Musculoskeletal Problems Functional limitation - … · 2015-01-11 · Musculoskeletal Problems and...
Transcript of Musculoskeletal Problems Functional limitation - … · 2015-01-11 · Musculoskeletal Problems and...
Bruusgaard EU 2005
Musculoskeletal Problemsand
Functional limitationThe great Public Health Challenge for the 21st Century
• Dag Bruusgaard• Professor, Head of dept.• Dept. of General Practice and
Community Medicine• University of Oslo, Norway
Bruusgaard EU 2005
Troublesomefor the patients,
problematicfor the health care
system, and
costly for the society
Bruusgaard EU 2005
Bruusgaard EU 2005
Musculoskeletal Conditions (MSC)
• 50% of population report MSC• 15-20% of consultations
in primary care• 30-50% of disability payment• 6% of total health care costs
(but 90% of indirect costs)
Bruusgaard EU 2005
• Musculoskeletal problems and conditions form a heterogeneous group for a great part with poorly understood causes. The group comprises clear cut diagnoses, biologically and clinically well defined such as rheumatoid arthritis and sciatica; biologically defined, but clinically less well defined diagnoses such as osteoporosis and arthrosis; as well as controversial conditions as nonspecified low back pain, fibromyalgiaand myofacial pain syndromes. The common denominators are pain and reduced function resulting from some disturbances in the musculoskeletal system ensuing mainly from inflammation, degenerative processes and trauma.
Bruusgaard EU 2005
European Community Health Indicators (ECHI)
• Demography and Socio-economic situation
• Health status• Determinants• Health systems (consequences)
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Musculoskeletal Conditions
ECHI hierarcy
Health statusPerceived and functional health
Chronic disease generalGeneral musculoskeletal pain
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Monitoring of Musculoskeletal Conditions
Routine data (running)
HIS/HES data (repeated)generic
HIS/HES data (repeated)spesific
Bruusgaard EU 2005
• Inflammatory arthritis• Osteoporosis• Osteoarthritis• Dorsalgia• Other localized pain• Chronic widespread
musculoskeletal pain• Trauma
Musculoskeletal Conditions
Bruusgaard EU 2005
Musculoskeletal ConditionsChronic musculoskeletal pain-A multisymptom syndrome?
• Chronic fatigue• Fibromyalgia• Myofacial pain syndrome• Amalgamism• El-allergy• Gulf war syndrome• Multichemical hypersensitivity
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Monitoring of MSC
1. Occurrence of self reported musculoskeletal painSelf report in health interview survey of pain and limited function from different regions, using the question above.
2. Occurrence of rheumatoid arthritisIncidense and prevalence of RA in existing and future regional registers
3. Occurrence of osteoarthritis in hip and kneePrevalence of OA in research projects based on health examination surveys, including x-ray
4. Occurrence of osteoporosisPrevalence of bone density monitored in health examination studies
Bruusgaard EU 2005
Monitoring of MSC
5. Reduced functionPrevalence of persons with reduced function, measured in health interview surveys as recommended by other in the health monitoring project
6. Work disabilityPermanent or temporal work disability, according to diagnosis from social security statistics
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Monitoring of MSC7. Occurrence of hip fracture
Incidence of hip fractures from hospital statistics
8. Hip and knee arthroplastyIncidence and indicators for hip and knee replacement from hospital statistics
9. Drugs for treatment and prevention of osteoporosisDefined daily doses of drugs (ATL05B) and actual prescription from whole sale statistics and prescription registers
10. Drugs for treatment of rheumatoid arthritisDefined daily doses of drugs (ATC L 04 A) and actual prescription from whole sale statistics and prescription registers
Bruusgaard EU 2005
• 1. During the last week, have you had any pain affecting your muscles, joints, neck or back which has occurred on most days and which has affected your ability to carry out the activities of daily living? If Yes, please tick the region(s) in the grid (column a)
• 2. Has this pain (or pains) lasted for 3 months or more? If Yes, please tick the region(s) in the grid (column b)
• Head – Neck - Shoulder(s) - Upper back Elbows - Wrist(s) / hand(s) - Low back -Hip(s) / thigh(s) - Knee(s) - Ankles / foot/feet
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Musculoskeletal Conditions
• Rheumatologists• Orthopedic surgeons• Traumatologists• Endocrinologists• Epidemiologists• General Practitioners
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• EULAR• B&J Decade
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Written declaration on rheumaticdiseases (41/2005)
The European Parliament calls on the Commission and Council to:
• Ensure that the EU´s 7th RFP makes rheumatic diseases one ofits explicit priorities;
• Ensure that the EU´s new healthstrategy makes arthritis(musculoskeletal disorders) oneof its priorities
• …
Bruusgaard EU 2005
Written declaration on rheumaticdiseases (41/2005)
The European Parliament calls on the Commission and Council to:
• Ensure that the EU´s 7th RFP makes rheumatic diseases one ofits explicit priorities;
• Ensure that the EU´s new healthstrategy makes arthritis(musculoskeletal disorders) oneof its priorities
• …
Bruusgaard EU 2005
Bruusgaard EU 2005
European Community Health Indicators
PAIN
FATIGUE
DEPRESSION
ANXIETY
Bruusgaard EU 2005
European Community Health Indicators
Health monitoring
Resources mon.
Compl/functional mon.
Disease monitoring
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European Community Health Indicators
• Health status– Mortality– Morbidity– Generic health status– Composite health status
This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.