Prevalence of disability in patients with musculoskeletal pain and rheumatic diseases in a population from Cuenca, Ecuador

Objective: The aim of this study was to determine the prevalence of disability in patients with musculoskeletal pain and rheumatic diseases in Cuenca, Ecuador. Methods: We performed a cross-sectional analytical study with randomized sampling in 4877 subjects, from urban and rural areas. COPCORD (Community Oriented Program for Control of Rheumatic Diseases)- validated questionnaire was administered house-to-house to identify subjects with nontraumatic musculoskeletal pain and rheumatic diseases. The subjects were assessed by rheumatologists for diagnostic accuracy, and the Health Assessment Questionnaire Disability Index was administered to assess functional capacity. A logistic regression analysis was conducted to determine the association of rheumatic diseases with functional disability. Results: Functional disability was found in 221 subjects (73.1% women), with mean age 62 (SD, 18.2)years, residing in rural areas (201 [66.5%]), with education of 6.9 (SD, 5.3)years, and of low income (77 [47.2%]). The value of HAQ-DI was a mean of 0.2 (0-2.9). The real prevalence of physical disability was 9.5%. Moderate and severe disability predominated in activities such as kneeling (4.9% and 3.3%), squatting (4.8% and 2.7%), and leaning to pick up objects (3.7% and 0.9%), respectively. Rheumatic diseases associated with physical disabilities were knee osteoarthritis (95 [31.4%]) and hand osteoarthritis (69 [22.8%]), mechanical low-back pain (43 [14.2%]), fibromyalgia (27 [9.5%]), and rheumatoid arthritis (11 [3.6%]; P < 0.001). Conclusions: Physical disability was associated with older age, female sex, rural residence, lower education, and lower income. Moderate and severe disability predominated in the dimensions of kneeling, squatting, and picking up objects. Rheumatic diseases associated with disabilitywere hand and knee osteoarthritis, back pain, fibromyalgia, and rheumatoid arthritis. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved

Validación del cuestionario COPCORD para detección de enfermedades reumáticas CUENCA - ECUADOR

Objetivo: Validar la adaptación cultural del ins-trumento (Community Orientade Programm in the Rheumatic Diseases) COPCORD para de-tectar malestares músculo-esqueléticos y en-fermedades reumáticas en la población del cantón Cuenca.Metodología: Validación transcultural del cues-tionario COPCORD y aplicación en la comuni-dad, para identificar síntomas reumáticos. Un médico reumátologo revisó a las personas para definir el diagnóstico.Se realizó análisis estadístico descriptivo de cada una de la variables; se midió el alfa de Chronbach, análisis de prueba de tamizaje (sensibilidad, especificidad, valor predictivo positivo y curvas roc). Resultados: Participaron 201 personas, 106 del área urbana y 95 del área rural. El 67,6% co-rrespondió a mujeres con una edad promedio 50,3 años, con escolaridad 7,5 años. El 57,7% reportó dolor músculo-esquelético, con una in-tensidad de 5,8 por EVA; al comparar el cues-tionario COPCORD con la evaluación clínica del reumatólogo, se observó una sensibilidad del 83,72, especificidad de 61,14%, razón de verosimilitud de 2,18 y área bajo la curva de 0,72; con una alfa de Cronbach de 0,7 para las características del dolor y 0,9 para capaci-dad funcionalObjective: To validate the cultural adaptation of the instrument (Community Orientate Pro-gram in the Rheumatic Diseases) COPCORD to detect musculoskeletal pain and rheumatic diseases in the population of Cuenca.Methodology: A COPCORD transcultural ques-tionnaire validation and its application were made in the community to identify rheumatic symptoms. A rheumatologist doctor checked people to define the diagnosis. A descriptive statistical analysis of each variable was per-formed. Chronbach alpha, analysis screening test (sensitivity, specificity, and positive predic-tive value and roc curves) was measured.Results: A total of 201 people participated, 106 in urban areas and 95 in rural areas. The 67.6% were women with an average age of 50.3 years with 7.5 years in school. The 57.7% reported musculoskeletal pain with an inten-sity of 5.8 for VSA. Comparing the COPCORD questionnaire with the clinical assessment of the rheumatologist an 83.72% of sensitivity, was observed, specificity of 61.14%, probability of 2.18 and area under the curve of 0.72; with a Cronbach’s alpha of 0.7 for pain characteris-tics and 0,9 for functional capacity.Conclusion: The COPCORD questionnaire is valid for using in rural and urban populations in Ecuador; it demonstrated good performance as a screening test

Estudio descriptivo: detección del dolor músculo - esquelético y enfermedades reumáticas aplicando el COPCORD en la población indígena de Saraguro - Ecuador

INTRODUCCIÓN: El instrumento COPCORD permite identificar el dolor músculo- esquelético y enfermedades reumáticas como artrosis, artritis reumatoide, lumbalgia. El objetivo de esta investigación es validar y adaptar transculturalmente el instrumento COPCORD en la población indígena como prueba de tamizaje para la detección de estas enfermedades. MÉTODOS: Se trata de un estudio descriptivo, el universo fue de 210 indígenas mayores de 18 años que residen en Saraguro – Loja, Ecuador. Durante el periodo del 1 diciembre de 2016 al 30 de enero de 2017. El COPCORD se ajustó al lenguaje español, se realizó adecuación y validación transcultural al contexto del grupo indígena. La información fue ingresada en el programa estadístico Stata Versión 11, se analizó: alfa de Cronbach, matrices de correlación con la prueba de Spearman. Se correlacionó las variables con el diagnóstico establecido por el reumatólogo. RESULTADOS: La edad promedio fue 46.1 años, 64.7 % del género femenino, la prueba de tamizaje para detectar una enfermedad reumática tiene sensibilidad del 92.3 % y especificidad de 57.9 %. La consistencia interna del cuestionario presentó unidimensionalidad en los apartados de carga biomecánica y capacidad funcional; y multidimensionalidad en la trayectoria del dolor músculo - esquelético y comorbilidades. Se observaron correlaciones significativas del COPCORD comparado con la evaluación del reumatólogo. CONCLUSIONES: Al realizar la validación y adaptación transcultural del cuestionario COPCORD se demostró su utilidad como prueba de tamizaje para la detección del dolor músculo - esquelético y enfermedades reumáticas en la población aplicadaDESCRIPTIVE RESEARCH: PAIN MUSCLE – ESQUELECTIC DETECCTION AND COPCORD APLICATION REUMATICS COPCORD REUMATICS ILLNESS IN INDIGENA POPULATION OF THE SARAGURO - ECUADOR BACKGROUND: The COPCORD instrument allows the identification of musculoskeletal pain and rheumatic diseases such as osteoarthritis, rheumatoid arthritis, low back pain. The aim of this research is to validate and cross-culturally adapt the COPCORD instrument in the indigenous population as a screening test for the detection of these diseases. METHODS: It is a descriptive study, the universe of 210 indigenous people over 18 years residing in Saraguro - Loja, Ecuador. During the period from December 1, 2016 to January 30, 2017. The COPCORD was adjusted to the Spanish language, a transcultural adaptation and validation was made to the context of the indigenous group. The information was entered into the statistical program of Stata Version 11, analyzed: Cronbach's alpha, correlation matrixes with the Spearman test. The variables were correlated with the diagnosis established by the rheumatologist. RESULTS: The average age was 46.1 years, 64.7 % of the female gender, the screening test to detect a rheumatic disease has sensitivity of 92.3 % and specificity of 57.9 %. The internal consistency of the questionnaire presented a dimensionality in the biomechanical load and functional capacity sections; and multidimensionality in the path of musculoskeletal pain and comorbidities. Significant correlations of the COPCORD were observed compared with the rheumatologist's evaluation. CONCLUSIONS: By carrying out the cross-cultural validation and adaptation of the COPCORD questionnaire, its usefulness could be demonstrated as a screening test for the detection of musculoskeletal pain and rheumatic diseases in the population of Saraguro.of approach including the laparoscopic approac

Prevalence of rheumatic diseases and quality of life in the Saraguro indigenous people, Ecuador: a cross-sectional community-based study

Rheumatic diseases are more prevalent and aggressive in indigenous population groups, providing medical attention for which poses a challenge for the rheumatologist. OBJECTIVE: To estimate the prevalence of musculoskeletal (MSK) disorders and rheumatic diseases in the Saraguro indigenous people in Ecuador, as well as to identify the main factors associated with the health status of this population. METHODS: This observational, cross-sectional study focused on the community was conducted using the COPCORD (Community-Oriented Program for Control of Rheumatic Diseases) methodology. The required data were obtained using the following instruments: (1) a screening for MSK disorders and rheumatic diseases; (2) a sociodemographic questionnaire; (3) a functional capacity Health Assessment Questionnaire Disability Index questionnaire; and (4) the quality of life EQ-5D-3L (EuroQoL) questionnaire. The rheumatologists working with the indigenous community were responsible for examining and treating study participants suffering from MSK disorders. RESULTS: The study sample comprised 2687 individuals, with mean age of 44 (SD, 19.9) years, 1690 (62.9%) of whom were women; Kichwa speakers comprised 32.4% (872), and 1244 (46.3%) reported MSK pain. The most prevalent conditions were as follows: low back pain (9.3%), hand osteoarthritis (OA, 7.2%), knee OA (6.5%), rheumatic regional pain syndrome (5.8%), fibromyalgia (1.8%), and rheumatoid arthritis (1.3%). Lower education level, unemployment, cooking with firewood, and rheumatic diseases were associated with a lower quality of life. CONCLUSIONS: Musculoskeletal disorders, rheumatic diseases, and rheumatoid arthritis were found to be highly prevalent in the studied population. Rheumatoid arthritis and hand OA had the most significant impact on the quality of life

Prevalence of musculoskeletal disorders and rheumatic diseases in Cuenca, Ecuador: a WHO-ILAR COPCORD study

The aim of this study was to determine the prevalence of musculoskeletal pain and rheumatic diseases in subjects over 18 years of age from the canton of Cuenca, Ecuador. Cross-sectional analytical community-based study was conducted in subjects over 18 years of age using the validated Community-Oriented Program for the Control of Rheumatic Diseases (COPCORD) questionnaire. Random sampling was used. The questionnaire was administered by standardized health workers. Subjects were visited house by house. Subjects positive for musculoskeletal (MSK) pain in the last 7 days and at some point in life were assessed by rheumatologists to confirm the diagnosis. A total of 4877 subjects participated, with an average age of 42.8 (SD 18.8) years of age; 59.7 % were women; 69.7 % lived in urban areas. 32.5 % reported MSK pain in the last 7 days and 45.7 % at some point in life. The prevalence of knee osteoarthritis was 7.4 %, hand osteoarthritis 5.3 %, low back pain 9.3 %, rheumatoid arthritis 0.8 %, fibromyalgia 2 %, gout 0.4 %, and lupus 0.06 %. Subjects from rural areas reported experiencing more MSK pain in the last 7 days and at some point in life, lower income, poorer health-care coverage, and increased physical activity involving repetitive tasks such as lifting weights or cooking with firewood. MSK pain prevalence was high. Osteoarthritis and low back pain were the most common diseases. Age, sex, physical activity, repetitive tasks, living in a rural area, and lack of health-care coverage were found to be associated with MSK pain

Syndemic and syndemogenesis of low back pain in Latin-American population: a network and cluster analysis

Introduction: Although low back pain (LBP) is a high-impact health condition, its burden has not been examined from the syndemic perspective. Objective: To compare and assess clinical, socioeconomic, and geographic factors associated with LBP prevalence in low-income and upper-middle-income countries using syndemic and syndemogenesis frameworks based on network and cluster analyses. Methods: Analyses were performed by adopting network and cluster design, whereby interrelations among the individual and social variables and their combinations were established. The required data was sourced from the databases pertaining to the six Latin-American countries. Results: Database searches yielded a sample of 55,724 individuals (mean age 43.38 years, SD = 17.93), 24.12% of whom were indigenous, and 60.61% were women. The diagnosed with LBP comprised 6.59% of the total population. Network analysis showed higher relationship individuals’ variables such as comorbidities, unhealthy habits, low educational level, living in rural areas, and indigenous status were found to be significantly associated with LBP. Cluster analysis showed significant association between LBP prevalence and social variables (e.g. Gender inequality Index, Human Development Index, Income Inequality). Conclusions:LBP is a highly prevalent condition in Latin-American populations with a high impact on the quality of life of young adults. It is particularly debilitating for women, indigenous individuals, and those with low educational level, and is further exacerbated by the presence of comorbidities, especially those in the mental health domain. Thus, the study findings demonstrate that syndemic and syndemogenesis have the potential to widen the health inequities stemming from LBP in vulnerable populations.Introduction: Although low back pain (LBP) is a high-impact health condition, its burden has not been examined from the syndemic perspective. Objective: To compare and assess clinical, socioeconomic, and geographic factors associated with LBP prevalence in low-income and upper-middle-income countries using syndemic and syndemogenesis frameworks based on network and cluster analyses. Methods: Analyses were performed by adopting network and cluster design, whereby interrelations among the individual and social variables and their combinations were established. The required data was sourced from the databases pertaining to the six Latin-American countries. Results: Database searches yielded a sample of 55,724 individuals (mean age 43.38 years, SD = 17.93), 24.12% of whom were indigenous, and 60.61% were women. The diagnosed with LBP comprised 6.59% of the total population. Network analysis showed higher relationship individuals’ variables such as comorbidities, unhealthy habits, low educational level, living in rural areas, and indigenous status were found to be significantly associated with LBP. Cluster analysis showed significant association between LBP prevalence and social variables (e.g. Gender inequality Index, Human Development Index, Income Inequality). Conclusions:LBP is a highly prevalent condition in Latin-American populations with a high impact on the quality of life of young adults. It is particularly debilitating for women, indigenous individuals, and those with low educational level, and is further exacerbated by the presence of comorbidities, especially those in the mental health domain. Thus, the study findings demonstrate that syndemic and syndemogenesis have the potential to widen the health inequities stemming from LBP in vulnerable populations