The gaps between patient and physician understanding of the emotional and physical impact of osteoporosis

Summary : A multinational survey was conducted to evaluate the gaps between patients and physicians understanding of osteoporosis. The International Osteoporosis Foundation recommends the creation of community-wide patient support programmes to increase prevention and treatment awareness of osteoporosis. Introduction: Osteoporosis is often undiagnosed and untreated, leaving millions of people at risk of debilitating fractures. A survey was designed to investigate any gaps that may exist between physician and patient knowledge of osteoporosis, understand barriers to patient adherence and identify ways to address unmet needs and improve communications. Methods: Telephone interviews were conducted with patients (n = 844) and physicians (n = 837) in 13 countries in June/July 2009. Patients were women with postmenopausal osteoporosis currently taking (or in the past 2years) prescribed medication. Physicians had experience in treating osteoporotic patients, which included only general practitioners who saw ≥10 (exception: in Hungary ≥5) and specialists who saw ≥20 patients with osteoporosis per month. Results: Physicians consistently underestimated their patients' adherence to treatment and beliefs on the impact of osteoporosis on their quality-of-life. Physicians underestimated how many patients worry about breaking a bone (51% vs 79%), as well as patient concerns about declines in activity levels (40% vs 70%), becoming dependent on others (30% vs 60%) and not being able to work for longer (30% vs 57%). Patients believed the most credible osteoporosis information was from specialists (94%). Patients (75%) would like easy to understand materials and 49% would welcome inter-patient discussions of their condition. Most physicians (88%) believed that osteoporosis organisations are among the most credible sources for information, 80% would give patients written materials to increase adherence and 76% would recommend patient programmes that encourage better communication on managing osteoporosis. Conclusion: Community-wide patient support programmes may help patients to manage their concerns and address unmet needs in osteoporosis managemen

Weißbuch Konservative Orthopädie und Unfallchirurgie

Millionen Menschen in Deutschland leiden an Rückenschmerz, Arthrose oder Osteoporose. Bei den meisten Betroffenen ist ein operativer Eingriff nicht angezeigt – stattdessen kommen konservative Verfahren wie Medikamente, manuelle Medizin, Schmerz- oder Physiotherapie zum Einsatz. Durch die steigenden Erkrankungszahlen haben Orthopäden und Unfallchirurgen einen gewaltigen Versorgungsauftrag, der mit der alternden Gesellschaft in Zukunft noch weiter wachsen wird. Konservative Behandlungsmethoden in der Orthopädie und Unfallchirurgie müssen daher gleichberechtigt neben dem operativen Teil stehen. Dieses Weißbuch bietet erstmalig strukturierte, evidenzbasierte Erkenntnisse zur Evaluation der konservativen Therapie in Orthopädie und Unfallchirurgie. Erfahrene Experten stellen zu jedem Indikationsgebiet die konservativer Behandlungsmethoden dar, beurteilen deren Stellenwert, decken Versorgungsmängel auf und beschreiben, wie die Defizite im konservativen Bereich so entwickelt werden können, dass das Fach Orthopädie / Unfallchirurgie in seiner ganzen Breite zukunftsfähig abgebildet wird

RENaBack: low back pain patients in rehabilitation—study protocol for a multicenter, randomized controlled trial

Background: Millions of people in Germany suffer from chronic pain, in which course and intensity are multifactorial. Besides physical injuries, certain psychosocial risk factors are involved in the disease process. The national health care guidelines for the diagnosis and treatment of non-specific low back pain recommend the screening of psychosocial risk factors as early as possible, to be able to adapt the therapy to patient needs (e.g., unimodal or multimodal). However, such a procedure has been difficult to implement in practice and has not yet been integrated into the rehabilitation care structures across the country. Methods: The aim of this study is to implement an individualized therapy and aftercare program within the rehabilitation offer of the German Pension Insurance in the area of orthopedics and to examine its success and sustainability in comparison to the previous standard aftercare program. The study is a multicenter randomized controlled trial including 1204 patients from six orthopedic rehabilitation clinics. A 2:1 allocation ratio to intervention (individualized and home-based rehabilitation aftercare) versus the control group (regular outpatient rehabilitation aftercare) is set. Upon admission to the rehabilitation clinic, participants in the intervention group will be screened according to their psychosocial risk profile. They could then receive either unimodal or multimodal, together with an individualized training program. The program is instructed in the clinic (approximately 3 weeks) and will continue independently at home afterwards for 3 months. The success of the program is examined by means of a total of four surveys. The co-primary outcomes are the Characteristic Pain Intensity and Disability Score assessed by the German version of the Chronic Pain Grade questionnaire (CPG). Discussion: An improvement in terms of pain, work ability, patient compliance, and acceptance in our intervention program compared to the standard aftercare is expected. The study contributes to provide individualized care also to patients living far away from clinical centers.German Pension Insurance Berlin-Brandenburg and Central GermanyPeer Reviewe

Diagnostic Value of Lumbar Facet Joint Injection: A Prospective Triple Cross-Over Study

The diagnosis “lumbar facet syndrome” is common and often indicates severe lumbar spine surgery procedures. It is doubtful whether a painful facet joint (FJ) can be identified by a single FJ block. The aim of this study was to clarify the validity of a single and placebo controlled bilateral FJ blocks using local anesthetics. A prospective single blinded triple cross-over study was performed. 60 patients (31 f, 29 m, mean age 53.2 yrs (22–73)) with chronic low back pain (mean pain persistance 31 months, 6 months of conservative treatment without success) admitted to a local orthopaedic department for surgical or conservative therapy of chronic LBP, were included in the study. Effect on pain reduction (10 point rating scale) was measured. The 60 subjects were divided into six groups with three defined sequences of fluoroscopically guided bilateral monosegmental lumbar FJ test injections in “oblique needle” technique: verum-(local anaesthetic-), placebo-(sodium chloride-) and sham-injection. Carry-over and periodic effects were evaluated and a descriptive and statistical analysis regarding the effectiveness, difference and equality of the FJ injections and the different responses was performed. The results show a high rate of non-response, which documents the lack of reliable and valid predictors for a positive response towards FJ blocks. There was a high rate of placebo reactions noted, including subjects who previously or later reacted positively to verum injections. Equivalence was shown among verum vs. placebo and partly vs. sham also. With regard to test validity criteria, a single intraarticular FJ block with local anesthetics is not useful to detect the pain-responsible FJ and therefore is no valid and reliable diagostic tool to specify indication of lumbar spine surgery. Comparative FJ blocks with local anesthetics and placebo-controls have to be interpretated carefully also, because they solely give no proper diagnosis on FJ being main pain generator

Improved education in musculoskeletal conditions is necessary for all doctors.

It is likely that everyone will, at some time, suffer from a problem related to the musculoskeletal system, ranging from a very common problem such as osteoarthritis or back pain to severely disabling limb trauma or rheumatoid arthritis. Many musculoskeletal problems are chronic conditions. The most common symptoms are pain and disability, with an impact not only on individuals' quality of life but also, importantly, on people's ability to earn a living and be independent. It has been estimated that one in four consultations in primary care is caused by problems of the musculoskeletal system and that these conditions may account for up to 60% of all disability pensions. In contrast, teaching at undergraduate and graduate levels--and the resulting competence and confidence of many doctors--do not reflect the impact of these conditions on individuals and society. Many medical students do not have any clinical training in assessing patients with bone and joint problems. Under the umbrella of the Bone and Joint Decade 2000-2010, experts from all parts of the world with an interest in teaching have developed recommendations for an undergraduate curriculum to improve the teaching of musculoskeletal conditions in medical schools. The goal for each medical school should be a course in musculoskeletal medicine concentrating on clinical assessment, common outpatient musculoskeletal problems and recognition of emergencies. Improving competency in the management of musculoskeletal problems within primary care settings through improved education is the next aim, but there are needs for improvement for all professionals and at all levels within the health care system

Improved education in musculoskeletal conditions is necessary for all doctors

It is likely that everyone will, at some time, suffer from a problem related to the musculoskeletal system, ranging from a very common problem such as osteoarthritis or back pain to severely disabling limb trauma or rheumatoid arthritis. Many musculoskeletal problems are chronic conditions. The most common symptoms are pain and disability, with an impact not only on individuals? quality of life but also, importantly, on people?s ability to earn a living and be independent. It has been estimated that one in four consultations in primary care is caused by problems of the musculoskeletal system and that these conditions may account for up to 60% of all disability pensions. In contrast, teaching at undergraduate and graduate levels - and the resulting competence and confidence of many doctors - do not reflect the impact of these conditions on individuals and society. Many medical students do not have any clinical training in assessing patients with bone and joint problems. Under the umbrella of the Bone and Joint Decade 2000-2010, experts from all parts of the world with an interest in teaching have developed recommendations for an undergraduate curriculum to improve the teaching of musculoskeletal conditions in medical schools. The goal for each medical school should be a course in musculoskeletal medicine concentrating on clinical assessment, common outpatient musculoskeletal problems and recognition of emergencies. Improving competency in the management of musculoskeletal problems within primary care settings through improved education is the next aim, but there are needs for improvement for all professionals and at all levels within the health care system

Sequences (groups of possible injection series).

<p>Sequences (groups of possible injection series).</p

Oblique needle technique of fluoroscopically guided lumbar fact joint injection.

<p>Oblique needle technique of fluoroscopically guided lumbar fact joint injection.</p

Tests on difference.

<p>*p = 0.05.</p><p>t1: 30 min after FJI, t2 60 min after FJI, t3: 2–3 h after FJI, t4: 6–8 h after FJI.</p