Musculoskeletal Diagnoses Research Articles

Effects of incline and decline walking on neuromuscular activation in individuals with femoroacetabular impingement

Purpose: Femoroacetabular impingement (FAI) is a proliferative musculoskeletal diagnosis in young adults and thought to be a significant contributor to hip OA development. Although level ground walking is considered the gold standard for quantifying lower extremity muscular activations, reported neuromuscular alterations in this population are limited and findings are inconsistent, thus highlighting whether more challenged walking tasks are necessary to better understand hip joint mechanics in individuals with FAI.

Utilization Patterns of Skeletal Muscle Relaxants Among Commercially Insured Adults in the United States from 2006 to 2018.

To examine the prevalence and duration of skeletal muscle relaxant (SMR) treatment among commercially insured adults in the United States. We used the MarketScan Research Database to identify a cohort of adults 18 to 64 years who had ≥2-year continuous enrollment between 2005 and 2018. We estimated the prevalence of SMR treatment using a repeated cross-sectional design and derived treatment duration using the Kaplan-Meier method. Analyses were stratified by age group, sex, geographic region, individual SMR agent, and musculoskeletal disorder. 48.7 million individuals were included. Treatment prevalence ranged from 61.5 to 68.3 per 1,000. About one-third of users did not have a preceding musculoskeletal disorder diagnosis. Cyclobenzaprine was the dominant agent accounting for >50% of prescriptions. The considerable growth in the use of baclofen, tizanidine, and methocarbamol paralleled with a decline in carisoprodol and metaxalone use. The prevalence was highest in the South while lowest in the Northeast. The median treatment duration was 14 days with 4.0%, 1.9%, and 1.0% of individuals using SMRs for more than 90, 180, and 365 days, respectively. Compared with cyclobenzaprine, patients initiating baclofen, tizanidine, and carisoprodol had longer treatment duration. SMRs are widely used in the United States. Their use slightly increased in recent years, but trends varied among individual agents, patient groups, and geographic regions. Despite limited evidence to support efficacy, a sizable number of U.S. adults used SMRs for long-term and off-label conditions. Further study is needed to understand determinants of treatment as well as outcomes associated with such use.

Thromboembolism in Malignant Musculoskeletal Tumour: A Literature Review.

Malignant musculoskeletal tumour may cause considerable burden to general health. The fast growth combined with the tumour characteristics and its invasion capability resulted in the poor prognosis of malignant musculoskeletal tumour. Malignant musculoskeletal tumour may cause significant disability by destroying normal tissue that plays important role in body kinematics. Thromboembolism, including deep vein thrombosis, pulmonary embolism, and other kinds of venous thromboembolism, is one of the most underestimated complications of musculoskeletal tumour. Normally, thrombosis ensues when pathologic factors overcame the body hemostatic regulatory capabilities, which will predispose the body to the formation of thrombus. Venous thromboembolism in musculoskeletal tumour may develop as a result of interaction between the tumour pathologic capabilities and its interaction with normal bodily functions. In this study, we reviewed the burden of musculoskeletal tumour and its complication on global health. Then, the review will focus on the pathologic and clinical aspect of thromboembolism in malignant musculoskeletal tumour, including pathophysiology, diagnosis, and treatment based on recent findings and literature.

Earnings and employment for women after bariatric surgery: a matched cohort study.

Bariatric surgery induces durable weight loss and improves health and quality of life. Less is known about how bariatric surgery affects labour market outcomes. This study examined the development of earnings and employment status among women with obesity who underwent bariatric surgery versus matched comparators. This study included two cohorts of women in Sweden who gave birth between 1992 and 2014: a cohort with bariatric patients and their full sisters (sister cohort) and a cohort with bariatric patients and comparators matched on BMI, education, birth year, and previous cardiovascular, psychiatric, and musculoskeletal inpatient care diagnoses (BMI-matched cohort). Taxable annual earnings were retrieved from the Swedish Income Tax Register from 2 years before to 5 years after surgery. Employment status was measured dichotomously (employed/not employed) based on earnings data. Adjusted mean and prevalence differences were estimated for earnings and employment by ordinary least squares regression. The sister cohort included 1400 patient-sister pairs. At baseline, patients and their sisters were of similar age (38.3 vs. 38.6 years) but had different BMI (37.3 vs. 26.7 kg/m2). The BMI-matched cohort included 2967 patient-comparator pairs with similar age (36.1 vs. 36.2 years) and BMI (37.1 vs. 37.0 kg/m2) before surgery. During follow-up, similar developments of earnings and employment status were observed between bariatric patients and the comparators in both cohorts. When comparing absolute levels of earnings in the sister cohort, the difference in earnings at 2 years before surgery [mean difference -$4137 (95% CI -5245 to -3028)] was similar to the difference in earnings at 5 years after surgery [-$5620 (-7024 to -4215)]. Similar results were found in the BMI-matched cohort, but of smaller magnitude. Bariatric surgery had little influence on the development of annual earnings and employment for women with obesity in Sweden over 5 years after surgery.

Avaliação musculoesquelética pediátrica por meio de duas ferramentas de triagem: o questionário para detecção precoce de artropatia crônica (DPA-12) e o pGALS (pediatric gait, legs, arms and spine)

INTRODUCTION: There are limitations in the teaching and training of the musculoskeletal exam for the general practitioner, but two screening tools have become available in recent years. OBJECTIVES: Evaluate feasibility and concordance of two musculoskeletal screening tools, the 12-item questionnaire for early arthritis detection of (DPA-12) and the musculoskeletal examination pGALS (pediatric, gait, arms, legs and spine), in the same patient, during the routine practice. METHODS: Participants between 5 and 18 years of age were examined by a trained resident, performing pGALS maneuvers and applying DPA-12 for parents. The diagnoses, descriptive analysis and scores were analyzed, categorizing the pGALS maneuvers as normal or abnormal and DPA-12 scores greater or lower than six. The internal consistency was calculated by Cronbach alpha coefficient and the correlation between categorical measures by kappa statistics. RESULTS: Sixtyseven participants were included, 40 (59.7%) were boys. Forty (59.7%) had at least one abnormal pGALS manoeuver. The diagnoses were classified as musculoskeletal (juvenile idiopathic arthritis and connective tissue diseases, flat feet, hypermobility syndrome, mechanical limb pain) and nonmusculoskeletal (cellulitis and constipation). There were 65 valid questionnaires, 21 (32.3%) scored greater or ecqual to 6, indicating higher probability of musculoskeletal diagnoses. The internal consistency scoreswere 0.79 and 0.87, respectively. The comparison of normal and abnormal variables results, resulted in low agreement by the Cohen kappa coefficient (0.31). CONCLUSION: The application of both tools in the same patients performed well, showing simplicity and feasibility, for identifying functional or structural abnormalities, regardless of the diagnosis. In practice, both tools may be useful and complementary for screening.

Patellofemoral pain syndrome

Patellofemoral pain syndrome (PFPS) is a clinical condition that is characterised by retropatellar and/or peripatellar pain related to activities involving lower limb loading (eg, walking, running, jumping, step mounting, and prolonged sitting and motility,walking down stairs, squatting. Patellofemoral pain syndrome (PFAS) is a common cause of anterior knee pain, often affecting young women. Patellofemoral pain, approximately 9-10% of all musculoskeletal complaints. It is one of the most common musculoskeletal diagnoses that make up 20-40% of knee problems. Patellofemoral pain, which was believed to be caused only by patellofemoral sequence disorder in the past, is considered as a complex and multifactorial problem today. Patellofemoral anamnesis, clinical and radiological findings should be evaluated together in the evaluation of patients with joint pain. Although there is still no clarity in the diagnosis of PFAS, the theory of tissue homeostasis, which suggests that the burden on the load on which it will resist tissue impairs tissue homeostasis and consequently the formation of pain, is gaining popularity. The amount of this resistance can vary depending on the person's characteristics (obesity, gender, sports, genetics, etc.).

Rapid deployment of a telemedicine service in orthopaedic surgery during the COVID-19 pandemic.

Rapid deployment of a telemedicine service in orthopaedic surgery during the COVID-19 pandemic.

Associations Between Obesity and Use for Pediatric Hospitalizations.

Obesity is associated with poor outcomes for specific clinical groups of hospitalized children, but few data exist on outcomes of children with obesity on a larger scale during hospitalization. Therefore, we aimed to determine if use outcomes differ between hospitalized children with obesity and hospitalized children without obesity. We performed a retrospective longitudinal cohort study of all children aged 2 to 19 years hospitalized at a single academic institution between January 1, 2009, and December 31, 2016. BMI was calculated from documented height and weight; obesity was defined by using age- and sex-specific BMI percentile guidelines from the Centers for Disease Control and Prevention. Only All Patient Refined Diagnosis-Related Groups (APR-DRGs) with >100 admissions during the study period were included. Primary outcome measures included hospital length of stay, hospital cost, and 14-day readmission. Generalized linear and logistic models were used to determine adjusted differences for outcome measures between patients with and without obesity. Of 78 756 included hospitalizations, obesity rates increased from 16.5% in 2009-2010 to 17.3% in 2015-2016 (P = .002). Only 6 (4.7%) of the 128 APR-DRGs examined were associated with increased use for patients with obesity: spinal procedures, tonsil and adenoid procedures, major respiratory procedures, peptic ulcer and gastritis, other musculoskeletal diagnoses, and other kidney and urinary tract diagnoses. There were no APR-DRGs with increased length of stay for children with obesity. Obesity is associated with increased hospitalization cost and readmission rates for a minority of diagnosis groups. Some groups of hospitalized children with obesity may benefit from targeted interventions to reduce obesity-specific risks. Future research should be focused on disparities in other relevant clinical outcomes.

Epidemiology of musculoskeletal complaints and diseases in Qatar: A cross-sectional study.

Background: Musculoskeletal (MSK) conditions are considered a significant public health problem on account of their high prevalence in communities worldwide and their pervasive impact. Knowledge of the epidemiology of MSK symptoms and diseases is lacking in Qatar. Obtaining this information will guide local health policymakers in the future strategic planning of the health budget.Objective: To estimate the prevalence rate of MSK disorders in the Qatari population above 15 years of age using the Community Oriented Program for the Control of Rheumatic Disease (COPCORD) survey.Methods: This cross-sectional study targeted 1000 Qatari participants, including 500 males and 500 females. A door-to-door survey was conducted using the Arabic version of the COPCORD questionnaire with the help of research assistants. Participants with positive surveys were asked to visit Hamad General Hospital Rheumatology outpatient clinics for clinical evaluation by a rheumatologist. When necessary, laboratory testing and X-rays were conducted to confirm any MSK diagnosis.Results: A total of 1239 (males, 50.8%) Qatari individuals randomly selected from the different municipalities of Qatar completed the COPCORD survey. Among the participants, 563 (45.4%) screened positive for MSK pain. Knee pain (24.5%) and back pain (23.3%) were the most common sites of pain, and both conditions showed no gender predominance (p = 0.073 and 0.108, respectively). Shoulder, wrist, hand, hip, and neck pain were significantly predominant in females (p < 0.001 for all). A total of 237 MSK disorders were diagnosed in 196 (15.8%) participants, including 181 degenerative joint diseases, 52 soft-tissue rheumatism conditions, and 4 autoimmune inflammatory disorders. Among degenerative joint diseases, knee osteoarthritis (6.4%) was the most common. Among soft-tissue rheumatic conditions, muscular lower back pain (1.9%), myofascial neck pain (0.64%), generalized body pain (0.32%), and shoulder tendinitis (0.7%) were the most common diseases. The autoimmune inflammatory disorders identified included rheumatoid arthritis (n = 2), connective tissue disease (n = 1), and inflammatory bowel disease-associated arthritis (n = 1).Conclusion: The overall prevalence rate of MSK disorders in this small cross-sectional cohort of Qatari individuals was 15.8%. Knee pain (24.5%) and knee osteoarthritis (6.4%) were the most common MSK complaints and diagnosis in the studied Qatari population. This study guides future efforts directed toward the prevention and management of MSK diseases. Further studies with a larger sample size are needed to verify the findings.

Identifying patients who access musculoskeletal physical therapy: a retrospective cohort analysis.

Musculoskeletal conditions are common and cause high levels of disability and costs. Physical therapy is recommended for many musculoskeletal conditions. Past research suggests that referral rates appear to have increased over time, but the rate of accessing a physical therapist appears unchanged. Our retrospective cohort study describes the rate of physical therapy use after referral for a variety of musculoskeletal diagnoses while comparing users and non-users of physical therapy services after referral. The study sample included patients in the University of Utah Health system who received care from a medical provider for a musculoskeletal condition. We included a comprehensive set of variables available in the electronic data warehouse possibly associated with attending physical therapy. Our primary analysis compared differences in patient factors between physical therapy users and non-users using Poisson regression. 15 877 (16%) patients had a referral to physical therapy, and 3812 (24%) of these patients accessed physical therapy after referral. Most of the factors included in the model were associated with physical therapy use except for sex and number of comorbidities. The receiver operating characteristic curve was 0.63 suggesting poor predictability of the model but it is likely related to the heterogeneity of the sample. We found that obesity, ethnicity, public insurance and urgent care referrals were associated with poor adherence to physical therapy referral. However, the limited predictive power of our model suggests a need for a deeper examination into factors that influence patients access to a physical therapist.

New Insight of Circular RNAs in Human Musculoskeletal Diseases.

Circular RNAs (circRNAs), a novel group of noncoding RNAs, are present in most eukaryotic cells. Different from messenger RNAs, circRNAs have a covalently closed single-stranded stable structure and often act in cell type and tissue-specific manners, indicating that they can be used as biomarkers. With the advance of high-throughput RNA sequencing technology and bioinformatics, a large number of circRNAs have been identified in association with musculoskeletal diseases, but the functions of most circRNAs have not been clarified. circRNAs regulate biological processes by adsorbing microRNA as "sponges," binding to proteins, acting as transcriptional regulators, and participating in translation of proteins. In this study, we discuss the latest understanding of biogenesis and gene regulatory mechanisms of circRNAs with special emphasis on new targets for musculoskeletal disease diagnosis and clinical treatment.

Incident Musculoskeletal Conditions Among Men and Women Veterans Returning From Deployment.

Military service confers an increased risk for musculoskeletal (MSK) injury among women and men Veterans. The objective of this study was to determine the prevalence of MSK conditions at first visit to Veterans Affairs (VA), and the incidence rates of new MSK conditions in women and men Veterans with and without a baseline MSK condition. A cohort study including Veterans whose end of last deployment was between October 1, 2001 and October 1, 2015. A total of 765,465 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans. Prevalent and incident MSK conditions identified through the International Classification of Diseases, ninth Revision, Clinical Modification diagnostic codes. Twenty-six percent of women and 29% of men present to the VA with a MSK condition. In those without an MSK diagnosis at baseline, the unadjusted rate of developing at least 1 MSK condition was 168 and 180 per 1000 person-year [hazard ratio (HR)=0.94; 95% confidence interval (CI)=0.92-0.95] in women and men. Women were more likely to develop newly diagnosed MSK conditions of the hip (HR=1.9; 95% CI=1.83-1.98) or the ankle/foot (HR=1.17; 95% CI=1.15-1.20) and less likely to develop MSK conditions of the upper extremity (HR=0.75; 95% CI=0.73-0.78), knee (HR=0.87; 95% CI=0.86-0.89), and spine (HR=0.94; 95% CI=0.93-0.96). In those with prevalent MSK conditions at baseline, the rate of developing a second MSK condition was higher in women than men (151 and 133/1000 person-year; HR=1.13; 95% CI=1.11-1.15). A high proportion of Veterans present to the VA with MSK conditions. Women are less likely to develop conditions related to the upper extremities, spine or knee, and more likely to have conditions of the hip or ankle/foot.

Work environment risk factors for the duration of all cause and diagnose-specific sickness absence among healthcare workers in Sweden: a prospective study

ObjectivesIncreasing sickness absence (SA) has been reported among healthcare workers in Sweden. Our aim was to analyse the impact of work environment factors on short-term and long-term SA based on...

Musculoskeletal Pain Survey Outcomes in Cleft Surgeons and Orthodontists.

Determine prevalence and characteristics of musculoskeletal pain and pathology in cleft providers. An IRB-exempt survey based on previously validated surveys was administered. Data collected included demographics, practice description, musculoskeletal pain history, formal diagnoses, and interventions. Survey was sent to all cleft centers approved by the American Cleft Palate-Craniofacial Association worldwide. All cleft surgeons and orthodontists at these centers met entry criteria. Eighty-three providers responded. Cleft center coordinators were unable to confirm the number of survey recipients. The hypothesis formulated prior to data collection was that prevalence would be comparable to general plastic surgeons and other at-risk health care providers. Average age of respondents was 49.8 ± 11.3 years; 33.9% of respondents were female. Average body mass index was 24.8 ± 3.5 kg/m2. Headaches were observed in 62.7% of surveyed respondents while musculoskeletal symptoms were reported in 89.8%. Of the 12 body parts addressed, most commonly affected were the neck (71.2%), shoulders (52.5%), and lower back (67.8%). Pain interfered with hobbies and home life in the majority of respondents (62.7%). Those who reported a formal diagnosis were more likely to undergo treatment including surgery (P < .01), medication (P = .03), and physical therapies (P < .01). Cleft surgeons and orthodontists experience a higher frequency of headaches compared to the general population, and musculoskeletal disorders are more prevalent than reported by general plastic surgeons. Pain interferes with hobbies and home life. Formal diagnosis leads to treatment. Preventative exercises and interventions are presented.

Exploring supervised machine learning approaches to predicting Veterans Health Administration chiropractic service utilization

BackgroundChronic spinal pain conditions affect millions of US adults and carry a high healthcare cost burden, both direct and indirect. Conservative interventions for spinal pain conditions, including chiropractic care, have been associated with lower healthcare costs and improvements in pain status in different clinical populations, including veterans. Little is currently known about predicting healthcare service utilization in the domain of conservative interventions for spinal pain conditions, including the frequency of use of chiropractic services. The purpose of this retrospective cohort study was to explore the use of supervised machine learning approaches to predicting one-year chiropractic service utilization by veterans receiving VA chiropractic care.MethodsWe included 19,946 veterans who entered the Musculoskeletal Diagnosis Cohort between October 1, 2003 and September 30, 2013 and utilized VA chiropractic services within one year of cohort entry. The primary outcome was one-year chiropractic service utilization following index chiropractic visit, split into quartiles represented by the following classes: 1 visit, 2 to 3 visits, 4 to 6 visits, and 7 or greater visits. We compared the performance of four multiclass classification algorithms (gradient boosted classifier, stochastic gradient descent classifier, support vector classifier, and artificial neural network) in predicting visit quartile using 158 sociodemographic and clinical features.ResultsThe selected algorithms demonstrated poor prediction capabilities. Subset accuracy was 42.1% for the gradient boosted classifier, 38.6% for the stochastic gradient descent classifier, 41.4% for the support vector classifier, and 40.3% for the artificial neural network. The micro-averaged area under the precision-recall curve for each one-versus-rest classifier was 0.43 for the gradient boosted classifier, 0.38 for the stochastic gradient descent classifier, 0.43 for the support vector classifier, and 0.42 for the artificial neural network. Performance of each model yielded only a small positive shift in prediction probability (approximately 15%) compared to naïve classification.ConclusionsUsing supervised machine learning to predict chiropractic service utilization remains challenging, with only a small shift in predictive probability over naïve classification and limited clinical utility. Future work should examine mechanisms to improve model performance.

Use of Opioids Increases With Age in Older Adults: An Observational Study (2005-2017).

AimPain is increasingly treated with opioids. Potential harms of opioid therapy disproportionally affect older patients. This study aims to provide information on trends, nature and duration of opioid prescribing to older adults, in primary care and to explore differences between older patients from different ages.MethodsPrimary care data (2005–2017) were derived from routine electronic medical records of patients in Nivel Primary Care Database. All opioid prescriptions with Anatomical Therapeutic Chemical Classification (ATC) code N02A were selected (except for codeine). Diagnoses were recorded using the International Classification of Primary Care (ICPC). Patients were categorized in three age groups (65–74, 75–84, and ≥85 years). Descriptive analyses were used to describe the trend of opioid prescriptions for specific opioids, the duration of use and underlying diagnoses.Results283,600 patients were included of which 32,287 had at least one opioid prescription in 2017. An increase in the number of older adults who received at least one opioid was seen between 2005 and 2017. The oldest patients were more likely to be prescribed an opioid, especially when it comes to strong opioids, the increase in the volume of prescribing was highest in this group. Moreover, over 40% of the oldest patients used strong opioids chronically. Strong opioids were mostly prescribed for musculoskeletal diagnoses. Cancer was the second most common diagnosis for strong opioids in the younger subgroups, whereas less specified diagnoses were as second in the oldest subgroup.ConclusionOpioid prescription changes with increasing age in frequency, nature, and duration, despite higher harm risks among older patients. Because of the high prevalence of chronic use, it is important to monitor the patient throughout the treatment and to critically evaluate the initiation and continuation of opioid prescriptions.

PMS1 MUSCULOSKELETAL HEALTH AND CAPABILITY OF WELL-BEING MEASURED BY THE ICECAP-A AND -ICECAP-O INSTRUMENTS

To explore the capability of well-being of individuals with musculoskeletal (MSK) health problems in the general population as measured by the ICEpop CAPability measure for Adults (ICECAP-A) / Older people (ICECAP-O). A cross-sectional computer-assisted personal interview survey was performed in 2019 involving a representative sample of the Hungarian population. ICECAP-A and ICECAP-O was applied for age groups 18-64 and 65 and older, respectively. MSK problems were assessed by the Health Assessment Questionnaire Disability Index (HAQ-DI), EQ-5D-5L and by the relevant questions (walking problems, self-reported MSK diagnosis) of the European Health Interview Survey. Subgroup comparisons were carried out by ANOVA tests and Pearson’s correlation coefficients were calculated between continuous variables. Ordinary least square regression analyses were performed to explore the determinants of well-being capabilities. Altogether 1568 (mean age 41.6) and 453 (mean age 73.3) respondents participated in the two age-groups. The average ICECAP-A/-O scores were 0.894 (SD=0.126) and 0.828 (SD=0.150), and the mean HAQ-DI scores were 0.052 (SD=0.253) and 0.463 (SD=0.586), respectively. Correlations between the HAQ-DI score and both ICECAP-A/-O scores were moderate, but it was bordering to high in the case of ICECAP-O. Both the ICECAP-A/-O index scores differed significantly across subgroups defined by self-reported MSK health problems. Also, both ICECAP-A/-O scores were lower in the subgroup with self-reported MSK diagnosis. HAQ-DI showed similar tendency, especially in hip and knee arthrosis. Regression results indicated that HAQ-DI scores were significantly (negatively) associated with ICECAP-A/-O scores. However, when EQ-5D-5L index and EQ VAS were included in the models, the HAQ-DI score was no longer significant. Individuals with MSK health problems have significantly worse well-being capabilities than those without. The HAQ-DI index can be used as a proxy to estimate ICECAP-A and ICECAP-O scores in case of lack of data, however the EQ-5D-5L performs better for that purpose.

Diagnosis-specific sickness absence and disability pension before and after multiple sclerosis diagnosis: An 8-year nationwide longitudinal cohort study with matched references

BackgroundMultiple sclerosis (MS) typically onsets when of working age and may reduce work capacity. Previous studies have examined the risk of sickness absence (SA) and disability pension (DP) among MS patients, however, limited knowledge is available on whether MS patients have an excess risk for SA/DP when compared with the general population in Sweden. Moreover, no information exists on the actual diagnoses for SA and DP among MS patients and whether the patterns of SA/DP diagnoses differs to those without MS. We aimed to explore diagnosis-specific SA and DP among working-aged MS patients both before and after MS diagnosis, in comparison to the levels and distributions of SA and DP diagnoses of a matched reference group and analyze the risk of diagnosis-specific DP. Materials and methodsLongitudinal Swedish register data of the 2567 MS patients diagnosed with MS in 2009–2012 when aged 25–59 and 10,268 population-based matched references (matched on sex, age, educational level, type of living area, and country of birth) were analysed regarding annual diagnosis-specific SA and DP in the four years before and four years after MS diagnosis. Annual differences in the mean numbers of SA and/or DP net days were calculated with 95% confidence intervals (CI). Hazard ratios (HR) with 95% CI from Cox proportional hazard models were used to compare risks for new all-cause and diagnosis-specific DP after MS diagnosis among the MS patients and references. ResultsThe mean SA/DP net days/year increased among MS patients over follow-up, due to both MS and other diagnoses. During follow-up, around 50% of MS patients had some SA/DP compared to 20% of references. The mean days of SA/DP among the MS patients compared to references increased from 10.3 more days (95% CI: 6.6–14.2) four years prior to MS diagnosis to 68.9 days (62.8–75.1) 4 years after MS diagnosis. Although most new DP among MS patients were due to MS, 15% were not. The adjusted HR for all-cause DP was 23.1 (18.1–29.5). MS patients also had higher risks of new DP due to all diagnoses except MS (HR 3.4; 2.4–4.8), musculoskeletal (HR 2.6; 1.1–6.0) and mental (HR 2.0; 1.1–3.6) diagnoses compared with references. ConclusionMS patients had higher levels of SA/DP days/year than the references, already 4 years before the MS diagnosis, and increasingly so thereafter. The excess of SA/DP prior to MS diagnosis could be related to MS onset. However, the excess of SA/DP days were not all due to MS diagnoses, even after being diagnosed with MS. MS patients had a higher risk of having a new DP after being diagnosed with MS in total, but also for diagnoses other than MS.

Pain Diagnosis, Pain Coping, and Function in Individuals with Chronic Musculoskeletal Pain.

PurposeResearch supports a role for coping responses in adjustment to chronic pain. However, it is likely that some coping responses play a larger role in adjustment to pain for some individuals than others. The identification of the factors that moderate the association between coping responses and pain-related outcomes has important clinical implications. This study sought to determine if musculoskeletal pain diagnosis moderates the associations between eight pain-coping responses and both pain and function.Patients and MethodsA non-probabilistic sample of 323 persons with different chronic musculoskeletal pain conditions completed measures of pain intensity, physical function, psychological function, and pain-coping responses.ResultsWith only one exception, the frequency of use of pain-coping responses was not associated with pain diagnosis. Statistically significant moderation effects of pain diagnosis on the association between coping and pain outcomes were found for two coping responses: 1) support seeking when predicting pain intensity, and 2) resting when predicting both physical and psychological function.ConclusionThe findings indicate that coping responses tend to play a similar role in patients' pain and function across different musculoskeletal pain conditions, with some important exceptions. If the findings are found to replicate in other samples, they would have important implications for determining when psychosocial pain treatments might (and when they might not) need to be adapted for specific diagnostic groups.

Quality of life trajectories differ across patients with femoral acetabular impingement and increasing hip osteoarthritis severity 24 months after hip arthroscopic surgery

Purpose: Femoral acetabular impingement is a proliferative musculoskeletal diagnosis among young-to-middle aged adults and proposed to be a significant risk factor for hip osteoarthritis. Arthroscopic surgery is a recommended treatment intended to decrease symptoms, restore joint mechanics and disrupt further articular cartilage damage, yet inconsistent evidence exists, and little is known about postoperative quality of life trajectories and its relationship with osteoarthritis severity. The purpose of this study was to investigate the quality of life trajectories from preoperative to 24-month postoperative hip arthroscopic surgery in patients with and without hip osteoarthritis.