Spier-skelet ziekten


Wijzig gegevens

Titel Spier-skelet ziekten
Looptijd 07 / 2005 - onbekend
Status Afgesloten
Onderzoeknummer OND1308931
Leverancier gegevens website EMGO

Samenvatting (EN)

Programme description. Musculoskeletal disorders occur frequently and, out of a population of 16 million in the Netherlands, approximately 3 million people suffer from musculoskeletal complaints. These include non-specific complaints such as back pain, neck pain, repetitive strain injury, chronic inflammatory or degenerative rheumatic disorders, and a wide range of sports injuries. Musculoskeletal disorders have a strong, negative effect on quality of life, and cause considerable personal suffering. These disorders are one of the main reasons for which patients visit their general practitioner, and they therefore impose a considerable burden on the health care system. Furthermore, musculoskeletal disorders cause substantial social economic problems because of the high costs incurred by work absenteeism and work disability. Therefore, it is highly important to acquire knowledge about the management of musculoskeletal disorders and how musculoskeletal health can be maintained. Due to the ageing of the population and unhealthy life-styles, it is anticipated that the incidence and prevalence of musculoskeletal disorders will increase substantially in the near future. Despite the magnitude of the problem, surprisingly little is known about the etiology and clinical course of most musculoskeletal disorders, or about the determinants of a healthy musculoskeletal system. Moreover, insight into the value of the available diagnostic tests and commonly used therapeutic interventions is often lacking. These circumstances have led to the formulation of a consensus document, The Bone and Joint Decade 2000-2010 for prevention and treatment of musculoskeletal disorders (Acta Orthop. Scand. [Suppl 281] 1998;69). This is an initiative of multiple national and international medical scientific societies and medical journals, supported by the World Health Organisation, with the general purpose of improving the health-related quality of life for people with musculoskeletal disorders throughout the world. OBJECTIVES. The objective of the EMGO research programme Musculoskeletal disorders is to obtain knowledge about the occurrence, prognosis and treatment of musculoskeletal disorders in the extramural setting, and the development and maintenance of a healthy musculoskeletal system during the course of life. Some of the studies focus on determinants that may influence the musculoskeletal system at a young age, or determinants that may influence the deterioration of the musculoskeletal system with ageing, while others focus on the occurrence and clinical management of musculoskeletal disorders. The emphasis is on disorders that occur frequently, such as back pain, neck pain, repetitive strain injury, osteoporosis, and osteoarthritis. The studies in this programme are being carried out in the general population, in general practice, in occupational settings and in rehabilitation clinics. The outcome measures include pain, disability, work absenteeism, quality of life and costs. The research programme encourages the development of research methodology. Within the framework of studies on musculoskeletal disorders, contributions are made to the clinimetric evaluation of measurement instruments, the methodology of diagnostic research and the methodology of systematic reviews. RESEARCH TOPICS. The research programme encompasses three broad topics of research and a methodological line of investigation. The research topics are: (1) the development and maintenance of a healthy musculoskeletal system, (2) the occurrence, prognosis and clinical management of musculoskeletal disorders, (3) the diagnosis and prognosis of minor ailments in primary care, and (4) research methodology is a central and important theme within the research programme, and contributes to all three topics. (1) Development and maintenance of a healthy musculoskeletal system. The Amsterdam Growth and Health Longitudinal Study (AGAHLS) focuses on determinants of the development of a healthy musculoskeletal system. The AGAHLS cohort was established in 1976, and with the measurement in 2000, the participating men and women have been monitored for 23 years. Within the framework of the Longitudinal Aging Study Amsterdam (LASA), determinants of maintenance of the musculoskeletal system in older men and women are being studied in two lines of investigation. The first line of investigation started in 1995 to study risk factors and the prevention of osteoporosis, falls and fractures, and a second line of investigation was initiated in 1998 to study sarcopenia (i.e. age-related loss of muscle mass and muscle strength). The occurrence and functional consequences of sarcopenia are being investigated, as well as the potential determinants of sarcopenia. (2) Occurrence, prognosis and clinical management of musculoskeletal disorders. Research on the occurrence, prognosis and clinical management of musculoskeletal disorders focuses on three professional settings: the occupational setting, primary care and rehabilitation. Within these settings, occupational physicians, general practitioners, physiotherapists and other professionals are interested in developing evidence-based management of the most important musculoskeletal disorders in their own specific fields. * Occupational setting. Within the framework of the Body@Work Research Centre on Physical Activity, Work and Health, TNO Vumc, research focuses on the determinants, prevention and management of back pain, neck pain and upper extremity disorders. The research efforts aim to contribute to the prevention or reduction of work absenteeism, disability and (occupational) health care utilization due to musculoskeletal disorders. The research comprises both cohort studies and intervention studies. * Primary care. A series of studies on the clinical course, prognosis, prevention and management of musculoskeletal disorders (including shoulder disorders, musculoskeletal complaints of the upper and lower extremities, back and neck pain, chronic pain, hip fractures, and sports-related injuries) are being performed in primary care. The results will give general practitioners and other professionals in primary care indications for optimal treatment and referral. * Rehabilitation. Rehabilitation medicine is concerned with the prevention and reduction of disability and handicaps in adults and children with chronic disorders. The research projects focus on the development of methods to predict functional status in patients with chronic invalidating musculoskeletal disorders and in patients with disorders that affect musculoskeletal functioning. In addition, the outcome of rehabilitation interventions is also being studied. Cost-effectiveness analyses are included in most of the intervention studies that are being carried out in occupational settings, primary care and rehabilitation. In addition to the initiation of new randomized clinical trials, many systematic reviews of the literature are being produced, mostly within the framework of the Cochrane Collaboration. Many existing Cochrane reviews are continuously being updated, and many new reviews and protocols for reviews have been added. (3) Diagnosis and prognosis of minor ailments in primary care. Disorders of the musculoskeletal system are worrying, and may result in longstanding disability. However, they are usually not life-threatening, and for most patients referral to secondary or tertiary care is not considered to be necessary. This also applies to other minor ailments in primary care, such as general fatigue, abdominal pain, and dizziness. More importantly, these symptoms show many similarities with musculoskeletal complaints with respect to risk factors, prognostic factors and, consequently, possibilities for intervention. In view of these similarities, minor ailments in primary care are also included in this research programme. The main focus is on the value of diagnostic testing (including aspects of patient history, physical examination, and additional tests) in the exclusion of specific diseases, and in estimating the most likely course of symptoms (prognosis) in patients with medically unexplained symptoms. A new network for education and research in general practice, which was initiated in 2002, provides an excellent infrastructure for research on musculoskeletal pain and minor ailments in primary care. Collaboration among researchers within the programme has facilitated the use of similar research methods and outcome measures, and provides many opportunities for research on the overlap of various types of complaints (musculoskeletal pain, fatigue, dizziness). (4) Methodology. Within the research programme considerable attention is paid to methodology, and several investigations focus on clinimetric issues. The clinimetric properties of the measurement instruments which are used in the RCTs that are conducted within the research programme have been studied. Systematic reviews are also performed to provide an overview of the clinimetric properties of all the available measurement instruments for a specific complaint (e.g. shoulder disability questionnaires). Another area of focus is the methodology of systematic reviews, including reviews on the efficacy of treatment, the value of diagnostic tests, the prognosis of functional status, and the clinimetric properties of measurement instruments. In order to facilitate systematic reviews on the accuracy of diagnostic tests, attention is being paid to improving the quality of reporting of diagnostic studies and compiling a Cochrane handbook for diagnostic reviews. RECENT RESULTS. 2004 was a good year for the research programme Musculoskeletal disorders. In the Riga Dome Cathedral in Latvia Prof. Han Kemper received an honorary doctoral degree from the Riga Stradins University. This was his third Doctor Honoris Causa: the first was from the University of Surrey in the UK in 1999, and the second was from the Semmelweis University in Budapest, Hungary in 2001. This demonstrates the worldwide recognition of his excellent work. Paul Lips gave his inaugural lecture as Professor of Endocrinology, on the subject bone and calcium metabolic disorders, and Raymond Ostelo was appointed as Associated Professor of Allied Health Care Research at the Amsterdam School of Allied Health Education. Eight PhD students who were involved in this research programme successfully defended their thesis in 2004. Han Anema defended his thesis entitled The Amsterdam Sherbrooke-model Evaluation Study (ASE study): effective prevention of chronic low back pain by integration of ergonomic measures. In the context of the same research project, Ivan Steensta defended his thesis entitled The Sherbrooke model: effective prevention of chronic low back pain by participative ergonomy and graded activity. Trudy Bekkering defended her thesis entitled Evaluation of the implementation of a clinical guideline for physiotherapists concerning non-specific low back pain. Another thesis on back pain entitled The cost-effectiveness of back schools for chronic and recurrent low back pain was defended by Martijn Heymans. Hugo Hoeksma defended his thesis entitled Manual therapy in osteoarthritis of the hip. Esther van Sluijs defended her thesis entitled A PACE intervention in general practice. Saskia te Velde defended her thesis entitled Relationship between birth weight and the development of biological and life-style risk factors (12-36 years) and indicators for osteoporosis and atherosclerosis at the age of 36. Evert Verhagen defended his thesis entitled The effectiveness of balance board training to prevent acute lateral ankle injury. The listing of international collaboration shows that a considerable number of joint activities have been carried out with various international research groups. An important international activity is the preparation of systematic reviews, usually within the framework of the Cochrane Collaboration. The listing of international functions shows that members of the research programme fulfill a variety of prestigious scientific functions. These functions include memberships of the editorial boards of international peer-reviewed scientific journals, memberships of scientific and organizing committees for scientific conferences, and memberships of international steering committees for large randomized clinical trials. FUTURE DEVELOPMENTS. The LASA study will continue to investigate genetic and biological parameters as risk factors for osteoporosis, falls and fractures. These studies focus on vitamin D, parathyroid hormone, sex hormones and cortisol as predictors of low bone density, falls and fractures. The effects of genetic polymorphisms of the vitamin D receptor gene, oestrogen receptor gene and cortisol receptor gene will also be studied. The fall risk profiles developed in LASA will be validated in other populations. The study on the prevalence of vitamin D deficiency in non-western immigrants will be followed by a clinical trial in which the effect of different doses of vitamin D and ultraviolet irradiation are compared. This trial is being carried out in 10 general practices and the Department of Internal Medicine. The Departments of General Practice, Public and Occupational Health and Rehabilitation Medicine all aim to strengthen the scientific basis of medical practice in their respective fields. For this purpose, research will be initiated in close co-operation with organizations and individuals in the field. Musculoskeletal disorders contribute strongly to absenteeism from work and the cost of compensation for work disability. The Department of Public and Occupational Health will therefore focus on the development and evaluation of programmes aiming at return to work. In order to reduce (occupational) health care utilization, work absenteeism and disability, the prevention of musculoskeletal disorders is indicated: the research efforts will therefore stress prevention. The Department of General Practice will continue to focus on the diagnosis and prognosis of medically unexplained symptoms. New research projects will investigate the similarities across different types of symptoms (musculoskeletal pain, fatigue and dizziness), with respect to patient characteristics, risk factors and prognostic factors. This research aims to explore common mechanisms in the etiology and prognosis of musculoskeletal pain and other common complaints in primary care. The Department of Rehabilitation Medicine is currently involved in various prognostic cohort studies and a number of clinimetric studies. The knowledge obtained in these studies will be used to guide future research on the effectiveness of rehabilitation interventions. The Department of Rehabilitation Medicine will also collaborate closely with the Revalidatie Centrum Amsterdam with regard to research activities. The close collaboration with the Jan van Breemen Institute that already exists in the rehabilitation of patients with rheumatic disorders will be continued, and it will be extended to include the rehabilitation of patients with chronic pain. In the fields of occupational medicine, general practice, primary health care and rehabilitation, randomized controlled trials and systematic reviews will continue to be important research activities in the future. Research in the occupational setting will be further strengthened by initiatives within the Research Center Body@Work TNO VUmc, in which there is close collaboration between the EMGO Institute, TNO Work and Employment, and TNO Prevention and Health ( For instance, three additional PhD studies on upper extremity disorders will be conducted, two of which in close collaboration with the Faculty of Human Movement Sciences. In line with the Body@Work TNO Vumc initiative, the EMGO Institute and the Coronel Institute (Academic Medical Center/University of Amsterdam) are in the final stage of negotiation with the National Institute for Employee Benefits (UWV) in order to establish a collaborative research center for disability assessment. In the Netherlands, just under 1 million people are currently receiving financial compensation because of disability for work. All matters involved in the payment of compensation are taken care of by one single semi-governmental body, the UWV, where some 1,000 physicians who are specifically trained for this purpose assess the medical aspects of disability claims. In order to further improve the quality of the assessments made by these physicians, in 2004 the UWV established a dedicated research center within the EMGO Institute and the Department of Public and Occupational Health in the VUmc. Part of the research in this new centre will be integrated in the research programme Musculoskeletal disorders. Researchers in this centre will operate in close collaboration with colleagues in the Coronel Institute, where a similar research centre will be established by the UWV. Following two policy reports (one on infrastructure for research in the field of sports medicine, presented to the Health Research Council, and the other on the health benefits of a physically active life-style, presented to the Ministry of Health, Welfare and Sport) the Ministry has provided the EMGO Institute with a grants in 2004, 2005, and 2006 to support infrastructure for research related to sports medicine and physical activity promotion. These grants will be used to strengthen the existing Body@Work TNO Vumc infrastructure. In the future, new research projects will focus on transmural care, i.e. care which is provided in a collaborative effort by generalists and specialists in health care. At present, the research programme focuses on primary health care, occupational medicine, rehabilitation, allied health care and public health care, and the professionals in these areas are mainly generalists. Research in all of these areas will be continued, but there will also be a new line of research focusing on collaboration between specialists and generalists in health care. This concerns the collaboration between orthopaedic surgeons, rheumatologists, or specialised rehabilitation physicians, on the one hand, and general practitioners and physiotherapists in primary health care and occupational medicine, on the other hand. Predictions about the future health status of the population show dramatic increases in the incidence and prevalence of chronic musculoskeletal disorders, which frequently require a collaborative health care approach from both specialists and generalists. Research projects will therefore focus on the efficacy and efficiency of these collaborative efforts. Examples of such projects include the assessment and rehabilitation by rehabilitation physicians and physiotherapists of impaired stability and balance in patients with osteoarthritis, the joint consultation of rehabilitation physicians and general practitioners concerning patients with chronic widespread pain, and the diagnosis of dizziness in elderly patients. A clinical trial on the prevention in transmural care of falls in elderly people with a high fall risk will start in 2005 as a joint effort from the Departments of General Practice, Geriatrics, and Internal medicine and the EMGO Institute. In this trial, the fall risk profile developed in LASA will be used to discriminate between patients with a low and a high fall risk. Future research in clinimetrics will encompass the further development of methodology for systematic reviews of health measurement instruments. In addition, qualitative research will focus on interpretation of the scores of health status questionnaires, not only elucidating the meaning of the answers given in a questionnaire, but also defining the minimal important changes in the scores of well known measurement instruments, such as rating scales for pain intensity and the Roland Disability Questionaire for low back pain. Furthermore, the usefulness of item response theory models in the development and evaluation of health questionnaires will be explored. Clinimetrics will be promoted in this and in other EMGO programmes, and also in other departments of the VUmc. Collaboration will also be sought with various departments and research institutes within the VUmc. The MOVE research institute has recently been established. MOVE is a joint effort of the VUmc, the VU Faculty of Human Movement Sciences and the Academic Centre for Dentistry in Amsterdam (ACTA), and its focus is on translational research, i.e. application-oriented research to bridge fundamental and applied science with respect to the human neuro-musculo-skeletal system. The MOVE research lines are: (1) loading and tissue regeneration, (2) structure and function, and (3) movement co-ordination. As both MOVE and the EMGO Institute study (disorders of) the musculoskeletal system, collaboration will be sought where appropriate. Several joint research projects have already been initiated, and the existing collaboration will be strengthened in the future.

Betrokken organisaties

Betrokken personen

Projectleider Prof.dr. J. Dekker
Projectleider H.C.W. de Vet


A73100 Eerstelijnsgezondheidszorg
A75000 Gezondheidsvoorlichting
A78000 Bedrijfsgezondheidszorg
D23210 Huid- en geslachtsziekten, reumatologie, orthopedie
D23380 Huisartsgeneeskunde
D23390 Arbeidsgeneeskunde, bedrijfsgeneeskunde
D24200 Preventieve gezondheidszorg, GVO

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