiple chronic conditions (multimorbidity) that impair health outcomes and are expensive to manage. Multimorbidity has been shown to reduce quality of life and increase mortality. People with multimorbidity also rely more heavily on health and care services and have poorer work outcomes. Musculoskeletal disorders (MSDs) are ubiquitous in multimorbidity because of their high prevalence, shared risk factors, and shared pathogenic processes amongst other long-term conditions. Additionally, these conditions significantly contribute to the total impact of multimorbidity, having been shown to reduce quality of life, increase work disability, and increase treatment burden and healthcare costs. For people living with multimorbidity, MSDs could impair the ability to cope and maintain health and independence, leading to precipitous physical and social decline. Recognition, by health professionals, policymakers, non-profit organisations, and research funders, of the impact of musculoskeletal health in multimorbidity is essential when planning support for people living with multimorbidity.

Patterns and Consequences of Multimorbidity in the General Population: There is No Chronic Disease Management Without Rheumatic Disease Management

OBJECTIVE

To identify empirical model-based patterns of multimorbidity from chronic noncommunicable diseases in the general population, with a focus on the contribution of rheumatic and musculoskeletal diseases (RMDs), and to quantify their association with adverse health outcomes.

METHODS

Cross-sectional data from the Portuguese Fourth National Health Survey were analyzed (n = 23,754). Latent class analysis was used to identify patterns of coexistence of 11 chronic noncommunicable diseases (RMDs, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, stroke, depression, myocardial infarction, cancer, osteoporosis, asthma, and renal failure). Based on the Outcome Measures in Rheumatology, filter 2.0, health outcomes included life impact, pathophysiologic manifestations, and resource use. We assessed the association between patterns and adverse health outcomes, through sex-, age-, and body mass index-adjusted prevalence ratios with 95% confidence intervals, obtained using Poisson regression.

RESULTS

Four patterns of chronic noncommunicable diseases co-occurrence were identified and labeled as low disease probability, cardiometabolic conditions, respiratory conditions, and RMDs and depression. RMDs were highly prevalent in patients with chronic diseases (from 38.6% in cardiometabolic conditions to 66.7% in RMDs and depression). While negative self-rated health, short-term disability, and chronic pain were more strongly associated with cardiometabolic conditions and respiratory conditions, all multimorbidity patterns were similarly associated with long-term disability, frequent health care utilization, and out-of-pocket health care expenses.

CONCLUSION

Our study emphasizes RMDs as a major presence in multimorbidity in the general population. All multimorbidity patterns were associated with a wide set of adverse health outcomes. Management strategies for the patient with chronic cardiometabolic, respiratory, or depressive conditions should also target RMDs.

QUESTIONÁRIO PARA AVALIAÇÃO DA DOR MUSCULOESQUELÉTICA EM PRATICANTES DE EXERCÍCIO (Q-ADOM)

RESUMO Introdução: As doenças cardiovasculares têm sido associadas à presença de desordens musculoesqueléticas. A dor presente nessas comorbidades pode constituir fator limitante para prática de exercício. No entanto, não foram encontrados instrumentos que proporcionem mensuração mais criteriosa e com informações precisas, que possam ser facilmente utilizados na prática clínica. Neste sentido, torna-se relevante a construção e validação de um instrumento mais específico para obtenção de informações detalhadas sobre a presença e gravidade desses sintomas e sua interferência nos aspectos funcionais, custos e fatores psicossociais, em diferentes momentos, resultando em uma avaliação mais precisa. Com isso, profissionais da equipe multidisciplinar envolvidos nos programas de reabilitação cardiopulmonar e metabólica (RCPM) podem utilizá-lo na prática clínica e abrir mão de estratégias especificamente direcionadas a essas afecções. Objetivo: Construir e validar um instrumento para avaliação da dor musculoesquelética em repouso e durante o exercício em participantes de RCPM. Métodos: Foram realizados procedimentos teóricos, empíricos e analíticos. A análise de concordância entre avaliadores (juízes) foi verificada pelo teste W de Kendall, a consistência interna dos itens, por meio do alfa de Cronbach e a reprodutibilidade e estabilidade de medidas, por meio do teste e reteste (coeficiente de correlação intraclasse - CCI e coeficiente de Kappa). Resultados: A concordância entre avaliadores foi significativa (p = 0,001) e a consistência interna apresentou valores satisfatórios (alfa de Cronbach > 0,82). O teste-reteste sinalizou boa reprodutibilidade e estabilidade de medidas (CCI < 0,40 e Kappa < 0,60). Conclusão: O questionário para avaliação da dor musculoesquelética em praticantes de exercício (Q-ADOM) mostrou-se válido, reprodutível e confiável para ser utilizado na avaliação da dor musculoesquelética de participantes de RCPM.

The Prevalence of Neck and Shoulder Symptoms and Associations with Comorbidities and Disability: The Johnston County Osteoarthritis Project

OBJECTIVES

Neck and shoulder pain are common but underreported by older people, raising important questions of frequency, medical comorbidities, gender and racial disparities and functional impact associated with neck and shoulder symptoms in elders, which we examined in this analysis.

METHODS

We performed a cross-sectional analysis in the community-based Johnston County Osteoarthritis Project, a cohort that is representative of the U.S. population, utilizing data from 1672 participants with a mean age of 68 years; 69% were white and 68% were women. Trained staff obtained data on participant-reported: symptoms, comorbidities, depression, and functional status; and performance-based functional assessments. Regression models of neck and shoulder symptoms and functional measures were adjusted for age, sex, race, and body mass index, and additionally for other joint symptoms and comorbidities.

RESULTS

Symptoms of neck (8%), shoulder (13%) or both (13%) were reported by participants. Neck symptoms were most frequently reported by White women; shoulder symptoms were evenly distributed among race and gender subgroups. Neck and shoulder symptoms were associated with cancer, diabetes mellitus, depression, and lung, cardiovascular, and other musculoskeletal problems, as well as pain, aching or stiffness at other sites, and independently with self-reported and performance -based functional measures.

CONCLUSIONS

These findings suggest that primary health care providers should inquire about neck and shoulder symptoms and address potential underlying causes to improve functional status and decrease disability in older people.

Musculoskeletal pain in people with and without type 2 diabetes in Taiwan: a population-based, retrospective cohort study

Background

Musculoskeletal pain in people with type 2 diabetes is a common issue even to this day. The study aimed to explore the 10-year cumulative incidence of musculoskeletal pain, the mean number of doctor visits for musculoskeletal pain, and the mean number of doctor visits for musculoskeletal pain by location in people with type 2 diabetes, compared with respective values for people without diabetes.

Methods

The study utilized a population-based retrospective cohort study design. The subjects were randomly obtained from the Taiwan National Health Insurance Research Database. The diabetic group included 6586 people with type 2 diabetes aged 18–50 years, while the non-diabetic group consisted of 32,930 age- and sex-matched people. Based on the medical records of individuals with musculoskeletal pain in the two groups from 2001 to 2010, the 10-year cumulative incidence of musculoskeletal pain, the mean number of doctor visits for musculoskeletal pain, and the mean number of doctor visits for musculoskeletal pain by location were calculated and compared, with the aim of identifying differences between the two groups.

Results

Showed that people in the diabetic group had a higher 10-year cumulative incidence of and a higher mean number of doctor visits for musculoskeletal pain than the non-diabetic group (p < 0.05). The relative risk (RR) of the 10-year cumulative incidence of musculoskeletal pain in the two groups was the highest (RR = 1.39) for people between 30 and 39 years of age. The mean number of doctor visits for musculoskeletal pain by location was significantly different between the two groups. However, the mean number of doctor visits for limb pain registered the largest difference between the two groups.

Conclusion

People with type 2 diabetes aged 18–50 years had a higher 10-year cumulative incidence of and a higher mean number of doctor visits for musculoskeletal pain than the non-diabetic group. Musculoskeletal pain might directly or indirectly interfere with or decrease the physical activity levels of people with diabetes. Therefore, it is important to detect and treat musculoskeletal pain early in order to promote physical activity and optimize blood sugar control.

Examination of cardiac rehabilitation participants referred to a musculoskeletal clinic

PURPOSE

To describe participants in a cardiac rehabilitation program who were referred to an in-house musculoskeletal clinic and their cardiac rehabilitation and musculoskeletal outcomes.

METHODS

A retrospective chart review was done on 51 participants who were referred to the musculoskeletal clinic between February 1, 2009, and March 31, 2010. Data on demographics, clinical characteristics, and cardiac rehabilitation and musculoskeletal outcomes were collected. Analyses included descriptive statistics and nonparametric analysis of outcome measures.

RESULTS

Of the 51 participants, 88.2% reported preexisting musculoskeletal conditions. The most common region of diagnosed musculoskeletal conditions included knee(s) (45.1%), back (25.5%), and shoulder(s) (17.6%). For those who attended the musculoskeletal clinic and had pre-/postintervention data (n = 14), there was a significant improvement from initial to final mean Numerical Pain Rating Scale scores (P = .001) and peak oxygen uptake measures (P = .002).

CONCLUSION

A musculoskeletal clinic within a cardiac rehabilitation program could allow for musculoskeletal conditions to be addressed in an effective manner and potentially minimize their negative impact on cardiac rehabilitation participation and outcomes.

Co-morditities of environmental diseases: A common cause

The global pandemic of non-vector borne environmental diseases may, in large part, be attributed to chronic exposures to ever increasing levels of exogenous lipophilic chemicals. These chemicals include persistent organic pollutants, semi-volatile compounds and low molecular weight hydrocarbons. Such chemicals facilitate the sequential absorption of otherwise not absorbed more toxic hydrophilic species that attack numerous body organs and systems, leading to environmental disease. Co-morbidities of non-communicable environmental diseases are alarmingly high, with as many as half of all individuals chronically ill with two or more diseases. Co-morbidity is to be anticipated, since all of the causative chemicals identified have independently been shown to trigger the individual diseases.

Disability correlates in Canadian Armed Forces Regular Force Veterans

PURPOSE

This study was undertaken to inform disability mitigation for military veterans by identifying personal, environmental, and health factors associated with activity limitations.

METHOD

A sample of 3154 Canadian Armed Forces Regular Force Veterans who were released during 1998-2007 participated in the 2010 Survey on Transition to Civilian Life. Associations between personal and environmental factors, health conditions and activity limitations were explored using ordinal logistic regression.

RESULTS

The prevalence of activity reduction in life domains was higher than the Canadian general population (49% versus 21%), as was needing assistance with at least one activity of daily living (17% versus 5%). Prior to adjusting for health conditions, disability odds were elevated for increased age, females, non-degree post-secondary graduation, low income, junior non-commissioned members, deployment, low social support, low mastery, high life stress, and weak sense of community belonging. Reduced odds were found for private/recruit ranks. Disability odds were highest for chronic pain (10.9), any mental health condition (2.7), and musculoskeletal conditions (2.6), and there was a synergistic additive effect of physical and mental health co-occurrence.

CONCLUSIONS

Disability, measured as activity limitation, was associated with a range of personal and environmental factors and health conditions, indicating multifactorial and multidisciplinary approaches to disability mitigation.

Tackling obesity in knee osteoarthritis

Obesity and knee osteoarthritis (OA), two of the most common chronic diseases, are often comorbid. Obesity increases the risk of knee OA by a variety of mechanisms, such as increased joint loading and changes in body composition, with detrimental effects related to metainflammation and behavioural factors, including diminished physical activity and subsequent loss of protective muscle strength. These complex interactions present a challenge to the managing physician. The risk of knee OA related to weight gain and obesity begins from an early age. Weight loss reduces the risk of incident knee OA, and, in established disease, reduces symptoms, improves function and is likely to reduce disease progression. We review strategies to facilitate weight loss, with particular reference to their application in people with knee OA. Although knee OA presents intrinsic barriers to weight management, weight loss is possible at all stages of disease. Exercise or muscle strengthening are desirable for general health and to improve function, but are not essential to achieve weight loss and a successful symptomatic result. The degree of weight loss required to achieve benefit might be greater with increasing disease severity. Finally, we outline the need for a societal approach to tackle obesity-related OA.

Risk factors for a 6-year decline in physical disability and functional limitations among elderly people with type 2 diabetes in the Japanese Elderly Diabetes Intervention Trial

AIM

Type 2 diabetes increases the risk of disability. The purpose of this study was to clarify the explanatory factors for disability in Japanese diabetic elderly.

METHODS

The 6-year decline in physical disability and functional limitations was investigated among 317 elderly people with type 2 diabetes recruited in a large-scale prospective study of the Japanese Elderly Diabetes Intervention Trial. Information about diabetes, blood examinations and complications was obtained, and basic activities of daily living (ADL) and instrumental ADL (IADL) were assessed by total score of the Barthel index and the Tokyo Metropolitan Institute of Gerontology Index of Competence, respectively.

RESULTS

After 6 years of follow up, 13.6% of patients had developed a new ADL disability and 38.3% had developed a new functional impairment. In the 65-74 years age group, basic ADL decreased only in males, whereas females became functionally impaired. In the 75-84 years age group, basic and IADL decreased in both males and females. Older age and metabolic syndrome were prognostic for impairment of basic ADL, whereas baseline IADL problems, lower cognitive function, physical inactivity and insulin therapy were significant predictors of a future decline in the IADL.

CONCLUSION

This study identified several factors predicting the future decline of basic ADL and IADL in diabetic elderly patients, and provided a conceptual framework that might help to clarify the pathways leading to disability. Because the specific causes of each functional problem are modifiable, comprehensive treatment and care are needed to allow Japanese diabetic elderly patients to have more favorable living conditions.

Use of conventional care and complementary/alternative medicine among US adults with arthritis

OBJECTIVE

Managing arthritis and co-morbid conditions is of public health importance. It is therefore critical to have a comprehensive understanding of healthcare utilization among US adults with arthritis. Thus, the present study identified characteristics associated with using both complementary and alternative medicine (CAM) and conventional healthcare.

METHOD

Using 2007 National Health Interview Survey data, multinomial logistic regression was performed to compare four categories of past year healthcare use (both CAM and conventional care vs. conventional care only, CAM only, and no healthcare use) on their potential correlates.

RESULTS

The sample (n=3850) was 62.8% female and 80.4% non-Hispanic White. Nearly half were at least 65 years old, and had used both CAM and conventional services in the previous year. The following characteristics were associated with having used neither CAM nor conventional care in the previous year (vs. having used both CAM and conventional care): being from an ethnic and racial minority group (ORs=2.44, 3.26, and 3.91) and being uninsured (OR=4.06), identifying individuals potentially at risk for unmet need.

CONCLUSION

To ensure access to comprehensive care, potentially underserved populations should be targeted with outreach (e.g., providing low-cost, accessible care, and education about benefits of various treatments for arthritis and co-morbid conditions).