Burden Of Musculoskeletal Disorders Research Articles

From Pain to Progress: Comprehensive Analysis of Musculoskeletal Disorders Worldwide.

Comprehensive analyses of the burden of musculoskeletal disorders (MSDs) are crucial for deepening our understanding of their impact on population health and for evaluating progress toward achieving international health goals. A comprehensive analysis was performed using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. We gathered data on the number of prevalent cases, incidences, deaths, and disability-adjusted life years (DALYs) for MSDs from 1990 to 2021. Subsequently, crude indicators, age-standardized rates (ASRs) and estimated annual percentage change (EAPC) were calculated for MSDs from 1990 to 2021 at the global, regional, national, age and gender levels. Finally, decomposition analysis, frontier analysis, and EAPC cluster analysis were employed to examine changes in the indicators and the factors influencing them. In 2021, there were 367,193,430 incident cases and 1,686,561,517 prevalent cases of MSDs globally. Between 1990 and 2021, the age-standardized incidence rates (ASIR) declined marginally from 4641.5 to 4351.79 cases per 100,000 population [EAPC: -0.16 (-0.19 to -0.13)], while the age-standardized DALY rates (ASDR) increased from 1886.2 to 1908.87 per 100,000 population [EAPC: 0.09 (0.07 to 0.11)]. The ASRs were markedly elevated in the high SDI regions in comparison to the remaining SDI regions. The EAPC and its phase clustering analyses indicated a notable upward trajectory in the burden of MSDs in the low and middle SDI regions, particularly in Central Asia. The prevalence of MSDs is highest among individuals aged 50-59 years and among women. At the global level, the burden of MSDs is 1.43 to 2.30 times higher for women than for men. From 1990 to 2021, the burden of MSDs has been concentrated in high SDI regions, with a gradual shift towards low and middle SDI regions.

Potential and Limitations of Induced Pluripotent Stem Cells-Derived Mesenchymal Stem Cells in Musculoskeletal Disorders Treatment.

The burden of musculoskeletal disorders (MSK) is increasing worldwide. It affects millions of people worldwide, decreases their quality of life, and can cause mortality. The treatment of such conditions is challenging and often requires surgery. Thus, it is necessary to discuss new strategies. The therapeutic potential of mesenchymal stem cells (MSC) in several diseases has been investigated with relative success. However, this potential is hindered by their limited stemness and expansion ability in vitro and their high donor variability. MSC derived from induced pluripotent stem cells (iPSC) have emerged as an alternative treatment for MSK diseases. These cells present distinct features, such as a juvenile phenotype, in addition to higher stemness, proliferation, and differentiation potential than those of MSC. Here, we review the opportunities, challenges, and applications of iPSC as relevant clinical therapeutic cell sources for MSK disorders. We discuss iPSC sources from which to derive iMSC and the advantages and disadvantages of iMSC over MSC as a therapeutic approach. We further summarize the main preclinical and clinical studies exploring the therapeutic potential of iMSC in MSK disorders.

The burden of musculoskeletal disorders in the Middle East and North Africa (MENA) region: a longitudinal analysis from the global burden of disease dataset 1990—2019

BackgroundMusculoskeletal (MSK) disorders are one of the main causes of disability among adults globally. The burden of MSK disorders varies greatly between different regions and is the highest in low- and middle income- countries. This study sought to investigate trends in the burden of MSK disorders across the MENA region, utilizing the GBD 2019 dataset.MethodsThis ecological study utilized data from the Global Burden of Disease (GBD) to report on the burden of musculoskeletal (MSK) disorders in The Middle East and North Africa (MENA) region between 1990 and 2019. Our analysis involved descriptive statistics and sociodemographic trends and did not employ any specific statistical analyses. Using age-standardized rates of prevalence and disability-adjusted life-years (DALYs), we reported trends in the burden of MSK disorders, as well as national variation between different countries. Furthermore, we analyzed trends in risk factors contributing to MSK disorders by age and gender.ResultsThe longitudinal analysis from 1990 to 2019 showed an increase in the age-standardized rate for prevalence and DALYs of MSK disorders by 5% and 4.80%, respectively. Low back pain continued to be the most prevalent MSK condition, while RA and other MSK disorders had the largest percentage increase for DALYs between 1990 and 2019. The study found that Afghanistan had the lowest age standardized DALYs rate attributed to MSK disorders, while Iran, Turkey, and Jordan had the highest. Further, Syria showed the most dramatic decrease while Saudi Arabia had the most notable increase in age standardized DALY rates from 1990 to 2019. In 2019, occupational risks, high body mass index, and tobacco smoking were the main risk factors for MSK disorders, with occupational risks being the largest contributor, and between 1990 and 2019, there was a decrease in the contribution of occupational risks but an increase in the contribution of high body mass index as a risk factor.ConclusionThis study highlights the significant burden of MSK disorders in the MENA region, with various risk factors contributing to its increasing prevalence in recent decades. Further research is needed to better understand the underlying factors and potential interventions that could improve health outcomes. Addressing MSK disorders should be a public health priority in the region, and efforts should be made to develop effective strategies to prevent and manage this debilitating condition.

Musculoskeletal Disorder Burden and Its Attributable Risk Factors in China: Estimates and Predicts from 1990 to 2044.

Musculoskeletal disorders are one of the three major disabling diseases in the world. However, the current disease burden in China is not well-known. This study aimed to explore the burden and risk factors of musculoskeletal disorders in China from 1990 to 2019, predicting the incidence trend from 2020 to 2044. All data were extracted from the Global Burden of Disease Study 2019 (GBD 2019). Joinpoint regression and age-period-cohort (APC) models were selected to analyze the epidemic trend, and descriptive analyses of the time trends and age distributions of risk factors were performed. The Bayesian APC model was used to foresee the incidence trend from 2020 to 2044. The results indicated that the burden of musculoskeletal disorders is higher in women and older adults. Its attributable risk factors were found to be tobacco, a high body mass index, kidney dysfunction and occupational risks. In 2044, musculoskeletal disorders in China showed a downward trend for 35-59-year-olds and a slight upward trend for 30-34- and 65-84-year-olds. The 70-74 year age group saw the largest increase in incidence at 4.66%. Overall, the incidence increased with age. Therefore, prevention and control policies should focus on women and the elderly, and health interventions should be carried out based on risk factors.

Patient preferences and decision-making when considering surgery for musculoskeletal disorders: A mixed methods systematic review.

The burden of Musculoskeletal disorders (MSD) is large. Surgery is an important management option but the factors that shape patients' surgical decisions are not well understood. As prior reviews have explored only single data types or conditions, a mixed methods appraisal across the musculoskeletal spectrum was undertaken. A mixed-methods systematic, convergent segregated approach was used, with PubMed, Cumulated Index to Nursing and Allied Health Literature (CINHAL), Embase and PsycINFO searched to identify studies of adult patients' decisions about whether to undergo surgery. A narrative synthesis was conducted, with identified themes integrated across quantitative, qualitative and mixed-methods studies. Forty-six studies were included (24 quantitative, 19 qualitative and three mixed methods), with four decision-making themes identified (symptoms, sociodemographic and health factors, information and perceptions). Decision-making involves a complex interaction of individual sociodemographic, health and symptom information, integrated with individual perceptions of candidacy and surgical expectations. While most studies investigated hip and knee surgery, across all included conditions, patients are more likely to favour surgery if symptoms and/or dysfunction are higher, and if perceptions of surgical candidacy and processes (outcomes, inconvenience, and risk) are favourable. Other factors including age, general health, race, financial context, professional and non-professional communication, and information sources also impact decision-making but exert a less consistent impact upon the propensity to prefer surgery. Patients are more likely to choose surgery for MSD when they have higher levels of symptoms or dysfunction and positive perceptions of surgical suitability and expectations. Other factors important to individuals, have a less consistent impact upon the propensity to prefer surgery. These findings have potential to aid the efficient referral of patients to orthopaedics. More research is needed to validate these findings across the spectrum of MSD.

The burden of musculoskeletal disorders in Belgium: a national population-based study

Abstract Background According to WHO, approximately one in three people worldwide live with a chronic, painful musculoskeletal (MSK) disorder. Low back pain (LBP), neck pain (NKP), osteoarthritis (OST) and rheumatoid arthritis (RHE) are among the most disabling MSK disorders. According to the Global Burden of Disease (GBD) study, LBP was the leading global cause in terms of years lived with disability and OST showed an increase in prevalence and is predicted to be one of the leading future causes. Our study aimed to analyse the burden of these MSK disorders in Belgium, providing a summary of morbidity and mortality outcomes from 2013 to 2018. Methods Prevalence and disability-adjusted life years (DALY) were computed using data from the Belgian health interview surveys from 2013 and 2018, the INTEGO database (Belgian registration network for general practitioners) and GBD study 2019. Mortality data was retrieved from the Belgian statistical office for people dying from RHE. Following GBD methodology, LBP, NKP and OST were assumed to not generate any deaths. Results The prevalence of MSK disorders increased from 2013 to 2018 with OST being the disorder with the highest number of cases (1.7 million cases in 2018). The burden was higher in women and the gender disparities increased with age. Women died also more frequently due to RHE compared to men. In total MSK disorders contributed to 180,746 comorbidity-adjusted DALYs for female and 116,063 comorbidity-adjusted DALYs for men in 2018, with LBP being the largest contributor (140,031 DALY). Conclusions The burden of MSK disorders has increased over the years. In 2018, 2.5 million Belgians were affected by at least one MSK disorder that resulted in almost 300,000 DALY. Our study provides valuable information of a part of the health burden that is known to have a great impact on the total burden of disease but that is sometimes disregarded by public health institutions. Key messages • MSK disorders represent a major health problem in Belgium. • Acting on risk factors associated to these disorders is crucial to mitigate their burden.

Burden of musculoskeletal disorders in the gulf cooperation council countries, 1990-2019: Findings from the global burden of disease study 2019.

ObjectiveThe purpose of this study was to investigate the burden of musculoskeletal (MSK) health conditions in Gulf Cooperation Council (GCC) countries based on the Global Burden of Disease (GBD) data.MethodsThe data for GCC countries were obtained from the 2019 GBD study to evaluate the burden of MSK disorders which include the following countries: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). The main outcome measures were age-standardized prevalence and years of life lived with disability (YLDs) associated with MSK disorders. The burden of MSK disorders attributable to the category of behavioral, metabolic, or environmental/occupational was reported to estimate the risk-attributable fractions of disease.ResultsMSK disorders prevalence ranked fifth in Kuwait, sixth in Bahrain, Oman, Qatar, and UAE, and seventh in Saudi Arabia among all the diseases in 2019. For all GCC countries, MSK disorders were ranked the second leading cause of disability as measured by YLDs for the years 1990 and 2019. The age-standardized prevalence of MSK disorders in 2019 for Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and UAE was 18.56% (95% UI: 17.51–19.66), 19.35% (18.25–20.52), 18.23% (17.14–19.36), 18.93% (17.81–20.06), 19.05% (17.96–20.22), and 18.26% (17.18–19.38), respectively. The age-standardized YLDs per 100,000 individuals of MSK disorders in 2019 for Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and UAE were 1,734 (1,250–2,285), 1,764 (1,272–2,322), 1,710 (1,224–2,256), 1,721 (1,246–2,274), 1,681 (1,207–2,235), and 1,715 (1,230–2,274), respectively. For risk factors, high body mass index (BMI) had the highest contribution to MSK disorders YLDs in most GCC countries (Bahrain, Kuwait, Oman, and Saudi Arabia), followed by the exposure to occupational ergonomic factors which had the highest contribution to MSK disorders YLDs in Qatar and UAE.ConclusionThere was an increase in both age-standardized prevalence of MSK disorders and YLDs between 1990 and 2019 that was observed for all GCC countries. Some risk factors such as higher BMI and exposure to occupational ergonomic factors were highly associated with YLDs due to MSK disorders. The results of this study provide guidance for the potential nature of preventative and management programs to optimize the individual’s health.

Global burden of musculoskeletal disorders and attributable factors in 204 countries and territories: a secondary analysis of the Global Burden of Disease 2019 study

ObjectiveTo evaluate the global burden of musculoskeletal (MSK) disorders, as well as the five common conditions, and their relevant risk factors from 1990 to 2019.DesignData from the Global Burden of...

Long-Term Prevalence and Risk Factors of Musculoskeletal Disorders among the Schoolteachers in Hail, Saudi Arabia: A Cross-Sectional Study

Background Musculoskeletal disorders (MSDs) are affecting up to 95% of teachers and are considered a primary occupational health hazard leading to absenteeism, early retirement, and lower quality of life and teaching quality. Aim The current study is aimed at exploring the prevalence and risk factors of MSDs among the schoolteachers in Hail, Saudi Arabia. Methods A cross-sectional study was conducted online among the teachers in Hail City using the Nordic Musculoskeletal Questionnaire. Teachers were randomly selected from randomly selected high schools. Teachers with at least 1 year experience were recruited for the study. Descriptive statistics, Cochran's Q test, and binominal regression were used to investigate the prevalence of MSDs among such teachers and to determine if the percentage of MSDs differed by anatomical region and risk factor (one hundred forty-five males and 106 females filled out the questionnaires). Results The prevalence of MSDs in the last 12 months was 93.63% (235 of 251 teachers). Interestingly, 91% of the affected participants (214 of 235 teachers) complained of MSDs in more than one anatomical region. The most affected site was the lower back (183 of 251 teachers, 72.91%), followed by the shoulders (168 of 251 teachers, 66.93%), and the least affected sites were the elbows (45 of 251 teachers, 17.93%). The females showed a higher prevalence of MSDs than the males. Only gender was a significant risk factor for shoulder and neck MSDs (p < 0.02). Conclusion Overall, the findings of the current study suggest a high prevalence of MSDs among teachers, especially in the lower back and shoulders. The affected teachers should learn more about biomechanics and ergonomics and should engage in exercise to improve their health. Future studies should focus on identifying the biomechanical and ergonomic risk factors of MSDs and on designing MSD prevention programmes to reduce the burden of MSDs.

Burden of Musculoskeletal Disorders in Adults of Rural Areas of Delhi: A Cross-sectional Study

Background: Musculoskeletal disorders (MSDs) are disabling chronic conditions prevalent worldwide. However, there is paucity of literature of such disorders from India.Objective: To study the epidemiology of Musculoskeletal disorders in adult population of rural areas of Delhi.Materials and Methods: The study was a descriptive, cross sectional, community-based study and conducted in a rural area of Delhi. Modified Nordic musculoskeletal questionnaire (NMQ-E) was used to determine the prevalence of MSDs. Data were summarized using frequencies, proportions and appropriate statistical tests were applied for significance. Binary logistic regression was used.Results: The lifetime prevalence of MSDs in the present study was found to be 57% (114) of the study participants, 53% (106) participants had history of MSDs in the past 12 months, 48% (96) participants had history of MSDs in the past 4 weeks while 35% (70) participants had history of MSDs at the time of interview. Lower backache was the most common complaints (54.2%). MSDs were found to be more associated with female gender, increasing age, being overweight or obese, and having a history of trauma.Conclusion:One in three adults was suffering from MSDs in rural Delhi and more so in females and elderly.

Prevalence, burden of disease, and lost in health state utilities attributable to chronic musculoskeletal disorders and pain in Chile

BackgroundMusculoskeletal disorders are a leading cause of disability adjusted life years (DALY) in the world. We aim to describe the prevalence and to compare the DALYs and loss of health state utilities (LHSU) attributable to common musculoskeletal disorders in Chile.MethodsWe used data from the Chilean National Health Survey carried out in 2016–2017. Six musculoskeletal disorders were detected through the COPCOPRD questionnaire: chronic musculoskeletal pain, chronic low back pain, chronic shoulder pain, osteoarthritis of hip and knee, and fibromyalgia. We calculated the DALY for each disorder for 18 sex and age strata, and LHSU following an individual and population level approaches. We also calculated the fraction of LHSU attributable to pain.ResultsChronic musculoskeletal pain disorder affects a fifth of the adult population, with a significant difference between sexes. Among specific musculoskeletal disorders highlights chronic low back pain with the highest prevalence. Musculoskeletal disorders are a significant cause of LHSU at the individual level, especially in the case of fibromyalgia. Chronic musculoskeletal pain caused 503,919 [283,940 - 815,132] DALYs in 2017, and roughly two hundred thousand LSHU at population level, which represents 9.7% [8.8–10.6] of the total LSHU occurred in that year. Discrepancy in the burden of musculoskeletal disorders was observed according to DALY or LSHU estimation. The pain and discomfort domain of LHSU accounted for around half of total LHSU in people with musculoskeletal disorders.ConclusionChronic musculoskeletal pain is a major source of burden and LHSU. Fibromyalgia should deserve more attention in future studies. Using the attributable fraction offers a straightforward and flexible way to explore the burden of musculoskeletal disorders.

General practitioners' knowledge, perception and utilisation of services in the Chiropractic management of musculoskeletal disorders in Harare, Zimbabwe

The World Health Organization ranks musculoskeletal disorders (MSD) as the second largest cause of premature termination of one’s career. Consequently, the burden of MSD and limited primary health care in developing countries warrants the need for an integrative approach to health care. Although Chiropractic Therapy (CT) has emerged as a well-recognised form of Complementary and Alternative Medicine (CAM), particularly in MSD, there is a paucity of literature on knowledge and perceptions of General Practitioners (GPs) about CT in developing countries. Therefore, this study examined the knowledge, perceptions and utilisation of GPs towards CT. A questionnaire-based, cross-sectional study obtained data from 48 GPs in private practice in the Avenues suburb of Harare, Zimbabwe. Of the 48 respondents (55% response rate from 88 questionnaires distributed), approximately one-third (31.3%; n=15) never heard of CT. Of those who had heard of CT (n=33), almost two-thirds (66.7%; n=22) believed chiropractors to be competent in the treatment of musculoskeletal complaints and approximately one-third (35.4%; n=17) in the treatment of neurological ailments. There was a positive correlation between knowledge and perception (r=0.668) of CT. However, the association between knowledge and utilisation of CT services was not statistically significant (p=0.4), while the relationship between perception and CT utilisation was statistically significant (p=0.006). This finding suggests that the perception of CT influenced a GP’s referral of patients to a chiropractor. The study highlights the need for improving the knowledge and perceptions of CT among GPs as a basis for improving CT utilisation in developing countries, where an interdisciplinary approach to MSD may serve as an efficient alternative to conventional medical care.

Burden of Musculoskeletal Disorders among Recent Dental Graduates in Saudi Arabia: A National Survey

Introduction: Musculoskeletal Disorders (MSDs) are one of the most prevalent occupational hazards affecting dental professionals. Aim: To assess the prevalence and associated risk factors of MSDs among recent dental graduates in Saudi Arabia and evaluates their practice of ergonomics as well as the impact of MSDs on their daily activities. Materials and Methods: This cross-sectional study was carried out among all dental interns (n=1552) who graduated from dental schools in Saudi Arabia in the academic year 2018-2019. Data was collected between January 2019 to March 2019 through online survey via SurveyMonkey™. Through the questionnaire, data about participants’ demographics, symptoms of MSDs in the previous 12 months, preventive ergonomic working practices, effects of MSDs on their daily activities, and coping strategies were collected. Descriptive statistics, including mean±Standard Deviation (SD) were computed for continuous variables, while frequencies and percentages were computed for categorical variables. Results: In total, 889 dental interns participated in this study (response rate of 57.3%). A total of 54.3% of the participants experienced symptoms of MSDs in atleast one body part in the previous 12 months. The neck (41%), shoulder (37%), and lower back (31.9%) were the most affected regions. Female interns demonstrated a significantly higher risk of presenting with MSDs than male participants (OR: 2.3, CI: 1.7, 3.1). Alternative therapy was the most reported strategy for dealing with pain (44%, n=190). In total, 58.2% of the interns who presented with MSDs had their daily activities affected (n=251). Conclusion: MSDs are significant health problems among recent dental graduates in Saudi Arabia affecting the daily activities of the majority of those affected. Females were at higher risk of developing MSDs than males. To prevent this issue, dental school authorities should develop and implement strategies to ensure effective integration of ergonomics education in dental school curricula.

Burden of musculoskeletal disorders among diabetics and their functional capacity in Southwest, Nigeria

Introduction: The complications associated with diabetes manifest in a systemic fashion including the musculoskeletal (MSS) system where it leads to a reduction in the quality of life and impacts the mental health of the patient. A study to determine the extent of the musculoskeletal and emotional burden it imposes on the patient may help ascertain the extent of support needed in their care. We thus set out to determine the rate and the clinical factors that are predictive of MSS and emotional disorders in them. Materials and Methods: Self-administered questionnaires which consist of the short MSS functional assessment were given out to diabetic patients at the Endocrinology Clinic of the hospital. Results: The rate of presence of MSS disorder in our series was 66.4%, while the presence of increasing age, presence of MSS disorders, previous bones, and joints surgeries were significantly associated with poor physical, functional, mobility, emotional, and bother index. Conclusion: This study has further shown the huge burden diabetes places on the musculoskeletal system and by extension the mind of the patients. Routine assessment as a form of surveillance for the presence of musculoskeletal and emotional disorders should be incorporated into the clinical management protocol for diabetes.

Musculoskeletal Disorders among Rag Pickers at Lucknow City

Context: The Musculoskeletal Disorders (MSDs) among rag pickers are mostly non-fatal injuries such as injuries, pain or discomfort in the anatomical area, muscles, joints, tendons, ligaments, nerves and in bones. The nature of their occupation requires the rag pickers constant bending, which raised the risk of Musculoskeletal Disorders in many body parts. Musculoskeletal Disorders were significantly higher for the lower back, upper back, knees, shoulder, neck and ankles among the rag pickers. Aim: The purpose of this study was to investigate the prevalence of Musculoskeletal Disorders in different body parts among rag pickers. Settings and Design: This study was carried out on sixty rag pickers comprising of male and female. Multistage random sampling technique was adopted in the study. The data has been collected from the rag pickers engaged in rag picking at Lucknow city. Materials and Methods: A self-structured and standardized interview schedule including modified version of Body Discomfort Scale (BDS) devised by Kuorinka et al., (1987) was used for the purpose of gathering information and measurement of pain in different body parts of the respondents. The study adopted survey research design and the respondents were interviewed personally. Statistical Analysis Used: The data was coded and analyzed using IBM SPSS 20.0 Version. The level of musculoskeletal pain in different body segments were analysed in the form of frequencies, mean, standard deviation and the significance was tested using ANOVA. Results: The study clearly revealed that rag pickers felt maximum pain in back, followed by knee pain, shoulder pain and hand pain. Conclusions: The study strongly recommends preventive and curative measures to minimize the burden of MSDs. A training program needs to be organized to detect the early signs and symptoms of MSDs so that rag pickers may adopt the curative measures.

Burden of musculoskeletal disorders in Iran during 1990-2017: estimates from the Global Burden of Disease Study 2017.

MSDs comprise most of the top causes of years lived with disability (YLDs) worldwide and are rapidly increasing in lower- and middle-income countries. Here, we present disability and mortality due to MSDs in Iran at the national level from 1990 to 2017. We used Global Burden of Disease (GBD) 2017 Study data and standard methodology and presented the burden of MSDs in rates of years of life lost (YLLs), YLDs, and disability-adjusted life years (DALYs) during 1990-2017, for population aged ≥ 5years old. We further explored attributable risk factors and decomposed the changing trend in DALYs to assess underlying causes. In Iran, MSDs were responsible for 1.82 million (95%uncertainty interval [UI] 1.3-2.4) DALYs, in 2017. During the past 28years, with 1.75% annualized percentage change (APC), Iran had the highest percentage increase in the all-ages MSD DALYs rate worldwide, while the age-standardized DALYs APC was negligible. Low back pain was the greatest contributor to DALYs and caused 4.5% of total DALYs. The female population is experiencing considerably higher burden of MSDs, with 115% and 48% higher all-ages YLLs and YLDs rates per 100,000, respectively (YLLs 28.7; YLDs 2629.1), than males (YLLs 13.2; YLDs 1766.1). However, due to wide UIs, difference was not significant. Only 17.6% of MSD YLDs are attributable to assessed risk factors. Despite that MSDs are rising as an important cause of disability in Iran, these conditions are not sufficiently addressed in health policies. There is urgent need for cross-sectoral engagement, especially addressing the MSDs in females.

Burden of musculoskeletal-related disorders resulting from non-fatal road traffic collisions in Africa: a protocol of a systematic review

IntroductionIn addition to their high mortality rates, road traffic collisions (RTC) are considered a burden within those who do survive. In Africa, injuries related to RTC have been identified as...

Spinal manipulation frequency and dosage effects on clinical and physiological outcomes: a scoping review

IntroductionThe burden of musculoskeletal disorders increases every year, with low back and neck pain being the most frequently reported conditions for seeking manual therapy treatment. In recent years, manual therapy research has begun exploring the dose-response relationship between spinal manipulation treatment characteristics and both clinical and physiological response to treatment.ObjectiveThe purpose of this scoping review was to identify and appraise the current state of scientific knowledge regarding the effects of spinal manipulation frequency and dosage on both clinical and physiological responses.MethodsA scoping review was conducted to identify all available studies pertaining to our research question. Retrieved papers were screened using a 2-phase method, a selective sorting with titles and abstracts. Potentially relevant studies were read, and data was extracted for all included studies. Randomized control trials were assessed using the Cochrane Risk of Bias Tool for quality assessment.ResultsThe search yielded 4854 publications from which 32 were included for analysis. Results were sorted by dosage or frequency outcomes, and divided into human or animal studies. Animal studies mainly focused on dosage and evaluated physiological outcomes only. Studies investigating spinal manipulation dosage effects involved both human and animal research, and showed that varying thrust forces, or thrust durations can impact vertebral displacement, muscular response amplitude or muscle spindle activity. Risk of bias analysis indicated only two clinical trials assessing frequency effects presented a low risk of bias. Although trends in improvement were observed and indicated that increasing the number of SM visits in a short period of time (few weeks) decreased pain and improve disability, the differences between the studied treatment frequencies, were often not statistically significant and therefore not clinically meaningful.ConclusionThe results of this study showed that SM dosage and frequency effects have been mostly studied over the past two decades. Definitions for these two concepts however differ across studies. Overall, the results showed that treatment frequency does not significantly affect clinical outcomes during and following a SM treatment period. Dosage effects clearly influence short-term physiological responses to SM treatment, but relationships between these responses and clinical outcomes remains to be investigated.

The burden of musculoskeletal disorders in Mexico at national and state level, 1990-2016: estimates from the global burden of disease study 2016.

We describe premature mortality and disability due to musculoskeletal (MSK) disorders in Mexico at national and state level from 1990 to 2016. Using data from the global burden of disease study 2016 (GBD 2016), we present rates and trends in years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) caused by MSK disorders in Mexico by state from 1990 to 2016. The burden of MSK disorders was computed using standard GBD methodology. To compare the burden of MSK disorders across the country, states were grouped by sociodemographic index (SDI). In Mexico, MSK disorders were the 3rd and 17th greatest cause of YLDs and YLLs in 2016, respectively, accounting for 1.95 million (95% UI 1.4-2.5) DALYs. Among all MSK disorders, low back and neck pain had the highest all-ages DALYs rate and represented 3.6% of total DALYs. All-ages YLLs and YLDs rates of MSK disorders were 234 and 37% higher in females (YLLs 102.2, 95% UI 79.9-110.7; YLDs 1677.9, 95% UI 1213.5-2209.4) than in males (YLLs 30.6, 95% UI 28.3-34.0; YLDs 1224.7, 95% UI 887.2-1608.3), respectively. Northern and high SDI states had higher rates of MSK disorders in comparison with southern and low SDI states. Only 16% of YLDs caused by all MSK disorders could be attributed to risk factors currently assessed in GBD. MSK conditions are an important cause of premature mortality and disability. Researcher engagement and cross-sectorial actions to address the burden of MSK disorders are essential.

Burden of musculoskeletal disorders among registered nurses: evidence from the Thai nurse cohort study

BackgroundMusculoskeletal disorders (MSDs) are a major public health problem among registered nurses (RNs) in Thailand. Information on their burdens at a national level is limited. This study estimated the prevalence of MSDs among RNs using the 2009 Thai Nurse Cohort, a nationally representative sample of RNs in Thailand.MethodsThis study is part of the first wave survey of the Thai Nurse Cohort Study (TNCS) conducted in 2009. Members of the cohort consisted of 18,756 RNs across Thailand. A 13-page self-administered questionnaire was sent to participants where MSDs were measured by self-reported answers to questions related to experiencing MSDs during a previous year. However, 1070 RNs were excluded from this study since they were unemployed during a previous year, therefore the final sample size was 17,686 RNs. A 12-month prevalence of MSDs and its 95% confidence interval (95% CI) were estimated based on normal approximation to binomial distribution. Chi-square test for trend was used.ResultsOf the 17,686 RNs, 47.8% (95% CI: 47.0–48.5) reported having MSDs during the previous 12 months. The prevalence of MSDs significantly increased with age, body mass index, and working duration (all P < 0.001). Compared to the non-MSD group, RNs with MSDs had a higher proportion who perceived MSDs as a long-term, chronic medical condition (78.1% vs 20.7%; p < 0.001), being currently on medication (49.4% vs 14.7%; p < 0.001), using pain relief medication almost every day (9.0% vs 1.9%; p < 0.001), experiencing sickness absence (15.7% vs 1.1%; p < 0.001), seeking medical specialist consultations (odds ratio, OR 2.2; 95% CI: 2.0–2.3; p < 0.001), and seeking alternative medications (OR 2.5; 95% CI: 2.3–2.7; p < 0.001).ConclusionsMusculoskeletal disorders affected almost half of the RNs in Thailand annually. They placed a major healthcare burden and were a major cause of working days lost due to sick leaves, diminished productivity and quality of patient care. More attention should be paid to the prevention and effective management of MSDs in RNs in Thailand. Further study on ergonomics related to MSDs and its prevention are needed.