RESEARCH - Musculoskeletal disorders hit quality of life hard and early

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Musculoskeletal disorders hit quality of life hard and early

Apr 4, 2005

Rheumawire

Nice, France - Patients with new-onset musculoskeletal conditions suffer a

10% drop in quality of life within the first 2 years after diagnosis, a new

study has found. Researchers say that patients are most affected physically,

but mental and social functions are also impaired in comparison with

controls. The finding, published in the April 2005 issue of ls of the

Rheumatic Diseases, reinforces recent recommendations for early treatment

and primary prevention [1].

" To our knowledge, this study is the first longitudinal comparison between

subjects with and without onset of musculoskeletal disorders, " comment the

researchers, led by Dr CH Roux (Service de Rhumatologie, CHU de Nice,

France). The group collected quality-of-life data from the same subjects

before and after the onset of their condition. They note that using

musculoskeletal-disorder-free controls matched for age and sex " strengthens

the conclusions. "

The researchers explain that because longitudinal studies in this area have

included patients in observational or interventional trials, they have

focused on subjects with existing disorders. Little is therefore known about

the true impact of such illness on previously healthy subjects. Roux and

colleagues wanted to test the hypothesis that people who develop a

musculoskeletal disorder have a significant change in subsequent quality of

life compared with controls matched for age and sex. They took into account

the nature of musculoskeletal illnesswhether it was chronic or acuteand the

influence of any comorbidities. The researchers note, " Unlike previous

investigations, disorder-free baseline quality-of-life data are available

for all subjects. "

Greatest change related to bodily pain

Roux and colleagues studied an inception cohort of 1202 subjects in France

aged 45 to 60 years free of musculoskeletal problems at baseline. Over 28

months of follow-up, 310 were diagnosed with musculoskeletal disorders and

matched for age and sex with 620 healthy controls. They assessed the impact

of the musculoskeletal-disorder onset on quality of life by the change in

Short Form-36 (SF-36) scores over time using a linear mixed analysis of

variance (ANOVA) model to compare the groups.

The researchers found that the incidence of musculoskeletal disorder was

13.6% per person-year in the spine, 4.2% per person-year in a joint, and

4.6% per person-year at an extra-articular site. The greatest change in

quality of life was a 10-point drop in the 100-point SF-36 bodily pain

dimension scale in the musculoskeletal group.

Compared with controls, they found that subjects with a musculoskeletal

condition had significantly greater reductions in the following dimensions:

Bodily pain (a 27.4-point difference in change).

Vitality (22.7).

General health (21.8).

Physical functioning (21.3).

Chronic conditions had a greater impact than acute disorders

Within the musculoskeletal group, the investigators found that chronic

disorders had a greater impact than acute ones on physical performance

(22.1), emotional well-being (28.4), and social functioning (25.9).

" This inception cohort study confirms previous cross-sectional results that

the onset of a musculoskeletal disorder reduces quality of life, " the

researchers comment. Roux and colleagues explain that while musculoskeletal

conditions rarely cause death and are only seventh in the numbers of

patients admitted to the hospital, they are fifth for drug costs, third for

chronicity, second for total health costs, and first for health-professional

consultations and are the most common disabling conditions in Western

countries. They write, " Worldwide, the proportion of the population disabled

by rheumatism ranges from 2.8% in the US to 8% in Great Britain. In Canada,

musculoskeletal problems accounted for 1.7% of the 1986 gross national

product, a higher figure than that for cancer. "

The investigators point out several limitations to their work. They note the

difficulties of self-reporting of symptom and disease occurrence by

questionnaire. The researchers explain that the onset of symptoms is more

likely reported than diagnosis is, on the one hand, and some disorders

already affecting patients at entry might have been omitted, on the other.

They also note that the mid-life age group of the study sample (45 to 60

years of age), in which 80% of subjects were still professionally active,

might limit the generalizability of the present findings and the

comparability with other population surveys on the occurrence of

musculoskeletal disorders.

Roux and colleagues conclude, " The bodily pain dimension is most affected,

with a 10-point loss on a 0 to 100 scale over 28 months of follow-up. " They

explain that according to Ware et al, a 5-point difference is sufficient to

reflect clinically and socially relevant change [2].

Sources

Roux CH, Guillemin F, Boini S, et al. Impact of

musculoskeletal disorders on quality of life: an inception cohort study. Ann

Rheum Dis 2005; 64:606-611.

Ware JE, Snow K, Kosinski M, et al. SF-36 health survey.

Manual and interpretation guide. Boston, MA: The Health Institute, New

England Medical Center; 1993.

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