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|Topic title||Musculoskeletal conditions (2016)|
|Topic owner||Rachel Sokal, Consultant in Public Health|
|Topic author(s)||Laura Dunkley, Public Health Intern|
|Topic quality reviewed||MSK JSNA Task & Finish Group|
|Current version||V1. 19/02/2016|
|Replaces version||New chapter|
|Linked JSNA topics|
|Insight Document ID||164064|
Musculoskeletal (MSK) conditions are those affecting the nerves, tendons, muscles and supporting structures, for example spinal discs[i]. This encompasses over 150 diseases and syndromes[ii]. Taken together, data from the Global Burden of Disease study (GBD) demonstrates that as of 2013 they are the leading cause of disability in England, accounting for 24% of all years lived with disability (YLD)[iii].
According to GBD data, low back and neck pain was the leading cause of disability in England in 2013, resulting in 1.3 million YLD – nearly 18% of all YLD - compared to 445,000 YLD attributable to the next leading cause (sense organ diseases). ‘Other musculoskeletal disorders’ were the tenth largest contributor of YLD, responsible for 235,000 YLD, while osteoarthritis was 15th, causing 136,000 YLD. In Nottingham City, 72% of the musculoskeletal burden (in terms of YLD) is due to low back and neck pain, and 9% due to osteoarthritis. The disability due to MSK disorders is expected to rise further with increases in obesity and sedentary lifestyles, along with an ageing population[iv].
This JSNA chapter focuses on these leading and most common causes of musculoskeletal morbidity and mortality: low back and neck pain and osteoarthritis. It excludes osteoporosis and fracture as this is covered in the separate JSNA chapter ‘Falls and Bone Health’[v]. Rheumatoid arthritis and MSK pain or damage as a result of trauma are also excluded, since in Nottingham these follow slightly different patient pathways and these conditions are less prevalent than neck and back pain, and osteoarthritis.
The impact of MSK conditions can be underestimated since most are not immediately life threatening (although both rheumatoid arthritis[vi],[vii] and, to a lesser extent, osteoarthritis[viii] are associated with increased mortality). Instead, sufferers can live with them for years, resulting in a long-term burden via pain and impaired functioning for the individual which can also impact on social functioning and mental health[ix]. There is also a substantial economic burden due to work days lost and primary and secondary health costs[x]. Official statistics often do not capture the full impact of the illness, as only a small proportion of those with MSK conditions will present to health services and so appear in health data. For example, only around 20% of those with low back pain will present with it to their GP[xi]. As a result, there is a large population of sufferers self-managing their condition at home, for whom the full impact of illness is difficult to capture.
[i] Institution of Occupational Safety and Health (2016) Musculoskeletal disorders. [online] Available at: http://www.iosh.co.uk/books-and-resources/our-oh-toolkit/musculoskeletal-disorders.aspx. [Accessed 19 January 16].
[ii] European Commission (2015) Musculoskeletal conditions. [online] Available at: http://ec.europa.eu/health/major_chronic_diseases/diseases/musculoskeletal/index_en.htm#fragment0. [Accessed 19 January 16].
[iv] Storheim, K. and Zwart, J.-A. (2014) Musculoskeletal disorders and the Global Burden of Disease study. Annals of the Rheumatic Diseases;73:949–950.
[v] Nottingham City Council (2015) Falls and Bone Health: Joint Strategic Needs Assessment (JSNA). [online] Available at: http://jsna.nottinghamcity.gov.uk/insight/Strategic-Framework/Nottingham-JSNA/Adults/Falls-and-Bone-Health-(2015).aspx. [Accessed 01 February 16].
[vi] Gonzalez, A., Kremers, H. M., Crowson, C. S., Nicola, P. J., Davis III, J. M., Therneau, T. M., Roger, V. L. and Gabriel, S. E. The widening mortality gap between rheumatoid arthritis patients and the general population. Arthritis & Rheumatism;56(11):3583–3587
[vii] Sihvonen, S., Korpela, M., Laippala, P., Mustonen, J., Pasternack, A. (2004) Death rates and causes of death in patients with rheumatoid arthritis: a population-based study. Scandinavian Journal of Rheumatology;33(4):221-7. Erratum in Scand J Rheumatol. (2006) Jul-Aug;35(4):332.
[viii] Nüesch, E., Dieppe, P., Reichenbach, S., Williams, S., Iff, S and Jüni, P. (2011) All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study. British Medical Journal;342:d1165.
[ix] Woolf, A. D. and Pfleger, B. (2003) Burden of major musculoskeletal conditions. Bulletin of the World Health Organisation;81(9):646-56.
[x] Parsons, S., Ingram, M., Clarke-Cornwell, A. M. and Symmons, D. P. M (2011) A heavy burden: The occurrence and impact of musculoskeletal conditions in the United Kingdom today. Arthritis Research UK and the University of Manchester: Manchester.
[xi] NICE (2009) Low back pain in adults: early management. Clinical guideline CG88. 27 May. NICE: London.
Musculoskeletal conditions are often chronic and are the leading cause of disability in England, although a large proportion of sufferers may not present at health services. The impact of these conditions is seen in economic data, including days off work and benefits claimed, as well as in health statistics. There is also a knock-on detrimental impact on mental health. In Nottingham City, 72% of the musculoskeletal burden (in terms of YLD) is due to low back and neck pain, and 9% due to osteoarthritis.
[i] Harper, L. (2011) Evaluation of drop-in service for patients with low back pain. East Lancashire Hospitals NHS Trust. NICE Shared learning database. [online] Available at: https://www.nice.org.uk/sharedlearning/physiotherapy-low-back-pain-drop-in-services [Accessed 19 February 2016]
[ii] Ludvigsson, M. L., Enthoven, P. (2012) Evaluation of physiotherapists as primary assessors of patients with musculoskeletal disorders seeking primary health care. Physiotherapy;98(2):131-7.
Prevention and effective management of MSK conditions becomes a strategic priority for Nottingham City. A focus on prevention activities for key risk factors (obesity, physical inactivity) could be expected to mitigate some of the predicted increase in MSK conditions. Recognition should be made that lower socioeconomic groups may be particularly at risk of rising prevalence rates and of facing more limitations due to their condition.