June 2000 Bulletin

Project moving on two fronts

By Carolyn Rogers

Efforts to measure the worldwide burden of musculoskeletal disease are moving ahead on two fronts—internationally and nationally.

The Bone and Joint Decade Monitor Project Steering Group met in Budapest, Hungary April 14 to 16 to assess its progress. One of the goals of the Steering Group, as well as of the January burden of disease conference in Geneva, Switzerland, is to submit data on musculoskeletal conditions to the Epidemiology and Burden of Disease Unit at the World Health Organization (WHO) for inclusion in its Global Burden of Disease 2000 report.

"Obtaining the data is challenging because of the need to obtain them stratified according to age and sex," says Cynthia Shewan, PhD, director of the AAOS department of research and scientific affairs, and the only U.S. member of the Steering Group. "While considerable data have been gathered, supplementary data collection is still needed."

The data submitted include incidence and prevalence rates for osteoarthritis, rheumatoid arthritis, back pain and osteoporosis from the six regions of the world—Africa, Eastern Mediterranean, Europe, Southeast Asia, the Americas and Western Pacific. Yet to come, and hopefully in time to be included in the report, are trauma data, Shewan says.

The Steering Group reviewed the status of the sections written for a WHO Technical Report and the data received to date, and assigned group members to review each section. The group believes that the data submitted are sufficient to support a scientific journal article in addition to the WHO Technical Report. Also, to increase awareness of the Bone and Joint Decade Monitor Project, editorials are being submitted to several journals, such as the British Medical Journal.

The steering group also is addressing broadening the scope of the musculoskeletal conditions it has included in the program. The Geneva conference and subsequent communications have noted the need to include spine conditions such as sprains and strains in addition back pain, tumors, soft tissue disorders and minor injuries.

The second meeting of the United States’ effort, "Measuring Burden of Disease II," held May 3 in Rosemont, Ill., expanded the diseases and injuries to be included in the musculoskeletal conditions project. The group added children’s musculoskeletal conditions and anomalies, and soft tissue disorders to the five major areas set out by the international Bone and Joint Decade group (osteoarthritis, rheumatoid arthritis, osteoporosis and related diseases, spinal disorders and musculoskeletal trauma).

The 15 attendees represented most of the major musculoskeletal care groups in the United States, as well as the Centers for Disease Control and Prevention and National Institute of Arthritis and Musculoskeletal and Skin Diseases.

The group decided that to proceed with a unified data collection effort a Centralized Data Group should be established to analyze the data and to determine what data need to be added. They suggested that a Scientific Advisory Board should be developed to interface with the Centralized Data Group. In addition, numerous medical specialties, advocacy groups and scientific groups which could input data to the centralized data group were identified. These groups represent each of the seven musculoskeletal condition groups.

An additional goal was to establish a steering committee to guide the U.S. burden of disease activities. The steering committee charges include receiving work from the Centralized Data Group, securing funding for projects, directing dissemination efforts, developing a process to report progress, and communicating with other groups, such as the Centralized Data Group, and the Scientific Advisory Board.

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