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PubMed2006

Method guidelines for Cochrane Musculoskeletal Group systematic reviews.

The Cochrane Musculoskeletal Group (CMSG), one of 50 groups of the not-for-profit international Cochrane Collaboration, prepares, maintains, and disseminates systematic reviews of treatments for musculoskeletal diseases. To enhance the quality and usability of systematic reviews, the CMSG has developed tailored methodological guidelines for authors of CMSG systematic reviews. Recommendations specific to musculoskeletal disorders are provided for various aspects of undertaking a systematic review, including literature searching, inclusion criteria, quality assessment, grading of evidence, data collection, and data analysis. These guidelines will help researchers design, conduct, and report results of systematic reviews of trials in the following fields of musculoskeletal health: gout, osteoarthritis, osteoporosis, pediatric rheumatology, rheumatoid arthritis, soft tissue rheumatism, spondyloarthropathy, systemic lupus erythematosus, systemic sclerosis, and vasculitis. Systematic reviews need to be conducted according to high methodological standards. These recommendations on developing and performing a systematic review will help improve consistency among CMSG reviews.

Clinical Trials as Topic↗
PubMed2005

Chitosan-RGDSGGC conjugate as a scaffold material for musculoskeletal tissue engineering.

In the present study, we have developed a novel and versatile method for the preparation of chitosan-peptide complex based on the selective reaction of chitosan with 2-iminothiolane. The new type of SH-chitosan derivative showed an excellent solubility to aqueous solution even in the alkaline conditions. This characteristic greatly facilitated further modification study of chitosan with a variety of bioactive substances. A synthetic peptide, RGDSGGC containing RGDS moiety that is known as one of the most important cell adhesive peptides, was readily coupled by disulfide bonds formation with sulfhydryl groups of SH-chitosan in the presence of dimethyl sulfoxide. Next, the effect of the introduction of RGDSGGC moiety to chitosan on cell adhesion and proliferation activity of chondrocytes and fibroblasts were evaluated. As a result, it was suggested that this polysaccharide-peptide conjugate exhibited excellent capacities for both cell adhesion and cell proliferation of chondrocytes and fibroblasts. Considering the growing importance of the biocompatible scaffolds in the recent tailored tissue engineering technique, these results indicate that the present strategy of 2-iminothiolane-based conjugation of polysaccharides with biologically active peptides will become a key and potential technology to develop desirable scaffold materials for the tissue regenerations.

Adsorption↗
PubMed2003

Modular data logger system for physical workload measurements.

Direct technical measurements of physical workload have advantages in studies of work-related musculoskeletal disorders. A data logger has been developed, based on 20 and 40 Mbyte PCMCIA (Personal Computer Memory Card International Association) flash memory cards, for electromyography (EMG), inclinometry and goniometry. They are provided with an input for marking of events that can be used for synchronization with other loggers and with video recordings. To make the data easier to access by the preceeding analysis software, application software has also been developed that reorganizes the data. The loggers are easy to operate and enable whole-day ambulatory field recordings without any need for reduction or compression of the data.

Electronic Data Processing↗
PubMed1999

Stress responses in low-status jobs and their relationship to health risks: musculoskeletal disorders.

Conditions typical of many low-status jobs are known to induce elevated stress. In keeping with this, blue-collar workers show elevated psychophysiological stress levels both during and after work compared with workers in more stimulating and flexible jobs. Health-related behaviors, such as cigarette smoking and drug abuse, that are known to contribute to the social gradient in health, can be seen as ways of coping with a stressful work situation in order to get short-term relief. Negative emotional states associated with low-status jobs, combined with a lack of economic resources, are also likely to reduce the individual's motivation to seek proper medical treatment and, thus, increase the risk that transient symptoms develop into chronic illness. With regard to musculoskeletal disorders, it is well documented that physically monotonous or repetitive work is associated with an increase in neck, shoulder, and low back pain problems. However, recent studies also report an association between psychosocial factors and muscle pain syndromes. Possible mechanisms explaining these findings involve the assumption that psychological stress may induce sustained activation of small, low-threshold motor units that may lead to degenerative processes, damage, and pain. Analysis of short periods of very low muscular electrical activity (EMG gaps) shows that female workers with a high frequency of EMG gaps seem to have less risk of developing myalgia problems than do workers with fewer gaps. Stress induced by psychosocial conditions at work, which is usually more lasting than that resulting from physical demands, may prevent the individual from shutting off their physiological activation and reduces the time for rest and recovery. In the modern work environment, with strong emphasis on a high work pace, competitiveness, and efficiency, it is possible that lack of relaxation is an even more important health problem than is the absolute level of contraction or the frequency of muscular activation.

Adaptation, Psychological↗
PubMed2004

Individual factors and musculoskeletal disorders: a framework for their consideration.

Individual factors have been variously defined as non-work, demographic, physiological or psychological factors. They may represent a variety of important constructs at different relevant levels that may not be initially evident in their measurement. These include: work-related factors e.g., job assignment, duration of exposure, work style, anthropometric mismatches, and differential responses to job demands; concomitant external or internal exposures e.g., sports, smoking, and endogenous hormones; and physical, psychological and social vulnerabilities e.g., prior injury, depression, socio-economic status. Such factors operate in different ways in the development, course and response to interventions of musculoskeletal disorders. Newer framings of their contribution to musculoskeletal disorders are providing new insights into the role of such factors as some among many which contribute to the burden of MSK disorders in working age populations. As researchers, practitioners and policy makers, we need to consider them in order to reduce burden, to protect the vulnerable and to match interventions to different groups of people most appropriately.

Disease Susceptibility↗
PubMedDate not supplied

Deferred care for adults with musculoskeletal complaints.

CONTEXT: Many ambulatory care facilities do not have resources to provide same-day care for all walk-in patients. Yet, there are few guidelines that identify patients for whom care can be safely deferred. OBJECTIVE: To describe the development and implementation of deferred-care guidelines for adults with musculoskeletal complaints. DESIGN: Consensus process and field test. GUIDELINE DEVELOPMENT: After an eight-member multidisciplinary physician panel identified critical factors that necessitate same-day care, we created 34 clinical scenarios to consider for deferred care. In 22 scenarios, the panel members agreed that deferred care was safe. These were formatted into screening guidelines for back, neck, isolated extremity, and generalized muscle pain. IMPLEMENTATION: In reliability testing between two nurses reading 40 patient scenarios, interrater agreement for deferred care was nearly perfect (kappa = 0.95). The guidelines were then applied to 448 patients presenting with musculoskeletal complaints to a Veterans Administration ambulatory care triage station. One hundred seven (24%) patients met guidelines for deferred care. Seventy-six patients agreed to have their care deferred, of which 66 kept their return appointment. CONCLUSIONS: Our guidelines suggest that a substantial proportion of patients with musculoskeletal complaints can have their care deferred. Most patients were willing to do so and kept their follow-up appointment. Use of these guidelines could help decompress ambulatory settings with limited resources to provide nonemergency same-day care.

Ambulatory Care↗
PubMed2006

Musculoskeletal injuries in sports.

A large number of adolescents participate in various sports. Not withstanding the methodologic problems with epidemiologic data, a large percentage of athletes sustain musculoskeletal injuries. In most instances, the athlete first presents to his or her primary care physician, who must perform the initial assessment and decide on further management. Many injuries can be managed by the primary care physician. It is important to recognize the unique characteristics of adolescent growth and development that have implications for the diagnosis and management of musculoskeletal injuries.

Acute Disease↗
PubMedDate not supplied

Relationships between physical symptoms and pubertal development.

INTRODUCTION: The purpose of this study was to examine relationships between physical symptoms and pubertal status and timing in adolescents. METHOD: This descriptive study was based on cross-sectional analysis of survey data from the National Longitudinal Study of Adolescent Health including a school-based sample of more than 20,000 adolescents in grades 7 through 12. Self-reported physical symptoms during the past 12 months were examined. Pubertal development was measured as pubertal status (early, mid, and advanced pubertal) and timing (early timing, on time, and late timing). RESULTS: Headaches and musculoskeletal pains were the most commonly reported symptoms among advanced pubertal status respondents. Headache was more prominent among girls; among boys, musculoskeletal complaints were predominant. For both sexes, on-time developers were less likely to report physical symptoms when compared with the two off-timing groups. Among girls, pubertal status and timing were more closely associated with various types of symptoms. DISCUSSION: This study underscores the importance of both the objective signs of pubertal changes and youngsters' own perception of their pubertal changes in assessing and addressing physical symptoms.

Abdominal Pain↗
PubMed2000

Methotrexate for rheumatoid arthritis.

OBJECTIVES: To estimate the short-term efficacy and toxicity of methotrexate (MTX) for the treatment of rheumatoid arthritis (RA). SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Group trials register, and Medline, up to July 1997, using the search strategy developed by the Cochrane Collaboration (Dickersin 1994). The search was complemented with bibliography searching of the reference list of the trials retrieved from the electronic search. Key experts in the area were contacted for further published and unpublished articles. SELECTION CRITERIA: Randomized controlled trials and controlled clinical trials comparing MTX against placebo in patients with RA. DATA COLLECTION AND ANALYSIS: Two reviewers determined the studies to be included based on inclusion and exclusion criteria (GW, MSA). Data were independently abstracted by two reviewers (EB, MSA), and checked by a third reviewer (BS) using a pre-developed form for the rheumatoid arthritis sub-group of the Cochrane Musculoskeletal Group. The same two reviewers, using a validated scale (Jadad 1996) assessed the methodological quality of the trials independently. Rheumatoid arthritis outcome measures were extracted from the publications. The pooled analysis was performed using standardized mean differences (SMDs) for joint counts, pain, and global and functional assessments. Weighted mean differences (WMDs) were used for erythrocyte sedimentation rate (ESR). Toxicity was evaluated with pooled odds ratios (OR) for withdrawals. A chi-square test was used to assess heterogeneity among trials. Fixed effects models were used throughout and random effects for outcomes showing heterogeneity. MAIN RESULTS: Five trials and 300 patients were included. A statistically significant benefit was observed for MTX when compared to placebo. Statistically significant differences were observed for all measures except ESR. The standardized weighted difference (effect size) between MTX and placebo for the various outcome measures varied between -0.43 and -1.5. No differences were observed in the total number of withdrawals and dropouts (OR = 0.95), although patients on MTX were three times more likely to discontinue treatment because of adverse reactions (OR=3.47) and four times less likely to withdraw due to lack of response (OR=0.22). REVIEWER'S CONCLUSIONS: Twenty-two percent of people on MTX withdrew due to adverse effects compared to seven percent of the placebo group. MTX has a substantial clinically and statistically significant benefit in the short term treatment of patients with RA.

Antirheumatic Agents↗
PubMed2000

Sulfasalazine for rheumatoid arthritis.

OBJECTIVES: To estimate the short-term efficacy and toxicity of sulfasalazine for the treatment of rheumatoid arthritis (RA). SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Group trials register, and Medline, up to July 1997, using the search strategy developed by the Cochrane Collaboration (Dickersin 1994). The search was complemented with bibliography searching of the reference list of the trials retrieved from the electronic search. Key experts in the area were contacted for further published and unpublished articles. SELECTION CRITERIA: All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing sulfasalazine against placebo in patients with RA. DATA COLLECTION AND ANALYSIS: Two reviewers determined the studies to be included based on inclusion and exclusion criteria (GW, MSA). Data were independently abstracted by two reviewers (EB, MSA), and checked by a third reviewer (BS) using a pre-developed form for the rheumatoid arthritis sub-group of the Cochrane Musculoskeletal Group. The same two reviewers, using a validated scale (Jadad 1996) assessed the methodological quality of the RCTs and CCTs independently. Rheumatoid arthritis outcome measures were extracted from the publications. The pooled analysis was performed using standardized mean differences (SMDs) for joint counts, pain, and global and functional assessments. Weighted mean differences (WMDs) were used for erythrocyte sedimentation rate (ESR). Toxicity was evaluated with pooled odds ratios (OR) for withdrawals. A chi-square test was used to assess heterogeneity among trials. Fixed effects models were used throughout and random effects for outcomes showing heterogeneity. MAIN RESULTS: Six trials, including 468 patients were included. A statistically significant benefit was observed for sulfasalazine when compared to placebo for tender and swollen joint scores, pain and ESR. The standardized weighted mean difference between treatment and placebo was -0.49 for tender and swollen joint scores, and -0.42 for pain. The difference for ESR was -17.6mm. Withdrawals from adverse reactions were significantly higher in the sulfasalazine group (OR=3.0). Patients receiving placebo were four times more likely to discontinue treatment because of lack of efficacy than patients receiving sulfasalazine. REVIEWER'S CONCLUSIONS: Sulfasalazine appears to have a clinically and statistically significant benefit on the disease activity of patients with RA. Its effects on overall health status and radiological progression are not clear at this time, but would appear to be modest.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

Musculoskeletal trauma: implications for critical care nursing practice.

The majority of trauma patients experience significant musculoskeletal injury (MSI). The patient who has developed complications related to orthopaedic trauma--such as compartment syndrome, fat embolus syndrome, and crush injury--requires astute nursing assessment. A thorough understanding of trauma pathophysiology and the pathogenesis of MSI pain will assist the nursing practitioner to anticipate physiologic needs, allowing a greater range of nursing process intervention.

Critical Care↗
PubMedDate not supplied

Gene therapy and tissue engineering in orthopaedic surgery.

A new biologic era of orthopaedic surgery has been initiated by basic scientific advances that have resulted in the development of gene therapy and tissue engineering approaches for treating musculoskeletal disorders. The terminology, fundamental concepts, and current research in this burgeoning field must be understood by practicing orthopaedic surgeons. Different gene therapy approaches, multiple gene vectors, a multitude of cytokines, a growing list of potential scaffolds, and putative stem cells are being studied. Gene therapy and tissue engineering applications for bone healing, articular disorders, intervertebral disk pathology, and skeletal muscle injuries are being explored. Innovative methodologies that ensure patient safety can potentially lead to many new treatment strategies for musculoskeletal conditions.

Animals↗
PubMed1999

Smoking. A risk factor for development of low back pain in adolescents.

STUDY DESIGN: A prospective, repeated-measures cohort design with high school students from Montreal, Canada. OBJECTIVES: To determine whether smoking was a risk factor for the development of low back pain or other musculoskeletal pain in a cohort of adolescents. SUMMARY OF BACKGROUND DATA: Smoking has been associated with low back pain in adults. Many adolescents smoke, and the prevalence of low back pain in this age group is 30%. A history of low back pain is predictive of future problems. METHODS: A total of 502 students from grades 7 to 9 were assessed from 3 schools. Data were collected at 3 times: at the beginning of the study, at 6 months, and at the end of a 12-month period. Students responded to a questionnaire addressing musculoskeletal health and life-style factors, which included smoking. Measurements of height, weight, trunk and leg flexibility, and trunk strength were obtained. Low back pain occurring at a frequency of at least once a week in the past 6 months was defined as the outcome. Multivariate methods were used to model the repeated-measures dichotomous outcome as a function of smoking and other covariates. RESULTS: Smokers experienced low back pain more than nonsmokers (odds ratio, 2.4; 95% confidence interval, 1.3-6.0). There was also a dose-response relationship between amount smoked and development of low back pain. Smokers tended to experience more upper limb or lower limb pain than nonsmokers, although this result was not significant. CONCLUSIONS: Smoking was found to increase the risk for low back pain in this cohort of adolescents.

Adolescent↗
PubMed1994

Development of observational methods for estimation of exposure to workplace postural stress.

Several recent studies have illustrated the need for a simple observational instrument for the estimation of exposure to postural stress in epidemiological studies of musculoskeletal disorders. Such an instrument is particularly necessary in developing countries. This paper describes the development of an observational instrument across a spectrum of industrial occupations in South Africa. The instrument was derived from adaptations to previously published observational methods and was specifically adapted to the measurement and application constraints identified during empirical development work in various industries. The final instrument fulfilled its aims of being applicable across a broad spectrum of jobs, including a broad spectrum of exposure variables and being reasonably cost- and time-effective. Some construct validity is indicated by the fact that two out of the three main exposure variables of interest showed significant associations with neck and shoulder pain in an epidemiological analysis. These variables were the score of summed estimates of the duration of time in sustained postures in a working day and the score of estimated overall repetitiveness based on cycle-time criteria. Further investigations are needed for pain at other anatomical sites. The measurement and scoring problems identified are discussed with reference to some aspects of these results.

Biomechanical Phenomena↗
PubMed2003

Bone and joint diseases around the world. Sweden: a brief update on burden and priority.

Musculoskeletal conditions are increasingly common with advancing age. The life expectancy increased early and rapidly in Sweden, and today 17% of the population is over age 65. Musculoskeletal problems are therefore common but in general are receiving low attention, despite enormous costs for society. The indirect costs for musculoskeletal conditions vastly exceed direct costs (80% vs 20%). This is obviated by the fact that in 2001, of all persons receiving disability pension or taking longterm sick leave, 60% had a diagnosis related to the musculoskeletal system. Further, in a population of 9 million, 70,000 fragility fractures occur each year, 18,000 of the hip and 25,000 of the forearm, corresponding to a hip fracture incidence of 20.14/10,000, among the highest in the world. Government policy is implemented through several agencies, national and local. State of the art reports are currently available in 12 areas of musculoskeletal condition, including osteoarthritis, rheumatoid arthritis, osteoporosis, and hip fracture, while no national evidence-based guidelines have been developed for these conditions. The Swedish Council on Technology Assessment in Health Care provides the scientific foundation of present methods for treatment through evidence-based evaluations. National registers are continuously evaluating orthopedic implant procedures, of which the Swedish Hip Register has provided valuable information on total hip replacements since 1979. For the future, there is a need for setting of priorities with regard to musculoskeletal conditions, including development of guidelines of mechanism of implementation.

Cost of Illness↗
PubMed1984

[Studies on health hazards among cooks providing school lunch service. Report 2. An analysis of factors associated with the development of health hazards].

The previous report revealed that the musculoskeletal symptoms of cooks are related to their working conditions, but the cause and effect relationship was not clarified. In the present report, the relationship between some causative factors and the health hazards is analyzed epidemiologically. The subjects were chosen from the cooks mentioned in the previous report. The results are as follows: A clear relationship was not observed between age and health hazards. A dose-response relationship was observed between the cumulative duration of cooking work and the subjective symptoms. An antecedent-consequent relationship was also shown between the cooking work and the health hazards. Another dose-response relationship was observed between the amount of cooking work and the subjective symptoms. The frequency of "carrying heavy objects" assigned as a cause of development of the hazards, especially of low-back pain, increased in accordance with the number of meals served in each kitchen. It was observed that the improvement of cooking equipment enabled the incidence of symptoms to decline, but the elevation of working speed due to mechanization could still be hazardous. As a result of the physical examination, a similarity was observed between the cooking work and the clinical findings in comparison with ticket-vending machine operators. It is concluded that these results demonstrate a cause and effect relationship between cooking work and the development of health hazards.

Adult↗
PubMed2002

Drug-induced metabolic bone disorders.

A number of drugs, either physician prescribed or those taken without the knowledge of the physician, may have metabolic effects on, and result in abnormal changes in, the musculoskeletal system. These medications may involve the developing fetus, infant, child, or adult and may manifest as drug-induced embryopathies, osteoporosis, osteomalacia, or rickets, or a combination of these, or they may be associated with proliferative changes. Not uncommonly, the radiologist may be the first physician to identify the metabolic manifestations of these medications. The radiological changes associated with such drugs will be reviewed. Certain drugs may have teratogenic effects, nonteratogenic effects, or both. These effects, dependent solely on the timing of administration, will be discussed separately.

Abnormalities, Drug-Induced↗
PubMed1999

Three-dimensional motion analysis of upper limb movement in the bowing arm of string-playing musicians.

OBJECTIVES: To explore the role of three-dimensional movement analysis in defining patterns of joint movement while bowing on different stringed instruments, and its potential for future use by the clinician in the study of musculoskeletal problems in musicians. DESIGN AND METHODS: A protocol was developed for analysis of bowing arm movements using the MacReflex 3-D analysis system- including definition of marker sites, positioning of the musician within the calibrated area and standardised bowing sequences. This protocol was then used to determine whether the system was sensitive to differences between instrument types and to variation in bowing style and technique between individual players. The ranges of movement in the shoulder, elbow and wrist were compared between instrument groups in a cohort of 39 asymptomatic string players. RESULTS: The system gave reproducible results on repeated testing, and demonstrated clear differences between instruments, as well as stylistic differences between players. Range of shoulder movement increased progressively towards the upper register of the cello, while decreasing on the violin. Maximum elevation of the shoulder was significantly greater on the cello (P<0.001), while elbow flexion, and therefore range, was consistently greater on the violin. CONCLUSIONS: Clear and reproducible differences in style and technique were demonstrated between individuals. The increased range of shoulder movement in the upper register of the 'cello may contribute to the greater prevalence of neck and shoulder symptoms among 'cellists. Further study is required to establish whether different musculoskeletal symptoms produce characteristic patterns which could help in diagnosis and development is required to make the system feasible for routine use. RELEVANCE: Musculoskeletal problems are common among musicians. Different instruments and playing positions make different demands on joints and may contribute to the variance in reported incidence of musculoskeletal symptoms among violinists and cellists. Three-dimensional analysis may prove helpful in the future for the diagnosis of different musculoskeletal syndromes in string players, or for identifying movement patterns which could exacerbate repetitive strain injuries. However, as this is the first application of the technique in this complex area, preliminary work was required to establish feasibility and to obtain data on normal players.

Arm↗