Burden Of Musculoskeletal Disease Research Articles

Global, Regional, and National Change Patterns in the Incidence of Low Back Pain From 1990 to 2019 and Its Predicted Level in the Next Decade.

Objectives: To analyze and describe the spatiotemporal trends of Low back pain (LBP) burdens from 1990 to 2019 and anticipate the following decade's incidence. Methods: Using data from the Global Burden of Disease (GBD) 2019 Study, we described net drifts, local drifts, age effects, and period cohort effects in incidence and forecasted incidence rates and cases by sex from 2020 to 2029 using the Nordpred R package. Results: LBP remained the leading cause of the musculoskeletal disease burden globally and across all socio-demographic index (SDI) regions. China is the top country. For recent periods, high-SDI countries faced unfavorable or worsening risks. The relative risk of incidence showed improving trends over time and in successively younger birth cohorts amongst low-middle-, middle- and high-middle-SDI countries. Additionally, the age-standardized incidence rates (ASIR) of LBP in both sexes globally showed a decreasing trend, but the incident cases would increase from 223 to 253 million overall in the next decade. Conclusion: As the population ages, incident cases will rise but ASIR will fall. To minimise LBP, public awareness and disease prevention and control are needed.

SPECTRAL CHARACTERISTICS OF THE ELECTROMYOGRAPHIC SIGNAL TO ASSESS THE QUALITY OF THERAPY AND REHABILITATION IN PATIENTS WITH LOW BACK PAIN

Disorders and diseases of the musculoskeletal system are the most important factor in the global need for rehabilitation services. Low back pain is the leading cause of the global burden of musculoskeletal disease. Objectification of the assessment of the state of the musculoskeletal system can help in diagnosing and differentiating the patient's conditions, assessing the quality of therapy and rehabilitation. This work is devoted to the analysis of quantitative criteria for assessing the state of the musculoskeletal system according to objective data of electromyographic research.

National Institutes of Health Funding to Departments of Orthopaedic Surgery at U.S. Medical Schools from 2015 to 2021.

National Institutes of Health (NIH) funding of orthopaedic surgery departments has historically lagged behind that of other surgical disciplines. In this study, we present an updated analysis of NIH grants awarded to orthopaedic surgery departments at U.S. medical schools and an evaluation of the characteristics of NIH-funded principal investigators (PIs). The NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) database was queried for grants awarded to orthopaedic surgery departments in the 2015 to 2021 fiscal years. Funding totals were calculated for 4 categories: award mechanism, awarding institute, recipient institute, and PI. Trends in funding from 2015 to 2021 were determined and compared with the annual NIH budget. Funding awarded to orthopaedic surgery departments was compared with awards received by other surgical specialties in 2021. The characteristics of NIH-funded PIs and co-PIs were evaluated. Funding awarded to orthopaedic surgery departments in 2021 was compared with funding in 2014 as reported in a previous study. In 2021, 287 grants were awarded to 187 PIs at 47 orthopaedic surgery departments for a total of $104,710,841, representing 0.4% of the overall NIH budget. The top 5 departments earned $41,750,321 (39.9%) of the total NIH funding for orthopaedic surgery. From 2015 to 2021, total funding increased by 79.7% (p < 0.001), but the rate of increase was not significantly different from that of the overall annual NIH budget (p = 0.469). In 2021, grants were most commonly awarded via the R01 mechanism (70.0% of total funding), with a median annual award of $397,144 (interquartile range [IQR], $335,017 to $491,248). The majority of grants (70.0%) supported basic science research, followed by translational (12.2%), clinical (9.4%), and educational (8.4%) research. NIH funding did not vary by the gender of the PI (p = 0.505), and the proportion of female PIs was significantly greater in 2021 than in 2014 (33.9% versus 20.5%, p = 0.009). Compared with other surgical departments, orthopaedic surgery departments ranked second-lowest in terms of the total NIH funding received in 2021. NIH funding to orthopaedic surgery departments continues to be limited and lags behind that of other surgical subspecialties, which may create challenges in addressing the rising burden of musculoskeletal disease in the U.S. These findings highlight the importance of efforts to identify barriers to grant procurement in orthopaedic surgery.

A Call to Action for Musculoskeletal Research Funding: The Growing Economic and Disease Burden of Musculoskeletal Conditions in the United States Is Not Reflected in Musculoskeletal Research Funding.

As a result of an aging population, musculoskeletal disease is a growing source of health and economic burden in the United States. In 2019, musculoskeletal conditions affected approximately 127.4 million people (more than a third of the U.S. population); they were the top driver of health-care spending in 2016, with an estimated direct annual cost of $380.9 billion. While musculoskeletal conditions represent a substantial and growing burden in terms of prevalence, disability, and health-care costs, National Institutes of Health (NIH) research funding has remained disproportionately allocated to other disease conditions. Therefore, our purpose was to provide an assessment of the current burden of musculoskeletal disease in terms of prevalence, disability, and health-care costs, and compare the changing burden of disease to trends in NIH funding.

Musculoskeletal diseases in Marfan syndrome: a nationwide registry study

BackgroundMarfan syndrome is associated with abnormalities in the musculoskeletal system including scoliosis, pectus deformities, protrusio acetabuli, and foot deformities. Over a life span, many patients with Marfan syndrome will need treatment; however, the musculoskeletal morbidity over a life span is not well described. The aim of the present study was to assess the overall burden of musculoskeletal disease in patients with Marfan syndrome.Materials and methodsA registry-based, nationwide epidemiological study of patients with a Ghent II verified Marfan syndrome diagnosis from 1977 to 2014. Each patient was matched on age, and sex with up to 100 controls from the background population.ResultsWe identified 407 patients with Marfan syndrome and 40,700 controls and compared their musculoskeletal diagnoses and surgical treatments using Cox proportional hazards ratio (HR). The risk of a registration of a musculoskeletal diagnosis in patients with Marfan syndrome was significantly increased compared to controls (HR: 1.94 (1.69–2.24). One out of six with Marfan syndrome was registered with scoliosis (HR: 36.7 (27.5–48.9). Scoliosis was more common in women with Marfan syndrome compared to men (HR: 4.30 (1.73–1.08)). One out of 11 were registered with a pectus deformity HR: 40.8 (28.1–59.3), and one out of six with a deformity of the foot. Primarily pes planus (HR: 26.0 (15.2–44.3). The proportion of patients with Marfan syndrome (94/407) that underwent musculoskeletal surgery was also significantly higher (HR: 1.76 (1.43–2.16)). The major areas of surgery were the spine, pectups correction, and surgery of the foot/ankle. Ten patients with Marfan syndrome had elective orthopedic surgery without being recognized and diagnosed with Marfan syndrome until later in life. None of these had scoliosis, pectus deformity or a foot deformity. Among patients with an aortic dissection, the age at dissection was 34.3 years in those with at least one major musculoskeletal abnormality. In patients without a major abnormality the age at dissection was 45.1 years (p < 0.01).ConclusionsThe extent of musculoskeletal disease is quite significant in Marfan syndrome, and many will need corrective surgery during their life span. Surgeons should be aware of undiagnosed patients with Marfan syndrome when treating patients with a Marfan syndrome like-phenotype.

The Unmet Need for Orthopaedic Services Among American Indian and Alaska Native Communities in the United States.

Historic and present-day marginalization has resulted in a high burden of disease and worse health outcomes for American Indian and Alaska Native (AI/AN) communities in the United States. Musculoskeletal disease is the leading cause of disability for the general population in the U.S. today. However, few have examined musculoskeletal disease burden and access to orthopaedic surgical care in the AI/AN communities. A high prevalence of hip dysplasia, arthritis, back pain, and diabetes, and a high incidence of trauma and road traffic-related mortality, suggest a disproportionately high burden of musculoskeletal pathology among the AI/AN communities and a substantial need for orthopaedic surgical services. Unfortunately, AI/AN patients face many barriers to receiving specialty care, including long travel distances and limited transportation to health facilities, inadequate staff and resources at Indian Health Service (IHS)-funded facilities, insufficient funding for referral to specialists outside of the IHS network, and sociocultural barriers that complicate health-system navigation and erode trust between patients and providers. For those who manage to access orthopaedic surgery, AI/AN patients face worse outcomes and more complications than White patients. There is an urgent need for orthopaedic surgeons to participate in improving the availability of quality orthopaedic services for AI/AN patients through training and support of local providers, volunteerism, advocating for a greater investment in the IHS Purchased/Referred Care program, expanding telemedicine capabilities, and supporting community-based participatory research activities.

Population Health Trends in the Delivery of High Value Care for Knee Osteoarthritis

Osteoarthritis (OA) of the knee is a common and disabling condition that represents around 20% of the global burden of musculoskeletal disease with a lifetime risk estimated at 13%-26%. The escalation in cases is associated with a rise in ageing and obese populations. OA of the knee is also now recognized as a multi-faceted problem affecting not only an individual's physical health but their psychological and social wellbeing. Thus, a condition-focused, whole person approach that encompasses a range of treatment strategies is critical to managing populations with this condition in order to achieve value – an improvement in health outcomes benefiting patients relative to cost. Comprehensive models focused on delivering high value care for knee osteoarthritis that aim to meet the preferences, values, and needs of patient populations with this condition have been developed at The Muskuloskeletal Institute at the University of Texas at Austin, Dell Medical School, and the Joint Health Program, at Duke University Health System. Both programs strive to address the risk factors underlined in this chapter via multi-disciplinary teams and multi-modal approaches that are highly coordinated, continuous over time and between visits, and designed around the patient's needs toward a common goal of value. In this article we discuss the population level impact and health trends associated with knee osteoarthritis, alongside the design, delivery, and impact of these comprehensive models of care delivery.

Multimorbidity and achievement of treatment goals among patients with type 2 diabetes: a primary care, real-world study

BackgroundType 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. have one or more long-term diseases in addition to T2D. Multimorbidity may play a role in the achievement of T2D treatment targets, but is still not fully understood. The aims of the present cross-sectional, register-based study were to evaluate the prevalence and the most common patterns of multimorbidity among patients with T2D; and to study the potential associations between multimorbidity and treatment goal achievement, including measurements of glycosylated haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and systolic blood pressure (sBP).MethodsThe study population consisted of 4545 primary care patients who received a T2D diagnosis between January 2011 and July 2019 in Rovaniemi Health Centre, Finland. Data on seven long-term concordant (T2D-related) diseases, eight long-term discordant (non-T2D-related) diseases, potential confounders (age, sex, body mass index, prescribed medication), and the outcomes studied were collected from patients’ records. Logistic regression models with odds ratios (ORs) and 95 % confidence intervals (CIs) were assessed to determine the associations between multimorbidity and the achievement of treatment targets.ResultsAltogether, 93 % of the patients had one or more diseases in addition to T2D, i.e. were considered multimorbid. Furthermore, 21 % had only concordant disease(s) (Concordant subgroup), 8 % had only discordant disease(s) (Discordant subgroup) and 64 % had both (Concordant and discordant subgroup). As either single diseases or in combination with others, hypertension, musculoskeletal (MS) disease and hyperlipidaemia were the most prevalent multimorbidity patterns. Being multimorbid in general (OR 1.32, CI 1.01–1.70) and belonging to the Concordant (OR 1.45, CI 1.08–1.95) and Concordant and discordant (OR 1.31, CI 1.00–1.72) subgroups was associated with achievement of the HbA1c treatment target. Belonging to the Concordant and discordant subgroup was related to meeting the LDL treatment target (OR 1.31, CI 1.00–1.72).ConclusionsMultimorbidity, including cardiovascular risk and the musculoskeletal disease burden, was extremely prevalent among the T2D patients who consulted primary health care. Primary care clinicians should survey the possible co-existence of long-term diseases among T2D patients to help maintain adequate treatment of T2D.

Acceptance of Telerheumatology by Rheumatologists and General Practitioners in Germany: Nationwide Cross-sectional Survey Study.

BackgroundThe worldwide burden of musculoskeletal diseases is increasing. The number of newly registered rheumatologists has stagnated. Primary care, which takes up a key role in early detection of rheumatic disease, is working at full capacity. COVID-19 and its containment impede rheumatological treatment. Telemedicine in rheumatology (telerheumatology) could support rheumatologists and general practitioners.ObjectiveThe goal of this study was to investigate acceptance and preferences related to the use of telerheumatology care among German rheumatologists and general practitioners.MethodsA nationwide, cross-sectional, self-completed, paper-based survey on telerheumatology care was conducted among outpatient rheumatologists and general practitioners during the pre-COVID-19 period.ResultsA total of 73.3% (349/476) of survey participants rated their knowledge of telemedicine as unsatisfactory, poor, or very poor. The majority of survey participants (358/480, 74.6%) answered that they do not currently use telemedicine, although 62.3% (291/467) would like to. Barriers to the implementation of telemedicine include the purchase of technology equipment (182/292, 62.3%), administration (181/292, 62.0%), and poor reimbursement (156/292, 53.4%). A total of 69.6% (117/168) of the surveyed physicians reckoned that telemedicine could be used in rheumatology. Surveyed physicians would prefer to use telemedicine to communicate directly with other physicians (370/455, 81.3%) than to communicate with patients (213/455, 46.8%). Among treatment phases, 64.4% (291/452) of participants would choose to use telemedicine during follow-up. Half of the participants would choose telecounseling as a specific approach to improve rheumatology care (91/170, 53.5%).ConclusionsBefore COVID-19 appeared, our results indicated generally low use but high acceptance of the implementation of telerheumatology among physicians. Participants indicated that the lack of a structural framework was a barrier to the effective implementation of telerheumatology. Training courses should be introduced to address the limited knowledge on the part of physicians in the use of telemedicine. More research into telerheumatology is required. This includes large-scale randomized controlled trials, economic analyses, and the exploration of user preferences.

Health Economic Evaluations of Hip and Knee Interventions in Orthopaedic Sports Medicine: A Systematic Review and Quality Assessment.

Background:The economic burden of musculoskeletal diseases is substantial and growing. Economic evaluations compare costs and health benefits of interventions simultaneously to help inform value-based care; thus, it is crucial to ensure that studies are using appropriate methodology to provide valid evidence on the cost-effectiveness of interventions. This is particularly the case in orthopaedic sports medicine, where several interventions of varying costs are available to treat common hip and knee conditions.Purpose:To summarize and evaluate the quality of economic evaluations in orthopaedic sports medicine for knee and hip interventions and identify areas for quality improvement.Study Design:Systematic review; Level of evidence, 3.Methods:The Medline, AMED, OVID Health Star, and EMBASE databases were searched from inception to March 1, 2020, to identify economic evaluations that compared ≥2 interventions for hip and/or knee conditions in orthopaedic sports medicine. We assessed the quality of full economic evaluations using the Quality of Health Economic Studies (QHES) tool, which consists of 16 questions for a total score of 100. We classified studies into quartiles based on QHES score (extremely poor quality to high quality) and we evaluated the frequency of studies that addressed each of the 16 QHES questions.Results:A total of 93 studies were included in the systematic review. There were 41 (44%) cost analyses, of which 21 (51%) inappropriately concluded interventions were cost-effective. Only 52 (56%) of the included studies were full economic evaluations, although 40 of these (77%) fell in the high-quality quartile. The mean QHES score was 83.2 ± 19. Authors consistently addressed 12 of the QHES questions; questions that were missed or unclear were related to statistical uncertainty, appropriateness of costing methodology, and discussion of potential biases. The most frequently missed question was whether the cost perspective of the analysis was stated and justified.Conclusion:The number of studies in orthopaedic sports medicine is small, despite their overall good quality. Yet, there are still many highly cited studies based on low-quality or partial economic evaluations that are being used to influence clinical decision-making. Investigators should follow international health economic guidelines for study design and critical appraisal of studies to further improve quality.

The Health & Economic Disparities of Congenital Musculoskeletal Disease Worldwide: An Analysis of 25 Years (1992-2017).

Background: Large disparities exist in congenital musculoskeletal disease burden worldwide. The purpose of this study is to examine and quantify the health and economic disparities of congenital musculoskeletal disease by country income level from 1992 to 2017. Methods: The Global Burden of Disease database was queried for information on disease burden attributed to “congenital musculoskeletal and limb anomalies” from 1992 to 2017. Gross national income per capita was extracted from the World Bank website. Nonparametric Kruskal–Wallis tests were used to compare morbidity and mortality across years and income levels. The number of avertable DALYs was converted to an economic disparity using the human-capital and value of a statistical life approach. Results: From 1992 to 2017, a significant decrease in deaths/100 000 was observed only in upper-middle and high income countries. Northern Africa, the Middle East, and Eastern Europe were disproportionately affected. If the burden of disease in low- and middle- income countries (LMICs) was equivalent to that in high income countries (HICs), 10% of all DALYs and 70% of all deaths attributable to congenital musculoskeletal disease in LMICs could be averted. This equates to an economic disparity of about $2 billion to $3 billion (in 2020 $USD). Conclusion: Considerable inequity exists in the burden of congenital musculoskeletal disease worldwide and there has been no change over the last 25 years in total disease burden and geographical distribution. By reducing the disease burden in LMICs to rates found in HICs, a large proportion of the health and economic consequences could be averted.

Elderly musculoskeletal disease burden in Karachi, Pakistan: Associations and implications for developing countries.

ObjectiveThe global rise in the older population has increased the rates of osteoporosis and osteoarthritis, conditions that impact mobility and functionality. There is limited data on musculoskeletal disease in older populations residing in developing countries.MethodsA community‐based study using multistage cluster random sampling of older individuals was conducted in Karachi. Predefined criteria were used for osteoporosis and osteoarthritis. Gait assessment was performed.ResultsMore than half of the participants were females and 53% reported illiteracy. Around 30% had osteoporosis and two‐thirds had osteoarthritis. Multivariate analysis showed associations of female sex, Pashtun ethnicity, illiteracy, and hypertension with the combined variable of osteoporosis and osteoarthritis.ConclusionsThe prevalence of osteoarthritis was higher than in other regional studies. Presence of both osteoporosis and osteoarthritis increased the risk of certain geriatric syndromes. High rates of musculoskeletal morbidity are seen in the elderly in Pakistan. Measures at a health‐system level are required for better outcomes in older adults.

Case Studies AAOS Clinical Practice Guideline: Management of Rotator Cuff Injuries.

Shoulder disease is a major cause of musculoskeletal disability in the United States. Chronic shoulder pain has been estimated to affect approximately 8% of all American adults, second only to chronic knee pain in our society's burden of musculoskeletal disease. Rotator cuff pathology is the leading cause of shoulder-related disability seen by orthopaedic surgeons, and surgical volume is on the rise. One study, for example, notes a 141% increase in rotator cuff repairs from 1996 to 2006 in the United States. Because rotator cuff disease is such a common condition with evidence of various strength supporting different common treatments, the American Academy of Orthopaedic Surgeons published a clinical practice guideline to help elucidate best practices for its treatment. A summary of these guidelines with the strength of the recommendations is available at OrthoGuidelines (http://www.orthoguidelines.org/topic?id=1027) with links to rationale behind each of the conclusions. This study will illustrate the use of these guidelines through presentation and discussion of hypothetical clinical cases.

Capacity building for the provision of rheumatological services in sub-Saharan Africa.

A project aimed to develop and deliver a clinical training course in Accra, Ghana, to increase patient access to physicians trained in the diagnosis, treatment and management of rheumatological conditions. We started with a scoping exercise followed by collaborative course curriculum development, co-delivered training course facilitated by both locally based rheumatologists and international faculty members. Evaluation data gathered from application forms, participant feedback forms and multiple-choice tests completed at the beginning and end of training and the test scores compared to evaluate a change in knowledge. A 4-day clinical training course developed and delivered to twenty medical professionals based across Ghana. Test scores suggest a 15.83% increase in clinical knowledge. The training model with the curriculum design and delivery teams drawing expertise from both locally based rheumatologists and internationally based faculty has guaranteed both world-class approach and content while ensuring contextual relevance. The inclusion of leadership and Training of Trainer (ToT) elements into the model of training has maximised reach and increased teaching capacity. The programme has been well-received by participating medical professionals and faculty and has been demonstrated to be effective within this multinational programme and the methodology may be applicable to similar needs in other countries. Key Points • The growing burden of musculoskeletal disease in West Africa means that strengthening capacity in the specialty of rheumatology is more important than ever. • A pilot workshop to strengthen capacity in rheumatology care in Ghana with the curriculum design and delivery teams drawing expertise from both the UK and West Africa has guaranteed both world-class approach and content while ensuring contextual relevance. • The programme has been well-received by participating medical professionals and faculty and may be applicable to similar needs in other countries across sub-Saharan Africa.

MD-PhD graduates remain underrepresented in orthopaedic surgery: National MD-PhD Program Outcome Survey update.

With the dramatic expansion of the biomedical knowledge base and increasing demands for evidence-based medicine, the role of the clinician-scientist is becoming increasingly important. In orthopaedic surgery, clinician-scientists are at the forefront of translational efforts to address the growing burden of musculoskeletal disease, yet MD-PhD trained investigators have historically been underrepresented in this field. Here, we examine the trend, over time, of MD-PhD graduates pursuing orthopaedic surgery, compared with other specialties. Survey data from the 2018 Association of American Medical Colleges National MD-PhD Program Outcomes Study, including data on 4,647 individuals who had completed residency training and 2,124 who were still in training, were reanalyzed. Numbers, proportions, workplace choice, and percent research effort of MD-PhD graduates completing orthopaedic surgery were compared with other surgical and nonsurgical specialties. Trends over time were analyzed by linear regression. While a decreasing proportion of MD-PhD graduates completed internal medicine training, just 1.1% of MD-PhD graduates completed orthopaedic surgery training, lower than that of all other surgical specialties. The proportion of MD-PhD graduates completing orthopaedic surgery has not increased over time and was mirrored in MD-PhD residents still in training. Though MD-PhDs are increasingly choosing to pursue "nontraditional" specialties, they remain underrepresented in orthopaedic surgery, compared with other clinical disciplines. Thus, there exists an opportunity to encourage MD-PhD graduates to pursue careers in orthopaedic surgery, to supplement the existing intellectual capital in the orthopaedic science workforce. This, along with other strategies to support all orthopaedic surgeon-scientists, will ultimately advance the care of musculoskeletal diseases.

Exposure to heavy physical work from early to later adulthood and primary healthcare visits due to musculoskeletal diseases in midlife: a register linked study

ObjectivesTo examine whether exposure to heavy physical work from early to later adulthood is associated with primary healthcare visits due to cause-specific musculoskeletal diseases in midlife.DesignProspective cohort study.SettingNationally representative Young...

Burden of musculoskeletal diseases increasing.

Burden of musculoskeletal diseases increasing.

The world-wide burden of musculoskeletal diseases: a systematic analysis of the World Health Organization Burden of Diseases Database

BackgroundMusculoskeletal (MSK) diseases are expected to have a growing impact worldwide.ObjectiveTo analyse the worldwide burden of MSK diseases from 2000 to 2015.MethodsDisability-adjusted life years (DALYs), which combines the years of...

Carrying water may be a major contributor to disability from musculoskeletal disorders in low income countries: a cross-sectional survey in South Africa, Ghana and Vietnam.

BackgroundThe Sustainable Development Goals include commitments to end poverty, and promote education for all, gender equality, the availability of water and decent work for all. An important constraint is the fact that each day, many millions of women and children, and much less frequently men, carry their household’s water home from off-plot sources. The burden of fetching water exacerbates gender inequality by keeping women out of education and paid employment. Despite speculation about the potential health impacts of fetching water, there is very little empirical evidence. We report the first large study of the health impacts of carrying water on women and children.MethodsA cross-sectional survey was conducted in South Africa, Ghana and Vietnam during 2012. It investigated water carrying methods and health status. Because areas of self-reported pain were correlated we undertook factor analysis of sites of reported pain, to interpret patterns of pain reporting. Regression analysis using Generalised Estimating Equations (GEE) investigated water carrying as a risk factor for general health and self-reported pain.ResultsPeople who previously carried water had increased relative risk of reporting pain in the hands (risk ratio RR 3.62, 95% confidence interval CI 1.34 to 9.75) and upper back (RR 2.27, 95% CI 1.17 to 4.40), as did people who currently carry water (RR hand pain 3.11, 95% CI 1.34 to 7.23; RR upper back pain 2.16, 95% CI 1.25 to 3.73). The factor analysis results indicate that factor 1, ‘axial compression’, which is correlated with pain in the head and upper back, chest/ribs, hands, feet and abdomen/stomach, is associated with currently (0.30, 95% CI 0.17 to 0.43) or previously (0.21, 95% CI 0.01 to 0.42) carrying water. Factor 2, ‘soft tissue strain’, which is correlated with pain in the neck, shoulders/arms, lower back and hips/pelvis or legs, is marginally negatively associated with currently (-0.18, 95% CI -0.32 to -0.04) carrying water. The factor ‘axial compression’ was more strongly associated with carrying water containers on the head.ConclusionsParticipants who reported a history of current or past water carrying more frequently reported pain in locations most likely to be associated with sustained spinal axial compression in the cervical region. Given the fact that cervical spinal conditions are globally one of the more common causes of disability, our findings suggest that water carrying, especially by head loading is a major contributing factor in musculoskeletal disease burden in low income countries. Our findings support the proposed indicator for monitoring SDG6.1: “Percentage of population using safely managed drinking water services at home.”

Access to Orthopaedic Surgical Care in Northern Tanzania: A Modelling Study

The global burden of musculoskeletal disease and resulting disability is enormous and is expected to increase over the next few decades. In the world's poorest regions, the paucity of information defining and quantifying the current state of access to orthopaedic surgical care is a major problem in developing effective solutions. This study estimates the number of individuals in Northern Tanzania without adequate access to orthopaedic surgical services. A chance tree was created to model the probability of access to orthopaedic surgical services in the Northern Tanzanian regions of Arusha, Kilimanjaro, Tanga, Singida, and Manyara, with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. Timeliness was estimated by the proportion of people living within a 4-h driving distance from a hospital with an orthopaedic surgeon, capacity by comparing number of surgeries performed to the number of surgeries indicated, safety by applying WHO Emergency and Essential Surgical Care infrastructure and equipment checklists, and affordability by approximating the proportion of the population protected from catastrophic out-of-pocket healthcare expenditure. We accounted for uncertainty in our model with one-way and probabilistic sensitivity analyses. Data sources included the Tanzanian National Bureau of Statistics and Ministry of Finance, World Bank, World Health Organization, New Zealand Ministry of Health, Google Corporation, NASA population estimator, and 2015 hospital records from Kilimanjaro Christian Medical Center, Machame Hospital, Nkoroanga Hospital, Mt. Meru Hospital, and Arusha Lutheran Medical Center. Under the most conservative assumptions, more than 90% of the Northern Tanzanian population does not have access to orthopaedic surgical services. There is a near absence of access to orthopaedic surgical care in Northern Tanzania. These findings utilize more precise country and region-specific data and are consistent with prior published global trends regarding surgical access in Sub-Saharan Africa. As the global health community must develop innovative solutions to address the rising burden of musculoskeletal disease and support the advancement of universal health coverage, increasing access to orthopaedic surgical services will play a central role in improving health care in the world's developing regions.