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PubMed2005

Locating the evidence base for musculoskeletal nursing: an overview of the rheumatology nursing literature.

The main aim of this study was to locate and classify publications, particularly research publications, produced by nurses working and/or researching in the area of rheumatology in order to develop a research strategy for a newly established academic and clinical nursing unit. Database searches were undertaken to identify journal articles. Theses, dissertations, research reports, conference abstracts and books were also included in the study. The publications once located were entered into a Reference Manager electronic database and the facilities of this package were used to analyse and classify the data. The findings of the study demonstrated that over the past 40 years nurses have been steadily increasing the publication output in this area and in the last 10 years there has been a substantial increase in all publications, but particularly research and investigative articles. However there is a lack of clinical research in this area and this needs to be addressed in future as nurses develop more advanced roles in this speciality. The main limitations was the difficulty in accurately identifying nursing publications because of inadequate details of authorship.

Academic Dissertations as Topic↗
PubMed2001

Musculoskeletal manifestations in a population-based cohort of inflammatory bowel disease patients.

BACKGROUND: Musculoskeletal disorders are the most common extra-intestinal manifestation of inflammatory bowel disease (IBD). Wide ranges of prevalence have been reported depending on the criteria used to define spondylarthropathy and on the selection of patients. We aimed to evaluate the prevalence and clinical spectrum of musculoskeletal manifestations in an inception cohort of European IBD patients. METHODS: From 1 October 1991 to 30 September 1993, 202 IBD patients were diagnosed in three centres of two countries (Italy and The Netherlands) by means of a population-based inception cohort study. Of this group of patients, 160 (79%) were interviewed and examined by a rheumatologist and a gastroenterologist in the period June-September 1996. A total of 139/160 patients had an antero-posterior radiograph of the pelvis, and in 140/160 HLA-B27 was determined. RESULTS: 53 (33.1%) of the 160 patients had experienced at least one musculoskeletal manifestation, 29 (18.1%) satisfied the European Spondylarthropathy Study Group (ESSG) criteria for spondylarthropathy and 5 (3.1%) satisfied the modified New York criteria for ankylosing spondylitis. However, 23 (14.4%) patients developed one or more spondylarthropathy-related manifestations without fulfilling any of the classification criteria. In patients satisfying ESSG criteria a significantly higher frequency of women (P = 0.03), of ocular and liver involvement (P = 0.01 and P = 0.03, respectively), and use of immunosuppressive drugs (P = 0.02) was observed. CONCLUSION: Our study shows a high prevalence of musculoskeletal manifestations in an inception cohort of IBD patients. The clinical spectrum is broader than that defined by spondylarthropathy criteria.

Adult↗
PubMed2005

Scope for improvement in the quality of reporting of systematic reviews. From the Cochrane Musculoskeletal Group.

OBJECTIVE: To assess the quality of reporting in Cochrane musculoskeletal systematic reviews (excluding back and injury reviews). METHODS: This study assessed all the Cochrane Musculoskeletal Group's systematic reviews from Issue 4, 2002, of the Cochrane Library Database of Systematic Reviews. Two reviewers independently extracted data and assessed quality. Two assessment tools were used, including an 18 item checklist and flow chart developed by the Quality of Reporting of Meta-analysis (QUOROM) consensus group, and a 10 item scale, the Oxman-Guyatt Overview Quality Assessment Questionnaire (OQAQ). One question on the latter scale (item 10) scores overall quality on a 7 point scale, with high scores indicating superior quality. Data were analyzed using univariate approaches. RESULTS: The 57 systematic reviews assessed were found to have good overall quality, with scores on individual items revealing only minor flaws. Documenting the flow of included and excluded studies and summarizing the results are 2 areas needing improvement in reporting. According to the Oxman-Guyatt scale the overall scientific quality of the Cochrane musculoskeletal reviews was good [mean 5.02 (95% CI 3.71-6.32)]. CONCLUSION: Our study found that the reporting quality of Cochrane musculoskeletal systematic reviews was generally good, although there was room for improvement. For example, it might be feasible to develop specific guidelines for reporting protocols. Certainly more work is needed in reporting search results, documentation of the flow of studies, identification of the type of studies, and summarization of the key findings.

Evidence-Based Medicine↗
PubMed2006

Infection and musculoskeletal conditions: Osteomyelitis.

Osteomyelitis can result from hematogenous or contiguous microbial seeding of the bone. Staphylococcus aureus is the most common infecting microorganism. Although any bone can potentially develop osteomyelitis, long-bone, vertebral, and foot osteomyelitis account for the majority of cases. Confirmatory diagnosis of osteomyelitis often depends on the results of a bone biopsy and bone cultures. Radiologic and laboratory studies are often helpful in leading to the diagnosis, determining the extent of the disease, and following up selected patients with osteomyelitis. Optimal therapy for osteomyelitis requires the collaboration of a multidisciplinary team of physicians. Debridement is often needed in contiguous osteomyelitis, whereas acute hematogenous and vertebral osteomyelitis can often be treated with a prolonged course of antimicrobial therapy.

Acquired Hyperostosis Syndrome↗
PubMedDate not supplied

Unusual musculoskeletal manifestations of Lyme disease.

We report on the imaging features of musculoskeletal abnormalities in a 52-year-old woman suffering from Lyme disease presenting with acrodermatitis chronica atrophicans (ACA). The patient developed recurrent attacks of migratory asymmetrical oligoarthritis, involving articular and peri-articular structures, including the metatarsophalageal (MTP) joints, scapular bone, thoracic spine, elbow, gluteal area, knee, ankle and metacarpophalangeal (MCP) joints. Six months after the first symptoms, Magnetic Resonance Imaging (MRI) showed bone marrow oedema within the proximal phalanx of the right fifth toe, adjacent to an ACA rash. A year after the onset of the disease, swelling at the right scapular region occurred, and MRI showed osseous, periosteal and soft tissue involvement of the superior margin of the right scapula and adjacent rib. On MRI of the spine, there was bone marrow infiltration with irregular delineation of the anterior corner of the thoracic vertebrae 4 to 6, corresponding to an osteoblastic bony lesion on radiographic examination. This case report is unique, because MRI documentation of bony abnormalities and periarticular soft tissue swelling, accompanying an attack of ACA has never been reported previously. Moreover, involvement of the osseous spine and the scapular bone have never been described in the radiological literature.

Acrodermatitis↗
PubMed1991

Small area analysis of hospital discharges for musculoskeletal diseases in Michigan: the influence of socioeconomic factors.

PURPOSE: The rise in health care costs has occasioned a number of initiatives in an attempt to reduce the rate of increase. Despite the growth of health maintenance organizations and preferred provider organizations and the introduction of Medicare's prospective payment system, health care costs have continued to increase. Coincident with these efforts, a number of researchers have shown that there exists wide variation in age-adjusted hospital discharge rates, which translate into significant variation in per capita expenditures. Much of the focus on the reasons for hospital admission variability has been on physician practice variation. If most of the variation in hospital discharge rates is due to physician practice style, then payment systems can be developed (e.g., capitation) that limit physician practice variation without harming patients. We examined socioeconomic factors in Michigan communities to assess their association with hospital discharge rates for patients with musculoskeletal diseases. PATIENTS AND METHODS: Data on hospital discharges from 1980 and 1987 were taken from the Michigan Inpatient Data Base. All admissions from the major diagnostic category 8, diagnosis-related group (DRG) 209-256 were included. Zip code-specific hospitalization data were grouped into small geographic areas or hospital market communities (HMCs). Discharge rates were calculated, and profiles of the socioeconomic characteristics of each of the HMCs were developed. A Poisson regression model with an extrasystematic component of variance was used to analyze the association of HMC socioeconomic characteristics with age-adjusted hospital use. RESULTS: We found that four socioeconomic variables, average annual income per capita, percent of the population with four years of college, percent of the population living in an urban area, and percent of families with incomes below the poverty line, explained 26.6% (R2) of the variation in overall hospital discharge rates (p less than 0.001). Moreover, we found that the ability of the model to explain variability was influenced by the type of disease, and that these socioeconomic variables had a consistent effect across the range of DRGs. Finally, we noted that, over the period of 1980 to 1987, socioeconomic factors remained important in explaining hospital use despite the dramatic changes in the delivery of care over this period. CONCLUSION: Socioeconomic factors play a significant role in explaining the observed variation in hospital discharge rates for musculoskeletal diseases. Models utilizing only physician practice variation to account for the population-based differences in discharge rates are overly simplistic. In order to ensure that vulnerable subsets of the population are not harmed by the introduction of cost-containment strategies based on simplistic models, more attention must be paid to the socioeconomic and epidemiologic factors related to hospital use.

Bone Diseases↗
PubMed2004

Musculoskeletal injuries associated with selected university staff and faculty in an office environment.

A research team with backgrounds in occupational therapy, rehabilitation, policy and rulemaking, and prevention programs affecting occupational health and safety designed, validated, and analyzed an ergonomics survey of university staff and faculty. The purpose of the study was to validate identified risk factors from the literature contributing to work-related musculoskeletal disorders (WRMDs) in an office setting within a university setting. The study was also designed to determine differences between faculty and staff in the university setting and their exposure to physical risk factors to WRMDs. The results suggest faculty have their keyboard in awkward positions more frequently than staff, and staff had more experience with mechanical stress than faculty. The researchers recommend parameters for the design of a university ergonomics program based on employee and education, management commitment, medical case management, problem job identification, and development of solutions.

Adult↗
PubMed2006

Risk factors for musculoskeletal discomfort in nurses.

Although musculoskeletal problems are commonly reported among the working population, including nurses, the prevalence and risk factors for musculoskeletal discomfort in nurses have not been extensively studied in Taiwan. To understand the risk factors and prevalence of musculoskeletal discomfort in different body parts among nurses in Taiwan, we performed a cross-sectional study using a self-administered questionnaire to collect data. A total of 5,269 (93%) nurses completed the questionnaire survey. Musculoskeletal discomfort was found to be prevalent in this group. In terms of location, the lower back was the most commonly reported site of discomfort, followed by lower legs, shoulders and neck. Considering limitation of motion as an indicator of musculoskeletal discomfort severity, the highest levels of prevalence were reported, respectively, in the lower back, shoulder, lower leg, and wrist. Numbness was most commonly reported in lower legs, hands, thighs, and lower back. Risk factors for pain in shoulders/neck included waist-bending and waist-twisting, while those for lower back pain included duration of standing, waist-bending, and weight-lifting. Risk factors for lower leg pain included duration of standing and weight-lifting. Musculoskeletal discomfort was prevalent among nurses (91.6%). Pain in different body parts was related to different ergonomic risk factors while at work, namely, bending and twisting of the waist, and standing for extended periods of time. The development and testing of interventions to minimize these risk factors is warranted in future studies.

Adult↗
PubMed2006

The ICF comprehensively covers the spectrum of health problems encountered by health professionals in patients with musculoskeletal conditions.

OBJECTIVES: The objective of this study was to investigate, whether the International Classification of Functioning, Disablity and Health (ICF) comprehensively covers the spectrum of health problems encountered by medical doctors and physiotherapists in patients with musculoskeletal conditions. METHODS: A worldwide e-mail survey with questionnaires that requested lists of relevant areas in the ICF components-body functions, body structures, activities and participation, and environmental factors-in patients with rheumatoid arthritis, osteoarthritis, low back pain and osteoporosis was conducted. The suitability of linking the named concepts to the ICF as well as the precision of the linking was characterized by assigning the concepts to six groups. RESULTS: All concepts that were named by the experts could be linked to the ICF, with the exception of personal factors. Between 32% (environmental factors) and 51% (activities and participation) of the named concepts were linked to an ICF category with an identical meaning and the same grade of precision. All other named concepts were linked to ICF categories with a lower level of precision, or encompassed more than one ICF category, or were linked to an ICF category with a related, but not identical meaning. CONCLUSIONS: The ICF covers comprehensively the spectrum of problems encountered in patients with musculoskeletal conditions by clinical experts throughout the world. This strengthens the validity of the ICF in the view of the users and will encourage the use of ICF-based applications such as the ICF checklist and the now-developed ICF Core Sets.

Activities of Daily Living↗
PubMed2003

Perception differences between groups of employees identifying the factors that influence a return to work after a work-related musculoskeletal injury.

Employee health and productivity losses as a result of work-related injury are estimated to be US dollars 1.2 trillion annually to US companies. This is approximately 14.3% of the gross domestic product [6,8,11,35]. Workers' compensation, medical care, and short and long-term disability are a part of these costs. Controlling or eliminating these costs is a problem for US employers [3,6,14,21,29]. The study discussed in this article examined the perceptions of manufacturing employees in identifying factors that influence a return to work after a work-related musculoskeletal injury. The classification of employees who participated in this study were safety professionals, supervisors and workers from the manufacturing industry in central Kentucky. The worker group consisted of material handlers, assembly line workers and quality control inspectors. The participants completed a developed survey instrument, the Return to Work Perception Survey. This survey instrument examined the perception of the participants on factors related to return to work: company policies and procedures, job satisfaction, worker relationships and work environment. The results indicated safety professionals and supervisors perceptions differ from workers on the variables of job satisfaction, worker relationships and work environment. Their perceptions did not differ on the variable relating to company policies and procedures. In addition, the safety professional and supervisor groups rated the items addressing job satisfaction higher than did the worker group. The worker group did not differ from one another on any of the factors. Implications of this study for manufacturing companies suggest (a). identifying those issues contributing to employee job satisfaction, (b). developing a plan for achieving increased job satisfaction and employee recognition at the workplace among all workers, and (c). consider allowing employees to develop new capacities and new learning, thus fostering motivation and job satisfaction [18,20].

Adult↗
PubMed2001

Spasticity management in the child with spastic quadriplegia.

In children with spastic quadriplegia, also described as 'whole body involvement', spasticity can interfere with motor function, contributes to the development of deformities and adversely impacts on care, positioning, and comfort. In this population, spasticity interventions address goals such as improving comfort, reducing pain, easing the burden of carers, slowing the progression of musculoskeletal deformities and perhaps improving function. Children with severe diplegia are distinguished from those with quadriplegia by their ability to ambulate, as well as by a greater emphasis being placed on functional motor goals even though similar treatment modalities are often employed to manage spasticity. The many treatment options currently available include, but are not limited to, botulinum toxin type A, phenol neurolysis, oral medications, intrathecal baclofen, selective dorsal rhizotomy, and orthopaedic surgery. The integration of these treatment modalities can help to optimize the overall care and function for a child with spastic quadriplegia or severe diplegia. However, the development of a management programme is complex and needs to take into account many factors, including age, weight and nutritional status, rate of progression of musculoskeletal deformities, developmental potential, comorbid conditions, current functional status and prognosis, and family and patient treatment goals. Children with marked spasticity are likely to benefit from a combination of interventions, rather than a single treatment modality. Because of these complexities, management should be planned and coordinated by a multidisciplinary team of medical and allied health professionals which recognizes the central role of the family in all decisions. Once the special characteristics of the child with spastic quadriplegia and the various treatment options are understood, outcomes can be maximized.

Child↗
PubMed2007

Adiposity, physical fitness and incident diabetes: the physical activity longitudinal study.

AIMS/HYPOTHESIS: The purpose of this study was to investigate the relationships among adiposity, physical activity, physical fitness and the development of diabetes in a diverse sample of Canadians. METHODS: The sample included 1,543 adults (709 men and 834 women) from the Canadian Physical Activity Longitudinal Study who were free of diabetes at baseline (1988). Several indicators of adiposity (BMI, waist circumference, WHR, sum of skinfold thicknesses), musculoskeletal fitness (sit-ups, push-ups, grip strength, trunk flexibility), cardiorespiratory fitness (maximal metabolic equivalents [METs]) and leisure-time physical activity levels were measured at baseline. Participants were followed until 2002-2004 for the ascertainment of new cases of diabetes. RESULTS: The 15.5-year cumulative incidence of diabetes was 5.0% (5.2% in men, 4.9% in women). Adiposity and physical fitness, but not physical activity, were significant predictors of diabetes after adjustment for age, sex and several covariates. For each standard deviation of the indicators of adiposity, the risk of diabetes was 99-194% higher. Conversely, the risk was 70 and 61% lower for each standard deviation of maximal METs and composite musculoskeletal fitness score, respectively. Receiver operating characteristic curve analyses confirmed that neither adiposity nor physical fitness provided a superior prediction of incident diabetes. CONCLUSIONS/INTERPRETATION: Adiposity and physical fitness were both important predictors of the development of diabetes in this cohort of Canadians.

Adipose Tissue↗
PubMed2006

The case for patient-centered care in orthopaedics.

Now is a critical time to develop a patient-centered care model in the field of orthopaedic surgery. Patient-centered care is defined by the American Academy of Orthopaedic Surgeons as the provision of safe, effective, and timely musculoskeletal care achieved through cooperation between the orthopaedic surgeon; an informed, respected patient (and family); and a coordinated health care team. Patient-centered care, a paradigm shift from disease-centered care, is being championed by government agencies, patient advocacy groups, and insurance companies. Orthopaedic organizations must develop a comprehensive education program to provide surgeons the tools they need to navigate this paradigm shift.

Adult↗
PubMed1999

Current techniques for assessing physical exposure to work-related musculoskeletal risks, with emphasis on posture-based methods.

Physical exposure to risks for potential work-related musculoskeletal injuries has been assessed using a variety of methods, including pen and paper based observation methods, videotaping and computer-aided analysis, direct or instrumental techniques, and various approaches to self-report assessment. These methods are critically reviewed in this paper. The applications of these techniques in ergonomic and epidemiologic studies are considered, and their advantages and shortcomings are highlighted. Finally, a strategy that considers both the ergonomics experts' view and the practitioners' needs for developing a practical exposure assessment tool is then discussed.

Electronic Data Processing↗
PubMedDate not supplied

The Human Genome Project: implications for the treatment of musculoskeletal disease.

The ultimate goal of the Human Genome Project is the determination of the molecular sequence of the entire human chromosomal complement. Realization of this goal will include characterization of all the genes that cause or predispose to disease, which will most certainly lead to the development of powerful new tools for diagnosis, prevention, and treatment in all medical fields, including orthopaedics. The authors review the fundamentals of human genetics and gene mapping, summarize the progress of the Human Genome Project thus far, and discuss the implications of this research as it relates to the treatment of musculoskeletal diseases.

Chromosome Mapping↗
PubMed1997

Correspondence between theoretical models and dual energy x-ray absorptiometry measurements of femoral cross-sectional growth during adolescence.

We have developed an analytical model of long bone cross-sectional ontogeny in which appositional growth of the diaphysis is primarily driven by mechanical stimuli associated with increasing body mass during growth and development. In this study, our goal was to compare theoretical predictions of femoral diaphyseal structure from this model with measurements of femoral bone mineral and geometry by dual energy x-ray absorptiometry. Measurements of mid-diaphyseal femoral geometry and structure were made previously in 101 Caucasian adolescents and young adults 9-26 years of age. The data on measured bone mineral content and calculated section modulus were compared with the results of our analytical model of cross-sectional development of the human femur over the same age range. Both bone mineral content and section modulus showed good correspondence with experimental measurements when the relationships with age and body mass were examined. Strong linear relationships were evident for both parameters when examined as a function of body mass.

Absorptiometry, Photon↗
PubMed2004

Load transfer across the scapula during humeral abduction.

Stress analysis in the individual parts of the scapula under normal physiological conditions is necessary to understand the load transfer mechanism, its relation with morphology of bone and to analyse the deviations in stress patterns due to implantation of the glenoid. The purpose of this study was to obtain stress distribution in the scapula during abduction of the arm and to obtain a qualitative estimate of the function of coracoacromial ligament. An accurate three-dimensional (3D) finite element (FE) model of the natural scapula has been developed for this purpose, using computed tomography data and shell-solid modelling approach. The model was experimentally validated. A musculoskeletal shoulder model of forces that calculates all muscle, ligament and joint reaction forces, in six load cases (30-180 degrees) during unloaded humeral abduction was used as applied loading conditions for the 3D FE model. High tensile and compressive stresses (15-60 MPa) were generated in the thick bony ridges of the scapula, like the scapular spine, lateral border, glenoid and acromion. High compressive stresses (45-58 MPa) were evoked in the glenoid and at the connection of glenoid-scapular spine-infraspinous fossa. The stresses in the infraspinous fossa and supraspinous fossa were low (0.05-15 MPa). These results indicated that the transfer of major muscle and joint reaction take place predominantly through the thick bony ridges, whereas the fossa area act more as attachment sites of large muscles. During humeral abduction, coracoacromial ligament was stretched, and presumably will be under tension.

Biomechanical Phenomena↗
PubMed2006

Biomechanics of side impact: injury criteria, aging occupants, and airbag technology.

This paper presents a survey of side impact trauma-related biomedical investigations with specific reference to certain aspects of epidemiology relating to the growing elderly population, improvements in technology such as side airbags geared toward occupant safety, and development of injury criteria. The first part is devoted to the involvement of the elderly by identifying variables contributing to injury including impact severity, human factors, and national and international field data. This is followed by a survey of various experimental models used in the development of injury criteria and tolerance limits. The effects of fragility of the elderly coupled with physiological changes (e.g., visual, musculoskeletal) that may lead to an abnormal seating position (termed out-of-position) especially for the driving population are discussed. Fundamental biomechanical parameters such as thoracic, abdominal and pelvic forces; upper and lower spinal and sacrum accelerations; and upper, middle and lower chest deflections under various initial impacting conditions are evaluated. Secondary variables such as the thoracic trauma index and pelvic acceleration (currently adopted in the United States Federal Motor Vehicle Safety Standards), peak chest deflection, and viscous criteria are also included in the survey. The importance of performing research studies with specific focus on out-of-position scenarios of the elderly and using the most commonly available torso side airbag as the initial contacting condition in lateral impacts for occupant injury assessment is emphasized.

Accidents, Traffic↗