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At least 649 records · Page 36Linked to original sources
PubMed2003

Implementing standardized cost categories within economic evaluations in musculoskeletal diseases.

We present a matrix of relevant resource utilization domains for use in standardizing applied cost assessment in musculoskeletal conditions. In addition,we highlight the importance of selecting cost categories during the development of an economic evaluation. A set of four steps was applied: (a) literature search identifying economic evaluations in osteoarthritis and osteoporosis, (b) listing and aggregation of cost categories mentioned in the identified articles, (c) development of a matrix of resource utilization domains, and (d) qualitative discussion regarding the generalizability of the matrix to other musculoskeletal conditions such as rheumatoid arthritis. We examined 41 full-length articles (25 cost-of-illness studies or cost-comparisons, 14 cost-effectiveness analyses, and 2 cost-utility analyses), of which 16 studies focused on osteoarthritis and 25 on osteoporosis. The reviewed studies used a total of 151 different cost categories which, after adjustment for synonymous labeling, made up 34 cost categories. A matrix of 16 separate resource utilization domains was developed including seven outpatient, three inpatient, four other disease-related, and two productivity cost domains. We found that cost assessment in economic evaluation in the key musculo-skeletal diseases (osteoarthritis, osteoporosis, and rheumatoid arthritis) is performed rather inhomogeneously. A generalized matrix of applicable resource utilization domains and a flowchart facilitating the development of appropriate resource utilization data have been developed.

Journal Article↗
PubMed1995

The outcome of children referred to a pediatric rheumatology clinic with a positive antinuclear antibody test but without an autoimmune disease.

OBJECTIVE: To assess the diagnostic value of positive antinuclear antibody (ANA) test results in children with musculoskeletal or dermatologic problems but without autoimmune disease at presentation. DESIGN: Retrospective chart review. SETTING: Pediatric rheumatology clinic in a tertiary care center. PATIENTS: Five hundred charts reviewed, comprising all new patients seen, 1978 to 1993. RESULTS: Of 500 children seen, 113 had positive ANA test results available at referral. Of those 113 patients, 72 (64%) had an autoimmune condition diagnosed at initial clinic visit; another 10 (9%) were lost to follow-up. Thirty-one children (27%) had no autoimmune condition diagnosed at initial clinic visit and had clinical follow-up over a mean of 37 months. Nonspecific musculoskeletal complaints and hypermobility accounted for the majority of presentations. Routine hematology data were usually normal. Median ANA titer was 1:160; ANA patterns varied. On follow-up, 25 patients (81%) cleared their symptoms; five (16%) had significant improvement. One patient developed an autoimmune disease (autoimmune hepatitis). CONCLUSIONS: Based on our findings, the vast majority of children who have positive ANA test results but do not have autoimmune conditions at initial diagnosis will not develop an autoimmune condition. ANA testing of children who have musculoskeletal or dermatologic problems in the absence of autoimmune conditions does not reveal new diagnoses, and represents unnecessary laboratory time and expense. The prognosis of children who have positive ANA test results in the absence of autoimmune conditions is usually excellent.

Adolescent↗
PubMed1997

Establishing Priorities for Occupational Health Research among Women Working in the Maquiladora Industry.

In order to estimate the prevalence of potentially hazardous exposures and the frequencies of, types of, and reasons for job transitions among women working in the Mexican maquiladora industry, an age- and occupation-stratified sample of 479 women, aged 16-40 years, living in 12 neighborhoods in Tijuana were interviewed. Considerable transition between industrial sectors was observed. About 20% had left their last job in a maquiladora because of hazardous or stressful working conditions and work-related health problems. Chemical exposures, ergonomic risks, noise, and stress were reported. The sociodemographic characteristics and occupational risk profile of the maquiladora workforce, considered in the broader context of Mexico's development, indicate that occupational health research in the maquiladora should focus on musculoskeletal injuries, adverse reproductive outcomes, neurologic damage, and mental illness. Appropriate methods for investigating occupational risks in a highly mobile workforce will need to be developed in order to avoid sampling bias and identify appropriate comparison groups.

Journal Article↗
PubMed2001

Multidisciplinary team evaluation of upper extremity injuries in a single visit: the UPPER Program.

Musculoskeletal disorders are the leading cause of disability among people between 18 and 64 years of age. Patients with musculoskeletal injuries of the upper extremities are usually evaluated and treated by an individual physician and therapist. However, for patients who have problems, especially after being treated by a hand surgeon and a certified hand therapist, there are few other management options. A multidisciplinary assessment program for patients with chronic upper limb pain has not been described in the literature. As part of The University of Michigan RERC (Rehabilitation Engineering Research Center), the UPPER Program (UPper extremity Protocol Evaluation in Rehabilitation) was developed to evaluate patients who have disabling upper limb musculoskeletal disorders. At the center of the program is a multidisciplinary team composed of a physiatrist (physical medicine and rehabilitation specialist), occupational therapist, physical therapist, exercise physiologist, vocational counselor and pain psychologist. The UPPER Program elements include a pre-evaluation questionnaire, individual team member assessments and a team meeting. It is followed by a patient appointment with the team physician to review the results and recommendations. The essential details of the program are presented in this article so it can be reproduced elsewhere.

Adolescent↗
PubMed1992

Occult posttraumatic avascular necrosis of hip revealed by MRI.

Three hips with avascular necrosis in two patients had associated traumatic lesions noted on magnetic resonance imaging. Location of stress fracture in two femoral necks and acetabular contusion development prior to avascular necrosis favors these processes as being etiologic. These cases are particularly noteworthy in that nondisplaced fractures or other musculoskeletal trauma not visible on plain films has rarely been associated with subsequent development of avascular necrosis.

Acetabulum↗
PubMedDate not supplied

Gene therapy for the treatment of musculoskeletal diseases.

Research into the orthopaedic applications of gene therapy has resulted in progress toward managing chronic and acute genetic and nongenetic disorders. Gene therapy for arthritis, the original focus of research, has progressed to the initiation of several phase I clinical trials. Preliminary findings support the application of gene therapy in the treatment of additional chronic conditions, including osteoporosis and aseptic loosening, as well as musculoskeletal tumors. The most rapid progress is likely to be in tissue repair because it requires neither long-term transgene expression nor closely regulated levels of transgene expression. Moreover, healing probably can be achieved with existing technology. In preclinical studies, genetically modulated stimulation of bone healing has shown impressive results in repairing segmental defects in the long bones and cranium and in improving the success of spinal fusions. An increasing amount of evidence indicates that gene transfer can aid the repair of articular cartilage, menisci, intervertebral disks, ligaments, and tendons. These developments have the potential to transform many areas of musculoskeletal care, leading to treatments that are less invasive, more effective, and less expensive than existing modalities.

Arthritis, Rheumatoid↗
PubMed2000

Agenda for women's health research. Improving women's musculoskeletal health.

Increased attention and resources focused on women's health during the past decade have resulted in new offices, policies, and programs of the Federal government. The Office of Research on Women's Health, established by the National Institutes of Health in 1990, is a focal point for all National Institutes of Health-supported efforts to improve women's health through biomedical and behavioral research. The Office of Research on Women's Health ensures women's appropriate inclusion in research studies supported by the National Institutes of Health. Through the development of a comprehensive agenda for research on women's health, the Office of Research on Women's Health encourages the consideration of gender issues and gender differences in health and disease in research sponsored by the National Institutes of Health. The importance of research to study and improve women's musculoskeletal health has become increasingly recognized. Clinicians, researchers, and representatives of professional and advocacy organizations concerned with women's musculoskeletal health participated in the development of the initial research agenda on women's health in 1991 and participated in the meetings to update and revise the agenda in 1996 and 1997. As a result of meetings convened to review and revise the agenda on women's health for the twenty-first century, many recommendations for additional research on women's musculoskeletal health have been developed and now are being implemented across the National Institutes of Health.

Female↗
PubMed2006

Principles of management of musculoskeletal conditions in children and young people.

Musculoskeletal symptoms and rheumatic conditions are common throughout childhood and adolescence. Age- and development-appropriate care and management of children and young people with such conditions is vital, acknowledging that they are NOT small adults! The major aspect of both paediatric and adolescent rheumatology care which differentiates it from adult care is the fact that children and young people are still growing, in contrast to the ageing and senescence which characterizes adult rheumatology. Growth must be considered in the global sense, incorporating cognitive and psychosocial growth as well as physical growth. Likewise, the reciprocal influences of growth and a chronic rheumatic condition should be considered when caring for young people with childhood-onset rheumatic disease. This chapter will detail the general principles of management of such symptomatology with primary reference to chronic conditions.

Adolescent↗
PubMedDate not supplied

Thick lips, bumpy tongue, and slipped capital femoral epiphysis--a deadly combination.

Multiple endocrine neoplasia type 2b (MEN 2b) is a rare genetic disorder. Affected individuals have malignant thyroid tumors, pheochromocytoma, and ganglioneuromatosis. The musculoskeletal manifestations of MEN 2b include a Marfanoid habitus, pes cavus, scoliosis, slipped capital femoral epiphysis, joint laxity, poor muscle development, and delayed maturation. The initial clinical presentation of MEN 2b frequently involves the musculoskeletal system. The characteristics ganglioneuromatosis of the lips and tongue, however, should alert the orthopedic surgeon to the underlying disorder. Effective treatment of the malignant neoplasms hinges on early diagnosis. The risk of perioperative hypertensive crisis is significant; it may be prevented by appropriate treatment of the pheochromocytoma.

Adolescent↗
PubMedDate not supplied

[The treatment organization of rheumatic children and adolescents in West Germany].

Pediatric rheumatology represents a specialized subject which overlaps with important fields of pediatrics, as well as with adult rheumatology. As a speciality it includes age-specific rheumatologic diseases, an age-dependent differential diagnosis, special growth disturbances and joint deformities that are also influenced by age, and a subgroup of juvenile chronic arthritis. Socio-medical problems arise from a child's impaired physical and psychosocial development and their impact on education, the individual's choice of career, and effects on the patient's family. For pediatricians who are trained in this field and who treat only or predominantly children with rheumatic diseases the subspeciality of pediatric rheumatology should be introduced. In the future, precise figures on incidence and prevalence of juvenile rheumatic diseases in Germany must be obtained. Therapy of children with chronic arthritis affords improvement and further development by comprehensive training and further education of physicians and physiotherapists. Thus, it is important to take advantage of possibilities of inpatient and outpatient care, as well as the co-ordination of existing institutions. Arthralgias and acute rheumatic disorders in children present in a relatively high frequency. Chronic arthritis, however, is rare and treatment requires a supra-regional center for pediatric rheumatology. Quality of therapy for children with chronic rheumatic diseases must be considered prior to a locally oriented care. More intensive research is needed, with more clinical studies and basic research. More effort must be made to integrate analyse of musculoskeletal function and the importance of joint-deformity development into the research program. Further cooperation between pediatric rheumatology centers and universities would offer significant advantages in the future.

Adolescent↗
PubMedDate not supplied

Systemic lupus erythematosus in children: a case report and review.

A 12-year-old Papua New Guinean female presented initially with nonspecific clinical symptoms, fever of unknown origin and anaemia. She subsequently developed multisystem disease involving the respiratory, gastrointestinal, central nervous, musculoskeletal and cutaneous systems. She was diagnosed to have systemic lupus erythromatosus (SLE) and started on treatment. Unfortunately the patient defaulted from follow-up after treatment, which covered seven months only, to present with acute respiratory distress from which she died within 24 hours. A relevant literature review with the clinical features of systemic lupus erythematosus in children is described.

Child↗
PubMed1998

Influence of muscle morphometry and moment arms on the moment-generating capacity of human neck muscles.

STUDY DESIGN: The function of neck muscles was quantified by incorporating experimentally measured morphometric parameters into a three-dimensional biomechanical model. OBJECTIVE: To analyze how muscle morphometry and moment arms influence moment-generating capacity of human neck muscles in physiologic ranges of motion. SUMMARY OF BACKGROUND DATA: Previous biomechanical analyses of the head-neck system have used simplified representations of the musculoskeletal anatomy. The force- and moment-generating properties of individual neck muscles have not been reported. METHODS: A computer graphics model was developed that incorporates detailed neck muscle morphometric data into a model of cervical musculoskeletal anatomy and intervertebral kinematics. Moment arms and force-generating capacity of neck muscles were calculated for a range of head positions. RESULTS: With the head in the upright neutral position, the muscles with the largest moment arms and moment-generating capacities are sternocleidomastoid in flexion and lateral bending, semispinalis capitis and splenius capitis in extension, and trapezius in axial rotation. The moment arms of certain neck muscles (e.g., rectus capitis posterior major in axial rotation) change considerably in the physiologic range of motion. Most neck muscles maintain at least 80% of their peak force-generating capacity throughout the range of motion; however, the force-generating capacities of muscles with large moment arms and/or short fascicles (e.g., splenius capitis) vary substantially with head posture. CONCLUSION: These results quantify the contributions of individual neck muscles to moment-generating capacity and demonstrate that variations in force-generating capacity and moment arm throughout the range of motion can alter muscle moment-generating capacities.

Biomechanical Phenomena↗
PubMed1984

Complex musculoskeletal anatomy: analysis using three dimensional surface reconstruction.

A new computer method has been developed that allows the reprocessing of standard CT scans to produce three dimensional surface images. The process requires only standard CT scanner hardware, and reconstruction time is comparable to that of sagittal and coronal reconstruction. Case reports illustrate the uniqueness of the perspective provided by this technique and its usefulness in clarifying areas of complex musculoskeletal anatomy. Surface images are especially valuable in conveying information to nonradiologist physicians who are unaccustomed to evaluating the numerous images produced in a standard CT scan.

Adult↗
PubMedDate not supplied

Prevalence of musculoskeletal complaints and disability in Cuba. A community-based study using the COPCORD core questionnaire.

OBJECTIVE: Rheumatic diseases are prevalent conditions around the world, but precise information is not easily obtainable in developing countries. The aim of this study was to estimate the prevalence of musculoskeletal complaints in the community in Cuba using the ILAR/COPCORD core questionnaire and published methodologies. METHODS: The ILAR/COPCORD core questionnaire was administered in the form of a home survey to 300 adult subjects. Cases, defined as those with present pain and no trauma, underwent a physical examination and selected laboratory or X ray evaluations. RESULTS: The questionnaire was filled out in a mean time of 8 minutes. Ninety-one subjects had present musculoskeletal pain not related to trauma and 83 had had pain in the past. The most frequently affected regions were the lower back (14%); cervical spine (14%); knee (11.5%) and shoulders (10%). Osteoarthritis was the most common diagnosis (19.6%). A total of 166 subjects sought professional help; 56 were treated by a rheumatologist. Most subjects were satisfied with the results of their medical treatment. CONCLUSIONS: Musculoskeletal symptoms were prevalent in this community. A larger study will be necessary to obtain a better estimate of diagnoses with a low prevalence.

Adult↗
PubMed2006

Attitudes to back pain amongst musculoskeletal practitioners: a comparison of professional groups and practice settings using the ABS-mp.

Chiropractors, osteopaths and physiotherapists play key roles in the management of low back pain (LBP) patients in the UK. We investigated the attitudes of these three professional groups to back pain using a recently developed and validated questionnaire, the Attitudes to Back Pain Scale for musculoskeletal practitioners (ABS-mp). A cross-sectional questionnaire survey was sent to 300 of each professional group (n=900). Responses were analysed from 465 practitioners: 132 chiropractors (28%), 159 osteopaths (34%) and 174 physiotherapists (37%). Overall, all three groups endorse a psychosocial approach to treatment, and see re-activation as a primary goal. However, physiotherapists and osteopaths tend to endorse attitudes towards limiting the number of treatment sessions offered to LBP patients more than chiropractors, and chiropractors endorse a more biomedical approach than physiotherapists. When practice setting (NHS versus private practice) was considered (in physiotherapists alone), physiotherapists working for the NHS endorsed limiting the number of treatment sessions more than those working in the private sector and would also less frequently advise their patients to restrict activities and be vigilant. The results may help explain current clinical practice patterns observed in these groups and their uptake of clinical guideline recommendations.

Adult↗
PubMed1996

Comparative development of the antitrochanter in three strains of domestic fowl.

Lameness and musculoskeletal disease were more frequent in two strains of broilers (selected [S] and relaxed [R]) than in an unselected layer (J). Defective fibrocartilage accounted for 0.15 of the total area of antitrochanteric cartilage at 29 weeks of age in the S-strain birds. There was more retained hyaline cartilage in the R- and S-strain birds at 15 weeks, and at 22 and 29 weeks there was delayed ossification. Occluded blood vessels, death of chondrocytes and degenerate areas of fibrocartilage occurred only in the broiler strains; they were worse in the S-strain and degenerate fibrocartilage occurred more frequently and in larger amounts. The area, length and depth of cartilage were larger in the heavier strains but the differences were considerably smaller than the difference in their relative bodyweights. The degeneration of the antitrochanter appeared to be associated with a reduction in the blood supply to the underlying hyaline cartilage and with the death of chondrocytes and the degeneration of matrix within the fibrocartilage of the antirochanter.

Acetabulum↗
PubMed2002

Functional morphology of proximal hindlimb muscles in the frog Rana pipiens.

Musculoskeletal models have become important tools in understanding motor control issues ranging from how muscles power movement to how sensory feedback supports movements. In the present study, we developed the initial musculotendon subsystem of a realistic model of the frog Rana pipiens. We measured the anatomical properties of 13 proximal muscles in the frog hindlimb and incorporated these measurements into a set of musculotendon actuators. We examined whether the interaction between this musculotendon subsystem and a previously developed skeleton/joint subsystem captured the passive behavior of the real frog's musculoskeletal system. To do this, we compared the moment arms of musculotendon complexes measured experimentally with moment arms predicted by the model. We also compared sarcomere lengths measured experimentally at the starting and take-off positions of a jump with sarcomere lengths predicted by the model at these same limb positions. On the basis of the good fit of the experimental data, we used the model to describe the multi-joint mechanical effects produced by contraction of each hindlimb muscle and to predict muscle trajectories during a range of limb behaviors (wiping, defensive kicking, swimming and jumping). Through these analyses, we show that all hindlimb muscles have multiple functions with respect to accelerating the limb in its three-dimensional workspace and that the balance of functions depends greatly on limb configuration. In addition, we show that muscles have multiple, task-specific functions with respect to the type of contraction performed. The results of this study provide important data regarding the multifunctional role of hindlimb muscles in the frog and form a foundation upon which additional model subsystems (e.g. neural) and more sophisticated muscle models can be appended.

Animals↗