Joint Decade Research Articles

A Review of Community-Oriented Program for Control of Rheumatic Diseases Studies from India

Abstract Background: Community-Oriented Program for Control of Rheumatic Diseases (COPCORD) is a global community-based program, emphasizing prevalence data. In India, it has been headed by the World Health Organization (WHO), the International League of Associations for Rheumatology (ILAR), and the Bone and Joint Decade (BJD), India. The Indian Council of Medical Research (ICMR) also utilized the COPCORD methodology. This study aimed to review Indian COPCORD data. Methods: PubMed, COPCORD website, conference proceedings, and citations were searched from inception to 2022. Search terms included WHO-ILAR, COPCORD, and India. Studies conducted in India and available in English were included. Abstracts from journal supplements or conference proceedings were included if they studied the Indian population. Results: Bhigwan, Pune, Bikaner, Lucknow, Calicut, and Trivandrum studies were published as full-length articles. Soft-tissue rheumatism showed a higher prevalence than most diseases everywhere. The appraisal checklist found a few lacunae in the description of the study setting and statistical analysis clarity. Bhigwan had a high prevalence of “ill-defined diagnosis” (6.25%). Osteoarthritis (OA) knee had a prevalence of 10.6% in Lucknow urban. RA prevalence was 2.54% in Bikaner. Pune exhibited the highest OA prevalence (6.25%). Age and gender were important risk factors in the Calicut study. Trivandrum found that functional impairment impacted workability and finances. Malappuram reported higher rheumatic musculoskeletal disease (RMSD) in women (70%). Conclusion: COPCORD studies were the first to highlight the burden of RMSD in India. Nonclinical aspects such as architecture and living conditions have been described. Further research regarding functional ability, work disability, and psychosocial factors is recommended. Future scope to look at economic aspects and environmental risk factors remains.

A History of Musculoskeletal Medicine and Its Place and Progress in Undergraduate Medical Education.

Musculoskeletal diseases are responsible for some of the most prevalent conditions affecting population health in the world. Despite the prevalence of these conditions, musculoskeletal medicine has a fraught history within the world of undergraduate medical education. We review the origins of musculoskeletal medicine, its evolution in undergraduate medical education, and progress that has been made over the last decade as a result of global initiatives such as the Bone and Joint Decade. Understanding the history of musculoskeletal medicine is essential to contextualizing the problems that exist today and creating comprehensive solutions to fill the gaps that persist in musculoskeletal curricula.

P010 Clinico-epidemiological characteristics and outcomes of Juvenile Idiopathic Arthritis (JIA) patients in Kenya: data from the KAPRI registry

Abstract Background Pediatric rheumatic diseases pose a significant disease burden upon children and their families (1–3). They lead to physical disability and diminished quality of life (1–3). Determination of the burden and clinical characteristics of these diseases is a critical first step to improving access to care and optimizing use of existing health systems for the well-being of these patients (4). This is in line with the goal of the Bone and Joint decade (2000–2010) aimed at increasing recognition and understanding of the impact of musculoskeletal diseases (5,6). The Kenya Pediatric Rheumatology Registry (KAPRI) offers a unique opportunity to pioneer and spearhead a systematic and organized format to inform policy and better healthcare provision. Our objective was to determine the patient characteristics, clinical features and outcomes of Juvenile Idiopathic Arthritis (JIA) patients assessed at the Aga Khan University Medical College East Africa from March 2019 to December 2020. Methods Data of JIA patients on age, gender, laboratory and clinical features at diagnosis and treatment options offered were extracted from the database. A further detailed chart review was undertaken to determine the proportion of patients who achieved remission or minimally active diseases. Results Among the 207 patients enrolled thus far, 16 (7.7%) were diagnosed to have JIA. Majority of the patients were females (75%; n = 12) with a mean age of 7 years and 3 months (Range : 1 year—13 years 7 months). All patients had joint pain and swelling as the initial presenting complaints. Majority of the patients had polyarticular JIA (75%, n = 12). The other 4 patients were oligoarticular (n = 2) and systemic JIA (n = 2). Among the polyarticular JIA patients (n = 12), only 3 (25%) were rheumatoid factor (RF) positive and 1 was antinuclear antibody (ANA) positive. The oligoarticular and systemic JIA patients were all negative for antinuclear antibody, rheumatoid factor and cyclic citrullinated peptide antibodies (anti-ccp). Seven patients (43.8%) required biological therapies; tocilizumab (n = 2: systemic JIA), adalimumab (n = 2: polyarticular JIA), etanercept (n = 2: polyarticular JIA) andtofacitnib (n = 1: polyarticular JIA). One patient with systemic JIA on tocilizumab developed herpes simplex which was successfully managed with oral acyclovir. All the other patients did not develop any infections, allergic reactions or any other untoward events as adverse outcomes following the use of biological therapies. Five patients have attained remission as illustrated in the table below. Two patients have been lost to follow up. Conclusion Seronegative polyarticular JIA was the predominant form of JIA observed with a predilection to affect more girls and boys. Over a period of 2 years, remission has been attained among 31.25% of the patients (5 of 16) with use of synthetic disease modifying anti-rheumatic drugs and biological therapies.

Physician Evaluation to Prevent and Manage Injured Person

In spite of the way that the WHO declared injury avoidance as a key issue of the Bone and Joint Decade 2000–2020 one needs to understand that injury counteraction has a very little significance in minds. Truth be told, wounds bring about more life years lost than neoplasms, cardiovascular sicknesses, cerebral strokes, or diabetes, and is thus viewed as a dismissed pestilence.

Global health policy in the 21st century: Challenges and opportunities to arrest the global disability burden from musculoskeletal health conditions.

The profound burden of disease associated with musculoskeletal health conditions is well established. Despite the unequivocal disability burden and personal and societal consequences, relative to other non-communicable diseases (NCDs), system-level responses for musculoskeletal conditions that are commensurate with their burden have been lacking nationally and globally. Health policy priorities and responses in the 21st century have evolved significantly from the 20th century, with health systems now challenged by an increasing prevalence and impact of NCDs and an unprecedented rate of global population ageing. Further, health policy priorities are now strongly aligned to the 2030 Sustainable Development Goals. With this background, what are the challenges and opportunities available to influence global health policy to support high-value care for musculoskeletal health conditions and persistent pain? This paper explores these issues by considering the current global health policy landscape, the role of global health networks, and progress and opportunities since the 2000–2010 Bone and Joint Decade for health policy to support improved musculoskeletal health and high-value musculoskeletal health care.

Critical considerations about the onset and epidemiology of whiplash associated disorders presented by the bone and joint decade 2000-2010 task force on neck pain

Critical considerations about the onset and epidemiology of whiplash associated disorders presented by the bone and joint decade 2000-2010 task force on neck pain

Using exploratory factor analysis to define functional constructs of cervical spine movement in a whiplash population

To determine the reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with grades I-IV neck pain and associated disorders (NAD).We systematically searched electronic databases to update the systematic review of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Eligible reliability and validity studies were critically appraised using modified versions of the QAREL and QUADAS-2 instruments, respectively. Evidence from low risk of bias studies were synthesized following best evidence synthesis principles.We screened 14302 articles, critically appraised 46 studies, and found 32 low risk of bias articles (14 reliability and 18 validity studies). We found preliminary evidence of: 1) reliability of visual inspection, aided with devices (CROM and digital caliper) to assess head posture; 2) reliability and validity of soft tissue palpation to locate tender/trigger points in muscles; 3) reliability and validity of joint motion palpation to assess stiffness and pain provocation in combination; and 4) range of motion tests using visual estimation (in cervical extension only) or devices (digital caliper, goniometer, inclinometer) to assess cervical mobility.We found little evidence to support the reliability and validity of clinical tests to assess head posture, pain location and cervical mobility in adults with NAD grades I-III. More advanced validity studies are needed to inform the clinical utility of tests used to evaluate patients with NAD.

Reliability and validity of self-reported questionnaires to measure pain and disability in adults with neck pain and its associated disorders: part 3-a systematic review from the CADRE Collaboration.

To determine the reliability and validity of self-reported questionnaires to measure pain and disability in adults with grades I-IV neck pain and its associated disorders (NAD). We updated the systematic review of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and systematically searched databases from 2005 to 2017. Independent reviewers screened and critically appraised studies using standardized tools. Evidence from low-risk-of-bias studies was synthesized according to best evidence synthesis principles. Validity studies were ranked according to the Sackett and Haynes classification. We screened 2823 articles, and 26 were eligible for critical appraisal; 18 were low risk of bias. Preliminary evidence suggests that the Neck Disability Index (original and short versions), Whiplash Disability Questionnaire, Neck Pain Driving Index, and ProFitMap-Neck may be valid and reliable to measure disability in patients with NAD. We found preliminary evidence for the validity and reliability of pain measurements including the Body Pain Diagram, Visual Analogue Scale, the Numeric Rating Scale and the Pain-DETECT Questionnaire. The evidence supporting the validity and reliability of instruments used to measure pain and disability is preliminary. Further validity studies are needed to confirm the clinical utility of self-reported questionnaires to assess pain and disability in patients with NAD. These slides can be retrieved under Electronic Supplementary Material.

Reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with neck pain and its associated disorders: Part 4. A systematic review from the cervical assessment and diagnosis research evaluation (CADRE) collaboration

PurposeTo determine the reliability and validity of clinical tests to assess posture, pain location, and cervical spine mobility in adults with grades I-IV neck pain and associated disorders (NAD). MethodsWe systematically searched electronic databases to update the systematic review of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Eligible reliability and validity studies were critically appraised using modified versions of the QAREL and QUADAS-2 instruments, respectively. Evidence from low risk of bias studies were synthesized following best evidence synthesis principles. ResultsWe screened 14302 articles, critically appraised 46 studies, and found 32 low risk of bias articles (14 reliability and 18 validity studies). We found preliminary evidence of: 1) reliability of visual inspection, aided with devices (CROM and digital caliper) to assess head posture; 2) reliability and validity of soft tissue palpation to locate tender/trigger points in muscles; 3) reliability and validity of joint motion palpation to assess stiffness and pain provocation in combination; and 4) range of motion tests using visual estimation (in cervical extension only) or devices (digital caliper, goniometer, inclinometer) to assess cervical mobility. ConclusionsWe found little evidence to support the reliability and validity of clinical tests to assess head posture, pain location and cervical mobility in adults with NAD grades I-III. More advanced validity studies are needed to inform the clinical utility of tests used to evaluate patients with NAD.

Validity and reliability of clinical prediction rules used to screen for cervical spine injury in alert low-risk patients with blunt trauma to the neck: part 2. A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration.

To update findings of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) on the validity and reliability of clinical prediction rules used to screen for cervical spine injury in alert low-risk adult patients with blunt trauma to the neck. We searched four databases from 2005 to 2015. Pairs of independent reviewers critically appraised eligible studies using the modified QUADAS-2 and QAREL criteria. We synthesized low risk of bias studies following best evidence synthesis principles. We screened 679 citations; five had a low risk of bias and were included in our synthesis. The sensitivity of the Canadian C-spine rule ranged from 0.90 to 1.00 with negative predictive values ranging from 99 to 100%. Inter-rater reliability of the Canadian C-spine rule varied from k=0.60 between nurses and physicians to k=0.93 among paramedics. The inter-rater reliability of the Nexus Low-Risk Criteria was k=0.53 between resident physicians and faculty physicians. Our review adds new evidence to the Neck Pain Task Force and supports the use of clinical prediction rules in emergency care settings to screen for cervical spine injury in alert low-risk adult patients with blunt trauma to the neck. The Canadian C-spine rule consistently demonstrated excellent sensitivity and negative predictive values. Our review, however, suggests that the reproducibility of the clinical predictions rules varies depending on the examiners level of training and experience.

Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1-A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration.

To determine the reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We updated the systematic review of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders. We also searched the literature to identify studies on the reliability and validity of Doppler velocimetry for the evaluation of cervical arteries. Two independent reviewers screened and critically appraised studies. We conducted a best evidence synthesis of low risk of bias studies and ranked the phases of investigations using the classification proposed by Sackett and Haynes. We screened 9022 articles and critically appraised 8 studies; all 8 studies had low risk of bias (three reliability and five validity Phase II-III studies). Preliminary evidence suggests that the extension-rotation test may be reliable and has adequate validity to rule out pain arising from facet joints. The evidence suggests variable reliability and preliminary validity for the evaluation of cervical radiculopathy including neurological examination (manual motor testing, dermatomal sensory testing, deep tendon reflexes, and pathological reflex testing), Spurling's and the upper limb neurodynamic tests. No evidence was found for doppler velocimetry. Little evidence exists to support the use of clinical tests to evaluate the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We found preliminary evidence to support the use of the extension-rotation test, neurological examination, Spurling's and the upper limb neurodynamic tests.

Hip sonography: background; technique and common mistakes; results; debate and politics; challenges.

Developmental dysplasia of the hip (DDH) is the commonest 'congenital' disease of the locomotor system throughout the world. According to the World Health Organisation (WHO) Bone & Joint Decade (2000-2010) 10%-15% of patients who are under the age of 50 when they require a hip replacement do so because of infant hip dysplasia.The background; technique and common mistakes; results; debate and politics; and the challenges of infant hip sonography are reviewed.

What's Important: Leadership: An American Orthopaedic Association (AOA) 2016 OrthoTalk.

What's Important: Leadership: An American Orthopaedic Association (AOA) 2016 OrthoTalk.

Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

To update findings of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and evaluate the effectiveness of non-invasive and non-pharmacological interventions for the management of patients with headaches associated with neck pain (i.e., tension-type, cervicogenic, or whiplash-related headaches). We searched five databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort studies, and case-control studies comparing non-invasive interventions with otherinterventions, placebo/sham, or no interventions. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria to determine scientific admissibility. Studies with a low risk of bias were synthesized following best evidence synthesis principles. We screened 17,236 citations, 15 studies were relevant, and 10 had a low risk of bias. The evidence suggests that episodic tension-type headaches should be managed with low load endurance craniocervical and cervicoscapular exercises. Patients with chronic tension-type headaches may also benefit from low load endurance craniocervical and cervicoscapular exercises; relaxation training with stress coping therapy; or multimodal care that includes spinal mobilization, craniocervical exercises, and postural correction. For cervicogenic headaches, low load endurance craniocervical and cervicoscapular exercises; or manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine may also be helpful. The management of headaches associated with neck pain should include exercise. Patients who suffer from chronic tension-type headaches may also benefit from relaxation training with stress coping therapy or multimodal care. Patients with cervicogenic headache may also benefit from a course of manual therapy.

Marked socioeconomic inequalities in hip fracture incidence rates during the Bone and Joint Decade (2000–2010) in Portugal: age and sex temporal trends in a population based study

BackgroundSocioeconomic factors may influence changes in hip fracture (HF) incidence over time. We analysed HF temporal trends during the Bone and Joint Decade in Portugal (BJD-Portugal), 2000–2010, by regional socioeconomic...

Medical management of osteoporosis and the surgeons' role

Osteoporosis is a worldwide public health issue and with the aging population the resultant increase in fragility fractures has generated a significant socioeconomic impact. Robust scientific research has increased our knowledge of the endocrine mechanisms and pathophysiology of osteoporosis. This information has led to Level 1 randomized clinical trials which demonstrate the beneficial effects of appropriate regimens in reducing the fracture risk and the coincident mortality. Despite these contributions the public health problem remains and has stubbornly failed many public awareness campaigns by governmental and private professional organizations.Effectiveness in delivering the message is greatly enhanced following the sentinel fragility fracture whether it be distal radius, hip, or spine. The treating orthopedic surgeon has the full attention of the injured patient who can be steered into osteoporosis screening programs and ultimately treatment. Studies in Canada have shown that if the surgeon initiates the process by so much as ordering the bone densitometry exam the patient is more likely to get treatment for their underlying disease than if it is just suggested that the patient see their medical doctor at some future date. The patient takes the cue from the surgeon. Patient compliance goes up and the treatment is instituted.We as surgeons must be part of the solution. This has been emphasized in the worldwide efforts in orthopedic surgery such as the “Bone and Joint Decade” and “Own the Bone” programs. This commitment to bone health and restoration is important. Our patients deserve no less.

A study on musculoskeletal disorders distribution and health-seeking behavior among geriatric people in the field practice area of rural health and training center of a tertiary care hospital

Background: The World Health Organization (WHO) Technical Report 2003 stated that musculoskeletal disorders (MSDs) include osteoporosis, osteoarthritis, rheumatoid arthritis, spinal disorders, severe limb injury, trauma, or fracture. The burden of MSDs is global and looking at the gravity of the situation, WHO declared 2000–2010 as the bone and joint decade. As the geriatric people are more vulnerable to osteoporotic changes, there is a possibility that prevalence of MSDs will be more. So this cross-sectional study has been carried out among the geriatric people. Objective: To assess the sociodemographic profiles of geriatric people, to find out the prevalence of MSDs among study participants, and to assess their health-seeking behavior toward MSD. Materials and Methods: A total of 400 geriatric people were included in the study as study participants. Systematic sampling was followed to identify the household. The semi-structured questionnaire from the SJH Report was used to gather information regarding MSD problems. Result: A total of 43% of the study participants belonged to lower middle class family, 48% participants had joint pain, and 21% had backache. Knee joint was the most commonly affected joint. Backache was more common in women (67%) than in men (33%) and was found to be statistically significant. A total of 31% of the participants had osteoarthritis, 2% had rheumatoid arthritis, 7% had soft tissue rheumatism, 1% had monoarticular joint pain and gout, 4.75% had severe limb injury, trauma, and fracture, 26% had pain at any site, and 13.3% had no complaint at all. Overall prevalence of MSD was 61%. A total of 45% were seeking treatment from local RMP, whereas 28% did not seek any treatment for MSD problem. Conclusion: The geriatric people should undergo investigations such as serum calcium, vitamin D-3, and bone marrow density.

After the bone and joint decade: it is still time to educate on the musculoskeletal system: commentary on an article by James D. Wylie, MD, MHS, et al.: "Physician provider type influences utilization and diagnostic utility of magnetic resonance imaging of the knee".

Medical providers should deliver a high quality of care to their patients without ordering unnecessary tests. This concept has been brought to the forefront at a time when health-care costs have markedly increased. Berwick and Hackbarth reminded us of the initial goals from the Institute of Medicine in providing care to patients and emphasized providing quality care that is safe, effective, timely, equitable, and patient-centered1. Today, an additional goal to improve quality is providing affordable care. We must understand these goals to improve the process of care in order to maintain high value and to minimize risk to our patients. The study by Wylie et al. uses knee pain as a model to evaluate this process of patient care. In 2011, the Bone and Joint Initiative demonstrated that up to 17% of adults presented to a physician with a chief symptom of knee pain2. Many different types of health-care providers are in a position to be the first to evaluate these patients with knee pain. All of these health-care providers should …

SP0101 Raising Awareness - the Perspective of the Bone and Joint Decade

Over 1.7 billion people worldwide are affected by musculoskeletal conditions which have the fourth greatest impact on the overall health of the global population, considering both death and disability. This...

One Week with the Experts: A Short Course Improves Musculoskeletal Undergraduate Medical Education

Musculoskeletal problems constitute a considerable workload across all medical and surgical disciplines. There is a mismatch between the burden of musculoskeletal medicine seen by non-orthopaedists clinically and the amount of time afforded it in undergraduate training. Recent initiatives to address this include the United States Bone and Joint Decade and curricular innovations that demonstrate a benefit from improved instruction. Such curricular interventions are usually situated within a wider program reform and last a short time. Gaining institutional support and securing curricular time are challenging. This article shows the positive evaluation of a brief, intense course on musculoskeletal medicine. A one-week course was offered to 154 medical students. The study took place in Ireland, where the student body comprises a mix of graduate students and undergraduate students, who enter medical school directly from second-level education. This course comprised brief didactic talks, case-based small group work, and physical examination skills demonstration. Attitudes toward musculoskeletal medicine prior to the course were elicited. The course was evaluated using pre-course and post-course standardized cognitive tests. Long-term retention was evaluated by end-of-year extended matching questions and an objective standardized clinical examination station. The test results between undergraduate and graduate students and student rating of musculoskeletal medicine as important or less important were compared. Complete data were available for 125 students (81%). Seventy-four percent of students rated musculoskeletal medicine to be of major or critical importance to their career. There was a significant difference (p < 0.001, r = 0.678) in the mean score of the standardized cognitive test between the pre-course test and the post-course test; the mean performance score (and standard deviation) was 48.2% ± 14.2% (range, 17% to 79%), with a pass rate of 3.3%, for the pre-course test and 75.3% ± 15.02% (range, 32% to 100%), with a pass rate of 61%, for the post-course test. At the end of the year, 69.9% of students passed the extended matching questions and 96.7% passed an objective standardized clinical examination station. Graduate students performed better on the post-course standardized cognitive test score (p < 0.001) and objective standardized clinical examination (p < 0.05). Students who rated musculoskeletal medicine as important did not perform better than those who rated it as less important (p = 0.334). We report a favorable evaluation of a short, intense course on musculoskeletal medicine and suggest that the introduction of basic concepts of musculoskeletal medicine is feasible within established curricula.