Bruusgaard EU 2005

Musculoskeletal Problemsand

Functional limitationThe great Public Health Challenge for the 21st Century

• Dag Bruusgaard• Professor, Head of dept.• Dept. of General Practice and

Community Medicine• University of Oslo, Norway

Bruusgaard EU 2005

Troublesomefor the patients,

problematicfor the health care

system, and

costly for the society

Bruusgaard EU 2005

Bruusgaard EU 2005

Musculoskeletal Conditions (MSC)

• 50% of population report MSC• 15-20% of consultations

in primary care• 30-50% of disability payment• 6% of total health care costs

(but 90% of indirect costs)

Bruusgaard EU 2005

• Musculoskeletal problems and conditions form a heterogeneous group for a great part with poorly understood causes. The group comprises clear cut diagnoses, biologically and clinically well defined such as rheumatoid arthritis and sciatica; biologically defined, but clinically less well defined diagnoses such as osteoporosis and arthrosis; as well as controversial conditions as nonspecified low back pain, fibromyalgiaand myofacial pain syndromes. The common denominators are pain and reduced function resulting from some disturbances in the musculoskeletal system ensuing mainly from inflammation, degenerative processes and trauma.

Bruusgaard EU 2005

European Community Health Indicators (ECHI)

• Demography and Socio-economic situation

• Health status• Determinants• Health systems (consequences)

Bruusgaard EU 2005

Musculoskeletal Conditions

ECHI hierarcy

Health statusPerceived and functional health

Chronic disease generalGeneral musculoskeletal pain

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Monitoring of Musculoskeletal Conditions

Routine data (running)

HIS/HES data (repeated)generic

HIS/HES data (repeated)spesific

Bruusgaard EU 2005

• Inflammatory arthritis• Osteoporosis• Osteoarthritis• Dorsalgia• Other localized pain• Chronic widespread

musculoskeletal pain• Trauma

Musculoskeletal Conditions

Bruusgaard EU 2005

Musculoskeletal ConditionsChronic musculoskeletal pain-A multisymptom syndrome?

• Chronic fatigue• Fibromyalgia• Myofacial pain syndrome• Amalgamism• El-allergy• Gulf war syndrome• Multichemical hypersensitivity

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Monitoring of MSC

1. Occurrence of self reported musculoskeletal painSelf report in health interview survey of pain and limited function from different regions, using the question above.

2. Occurrence of rheumatoid arthritisIncidense and prevalence of RA in existing and future regional registers

3. Occurrence of osteoarthritis in hip and kneePrevalence of OA in research projects based on health examination surveys, including x-ray

4. Occurrence of osteoporosisPrevalence of bone density monitored in health examination studies

Bruusgaard EU 2005

Monitoring of MSC

5. Reduced functionPrevalence of persons with reduced function, measured in health interview surveys as recommended by other in the health monitoring project

6. Work disabilityPermanent or temporal work disability, according to diagnosis from social security statistics

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Monitoring of MSC7. Occurrence of hip fracture

Incidence of hip fractures from hospital statistics

8. Hip and knee arthroplastyIncidence and indicators for hip and knee replacement from hospital statistics

9. Drugs for treatment and prevention of osteoporosisDefined daily doses of drugs (ATL05B) and actual prescription from whole sale statistics and prescription registers

10. Drugs for treatment of rheumatoid arthritisDefined daily doses of drugs (ATC L 04 A) and actual prescription from whole sale statistics and prescription registers

Bruusgaard EU 2005

• 1. During the last week, have you had any pain affecting your muscles, joints, neck or back which has occurred on most days and which has affected your ability to carry out the activities of daily living? If Yes, please tick the region(s) in the grid (column a)

• 2. Has this pain (or pains) lasted for 3 months or more? If Yes, please tick the region(s) in the grid (column b)

• Head – Neck - Shoulder(s) - Upper back Elbows - Wrist(s) / hand(s) - Low back -Hip(s) / thigh(s) - Knee(s) - Ankles / foot/feet

Bruusgaard EU 2005

Musculoskeletal Conditions

• Rheumatologists• Orthopedic surgeons• Traumatologists• Endocrinologists• Epidemiologists• General Practitioners

Bruusgaard EU 2005

• EULAR• B&J Decade

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Written declaration on rheumaticdiseases (41/2005)

The European Parliament calls on the Commission and Council to:

• Ensure that the EU´s 7th RFP makes rheumatic diseases one ofits explicit priorities;

• Ensure that the EU´s new healthstrategy makes arthritis(musculoskeletal disorders) oneof its priorities

• …

Bruusgaard EU 2005

Written declaration on rheumaticdiseases (41/2005)

The European Parliament calls on the Commission and Council to:

• Ensure that the EU´s 7th RFP makes rheumatic diseases one ofits explicit priorities;

• Ensure that the EU´s new healthstrategy makes arthritis(musculoskeletal disorders) oneof its priorities

• …

Bruusgaard EU 2005

Bruusgaard EU 2005

European Community Health Indicators

PAIN

FATIGUE

DEPRESSION

ANXIETY

Bruusgaard EU 2005

European Community Health Indicators

Health monitoring

Resources mon.

Compl/functional mon.

Disease monitoring

Bruusgaard EU 2005

European Community Health Indicators

• Health status– Mortality– Morbidity– Generic health status– Composite health status

This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.