Information support of evidence-based managing of patients with musculoskeletal disorders in primary health care

Authors

  • V.V. Povoroznyuk MD, PhD, Professor, Head of the Department of clinical physiology and pathology of locomotor apparatus, State Institution “D.F. Chebotarev Institute of Gerontology of the NAMS of Ukraine”, Kyiv, Ukraine, e-mail: okfpodac@ukr.net http://orcid.org/0000-0002-9770-4113
  • O.G. Puzanova MD, PhD, Professor at the Department of internal and occupational diseases, Private Higher Education Institution “Kyiv Medical University”, Kyiv, Ukraine; e-mail: vizhankova@gmail.com; phone: +38 (050) 383-23-00 http://orcid.org/0000-0002-4451-659X

DOI:

https://doi.org/10.22141/2224-1507.9.4.2019.191922

Keywords:

musculoskeletal disorders, primary care, evidence-based medicine, computer databases, Cochrane reviews, clinical recommendations and protocols

Abstract

Health care efficacy depends on its resource support quality and adherence to the evidence-based approach. The study aimed to characterize the information support of evidence-based managing of patients with musculoskeletal disorders at the level of  primary care. Materials and methods. Using information ana­lysis, expert assessments and statistical methods, in the period of 2009–2019 we have been studying evi­dence-based medicine computer meta-databases, guidelines of both US Preventive Servi­ces Task Force (USPSTF) and Canadian Task Force of Preventive Health Care (CTFPHC), medical-and-technological documents of the Ministry of Health of Ukraine. Results. We have demonstrated intensive development of the Cochrane reviews on musculoskeletal disorders (up to 16 per year), their high rating (from 20 to 33.3 % among the top-ranking ones on the Cochrane Colla­boration website, mostly concerning neuropathic pain and fibromyalgia), search option efficiency for a total of 785 reviews from this source and in the Cochrane Library on 40 topics from the ca­tegories “Rheumatology” and “Orthopaedics & Trauma”, of which 27.0 % are in Russian. The TRIP databases consistent advantages are identified, among them access to the latest evidence and their advanced search; it contains 130 documents on primary care, of which 4 (3.1 %) on musculoskeletal pain. EvidenceAlerts has even more evidence on the primary care — 13,259 documents, of which 140 (1.1 %) on the musculoskeletal system. The principal subject of both USPSTF and CTFPHC is fracture prevention in adults, as supported by their guidelines on screening for osteoporosis, recommendations on falls, ta­king vitamin D and calcium. Musculoskeletal disorders were focus of 6 out of 93 (6.5 %) guidelines and 3 out of 123 (2.4 %) unified protocols approved by the Ministry of Health of Ukraine during 2012–2017, and 165 out of 962 (17.2 %) new protocols, of which 98.8 % of which have chaptered entitled “Traumatology”, “Orthopaedics” and “Rheumato­logy”. Their share exceeds the musculoskeletal disorders’ share in the structures of diseases prevalence for the general population of Ukraine (5.4 %) and for the people of the working­age (5.6 %). Conclusions. Musculoskeletal diseases, pain and fractures make up the key and most popular subjects of the Cochrane Collaboration, whose website along with the Cochrane Library, TRIP and EvidenceAlerts is a useful source primarily for scientists. For the primary care specialists of Ukraine, the information support on musculoskeletal disorders relies on single unified protocols and 165 new ones, that should be used in continuing medical education. The population health may be improved by developing an adult fracture prevention program, taking into account the Cochrane Library’s source and the USPSTF and CTFPHC guidelines as especially useful for health managers and scientists.

Downloads

Download data is not yet available.

References

World Health Organization (WHO). The World Health Report 2008: Primary Health Care - Now More Than Ever. Available from: https://www.who.int/whr/2008/en/.

Sysojenko IV, Jarynich KV, Kyrychenko OM, et al. The Law Project of Ukraine On Primary Health Care Based on Family Medicine. Health of Society. 2018;7(1):53-68. (in Ukrainian).

Kovalenko VM, Kornac'kyj VM, editors. Stan zdorov’ja narodu Ukrai'ny ta medychnoi' dopomogy tretynnogo rivnja [The state of health of the people of Ukraine and medical care at the tertiary level]. Kyiv; 2019. 224 p. (in Ukrainian).

Greenhalgh T. How to Read a Paper: The Basics of Evidence-Based Medicine. 4th ed. Hoboken, NJ: Wiley-Blackwell; 2010. 256 p.

Puzanovа OG, Gruzeva TS. Information support of evidence-based health care. Part I. Bol', sustavy, pozvonočnik. 2014;(16):21-33. https://doi.org/10.22141/2224-1507.4.16.2014.79639. (in Ukrainian).

Wieringa S, Engebretsen E, Heggen K, Greenhalgh T. Has evidence based medicine ever been modern? A Latour-inspired understanding of changing EBM. J Eval Clin Pract. 2017 Oct;23(5):964-970. https://doi.org/10.1111/jep.12752.

Puzanova OG, Plenova OM, Malchevska TY. Evidence based prevention in health care: development and implementation of the concept in Ukraine. In: Maciejewski R, Wrońska I, Furtak-Niczyporuk M, editors. Development and modernization of medical science and practice: experience of Poland and prospects of Ukraine. Vol 3. Lublin, Poland: Baltija Publishing; 2017. 156-173 pp.

Galbraith K, Ward A, Heneghan C. A real-world approach to Evidence-Based Medicine in general prac-tice: a competency framework derived from a systematic review and Delphi process. BMC Med Educ. 2017 May 3;17(1):78. https://doi.org/10.1186/s12909-017-0916-1.

Puzanovа OG, Gruzeva TS. Information support of evidence-based health care. Part II. Bol', sustavy, pozvonočnik. 2015;(17):21-33. https://doi.org/10.22141/2224-1507.1.17.2015.79017. (in Ukrainian).

Puzanovа OG, Gruzeva TS. Information support of evidence-based health care. Part III. Bol', sustavy, pozvonočnik. 2015;(18):21-33. https://doi.org/10.22141/2224-1507.2.18.2015.79098. (in Ukrainian).

Ministry of Нealth of Ukraine. Order on September 9, 2012 № 751. On Creation and Implementation of Medical and Technological Documents on the Standardization of Medical Care in the System of the Ministry of Health of Ukraine. Available from: https://zakon.rada.gov.ua/laws/show/z2001-12?lang=uk. Accessed: September 9, 2012. (in Ukrainian).

Puzanovа OG. Problems of evidence-based management of the patients with musculoskeletal disorders. Litopys of traumatology and orthopedics. 2018;(37-38):157-160. (in Ukrainian).

Povoroznyuk VV, Puzanova OG. Evidence-based approach to managing musculoskeletal disorders: problems of implementation. In: Abstracts of the 4th Central and Eastern European Summit on Bone Diseases, December 7th, 2017, Vienna. J Miner Stoffwechs Muskuloskelet Erkrank. 2018;28(1):6. https://doi.org/10.1007/s41970-017-0020-3.

Wiffen PJ, Derry S, Bell RF, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Data-base Syst Rev. 2017 Jun 9;(6):CD007938. https://doi.org/10.1002/14651858.CD007938.pub4.

Moore RA, Derry S, Aldinghton D, Cole P, Wiffen PJ. Amitryptyline for neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2015;(7): CD008242. https://doi.org/10.1002/14651858.CD008242.pub3.

Khalil N, Nicotra A, Rakowicz W. Treatment for meralgia paraesthetica, a condition causing numbness and sometimes pain in the thigh. Cochrane Database of Systematic Reviews. 2012;(12): CD004159. https://doi.org/10.1002/14651858.CD004159.pub3.

Bastian H, Glasziou P, Chalmers I. Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up? PLoS Med. 2010 Sep 21;7(9):e1000326. https://doi.org/10.1371/journal.pmed.1000326.

Wieringa S, Engebretsen E, Heggen K, Greenhalgh T. Rethinking bias and truth in evidence-based health care. J Eval Clin Pract. 2018 Oct;24(5):930-938. https://doi.org/10.1111/jep.13010.

Whittaker GA, Munteanu SE, Menz HB, Bonanno DR, Gerrard JM, Landorf KB. Corticosteroid injec-tion for plantar pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019 Aug 17;20(1):378. https://doi.org/10.1186/s12891-019-2749-z.

Dakin P, DiMartino SJ, Gao H, et al. The Efficacy, Tolerability, and Joint Safety of Fasinumab in Oste-oarthritis Pain: A Phase IIb/III Double-Blind, Placebo-Controlled, Randomized Clinical Trial. Arthritis Rheumatol. 2019 Nov;71(11):1824-1834. https://doi.org/10.1002/art.41012.

Caballol Angelats R, Gonçalves AQ, Aguilar Martin C, et al. Effectiveness, cost-utility, and benefit of a multicomponent therapy to improve the quality of life of patients with fibromyalgia in primary care: A mixed methods study protocol. Medicine (Baltimore). 2019 Oct;98(41):e17289. https://doi.org/10.1097/MD.0000000000017289.

Kesten J, Thomas K, Scott L, et al. Acceptability of a primary care-based opioid and pain review ser-vice: a mixed method evaluation in England. Br J Gen Pract. 2019 Oct 8. pii: bjgp19X706097. https://doi.org/10.3399/bjgp19X706097.

US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Interventions to Prevent Falls in Community-Dwelling Older Adults. US Preventive Services Task Force Recommendation Statement. JAMA. 2018 Apr 24;319(16):1696-1704. https://doi.org/10.1001/jama.2018.3097.

US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: US Preven-tive Services Task Force Recommendation Statement. JAMA. 2018 Apr 17;319(15):1592-1599. https://doi.org/10.1001/jama.2018.3185.

Povoroznyuk VV, Grigoryeva NV, Orlik TV, Nishkumay OI, Dzerovich NI, Balatskaya NI. Osteoporosis in the practice of an internist. Kyiv; 2014. 198 p.

Pludowski P, Holick MF, Grant WB, et al. Vitamin D supplementation guidelines. J Steroid Biochem Mol Biol. 2018 Jan;175:125-135. https://doi.org/10.1016/j.jsbmb.2017.01.021.

Moyer VA, US Preventive Services Task Force. Vitamin D and calcium supplementation to prevent fractures in adult: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2013 May 7;158(9):691-6. https://doi.org/10.7326/0003-4819-158-9-201305070-00603.

LeFevre ML, US Preventive Services Task Force. Screening for vitamin D deficiency in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015 Jan 20;162(2):133-40. https://doi.org/10.7326/M14-2450.

US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for Adolescent Idiopathic Scoliosis: US Preventive Services Task Force Recommendation Statement. JAMA. 2018 Feb 13;319(6):588-594. https://doi.org/10.1001/jama.2017.21926.

Hresko MT, Schwend RM, Hostin RA. Early Detection of Scoliosis-What the USPSTF "I" Means for Us. JAMA Pediatr. 2018 Mar 1;172(3):216-217. https://doi.org/10.1001/jamapediatrics.2017.5585.

Moyer VA, US Preventive Services Task Force. Prevention of falls in community-dwelling older adults. U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012 Aug 7;157(3):197-204. https://doi.org/10.7326/0003-4819-157-3-201208070-00462.

Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014 Oct;25(10):2359-81. https://doi.org/10.1007/s00198-014-2794-2.

Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. https://doi.org/10.1210/jc.2011-0385.

American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommen-dations abstracted from the American Geriatrics Society Consensus Statement on vitamin D for preven-tion of falls and their consequences. J Am Geriatr Soc. 2014 Jan;62(1):147-52. https://doi.org/10.1111/jgs.12631.

US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2018 Jun 26;319(24):2521-2531. https://doi.org/10.1001/jama.2018.7498.

Committee on Practice Bulletins-Gynecology, The American College of Obstetricians and Gynecol-ogists. ACOG Practice Bulletin N. 129. Osteoporosis. Obstet Gynecol. 2012 Sep;120(3):718-34. https://doi.org/10.1097/AOG.0b013e31826dc446.

Watts NB, Adler RA, Bilezikian JP, et al. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012 Jun;97(6):1802-22. https://doi.org/10.1210/jc.2011-3045.

Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists and American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2016: executive summary. Endocr Pract. 2016 Sep;22(9):1111-8. https://doi.org/10.4158/EP161435.ESGL.

Gates M, Pillay J, Theriault G, et al. Screening to prevent fragility fractures among adults 40 years and older in primary care: protocol for a systemic review. Syst Rev. 2019 Aug 23;8(1):216. https://doi.org/10.1186/s13643-019-1094-5.

Shepstone L, Lenaghan E, Cooper C, et al. Screening in the community to reduce fractures in older women (SCOOP): a randomized controlled trial. Lancet. 2018 Feb 24;391(10122):741-747. https://doi.org/10.1016/S0140-6736(17)32640-5.

Elders PJM, Merlijn T, Swart KMA, et al. Design of the SALT Osteoporosis Study: a randomised prag-matic trial, to study a primary care screening and treatment program for the prevention of fractures in women aged 65 years or older. BMC Musculoskelet Disord. 2017 Oct 27;18(1):424. https://doi.org/10.1186/s12891-017-1783-y.

Downloads

Published

2019-12-29

How to Cite

Povoroznyuk, V., & Puzanova, O. (2019). Information support of evidence-based managing of patients with musculoskeletal disorders in primary health care. PAIN, JOINTS, SPINE, 9(4), 222–236. https://doi.org/10.22141/2224-1507.9.4.2019.191922

Issue

Section

Original Researches

Most read articles by the same author(s)

<< < 1 2 3 4 5 6 7 8 > >>