Musculoskeletal, Metabolic And Multi System Health Dysfunctions
Musculoskeletal, Metabolic And Multi System Health Dysfunctions
Describe some of the more common pathophysiological changes and abnormal findings associated with musculoskeletal, metabolic, and multisystem health dysfunctions. Explain what symptoms are associated with the findings and how these affect patient function.
Musculoskeletal disorders comprise diverse conditions affecting bones, joints, muscles, and connective tissues. These disorders may result in pain and loss of function and are among the most disabling and costly conditions in the United States (USBJI, 2014a). The Social Security Administration (SSA) defines disorders of the musculoskeletal system as conditions that might result from hereditary, congenital, or acquired pathologic processes. Impairments may result from infectious, inflammatory, or degenerative processes; traumatic or developmental events; or neoplastic, vascular, or toxic/metabolic diseases (SSA, 2008)Musculoskeletal, Metabolic And Multi System Health Dysfunctions.
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SSA noted three categories of musculoskeletal disorders—disorders of the back, osteoarthritis (OA), and other arthropathies—as suggestions for conditions that the committee might wish to explore. Based on the committee’s clinical expertise and knowledge of the medical and research literature on musculoskeletal disorders, the committee agreed that disorders of the back and OA were two of the most disabling musculoskeletal conditions; within the category of “other arthropathies,” the committee agreed that inflammatory arthropathies in particular ranked among the most disabling conditions that might improve with treatment. Although rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are classified by SSA as “immune disorders,” their most common—and, in many cases, most disabling—manifestation is inflammation of the joints leading to joint destruction and deformity. Thus, the committee believes that those conditions merit consideration as leading causes of musculoskeletal impairment.
The specific conditions being examined in this chapter are listed in These conditions commonly result in disability; however, they may improve with appropriate treatment and do not necessarily result in permanent disability for most adults.
Musculoskeletal disorders are prevalent and are among the most disabling and costly conditions in the United States. Chronic pain and a loss of function are the primary mechanisms through which musculoskeletal disorders lead to disability and work loss. The National Health Interview Survey (NHIS) for 2013–2015 estimated that one in two U.S. adults (126.6 million) had a musculoskeletal condition (USBJI, 2014a). The Global Burden of Disease Study, which provides a comprehensive annual assessment of health loss related to specific diseases, injuries, and risk factors, consistently ranks musculoskeletal disorders among the top causes of disability. In 2016 the top causes of years lived with disability in the United States included low back pain (no. 1), other musculoskeletal disorders (no. 4), neck pain (no. 6), OA (no. 12), and RA (no. 20) (Mokdad et al., 2018)Musculoskeletal, Metabolic And Multi System Health Dysfunctions.
Musculoskeletal disorders have a considerable economic impact. In 2015 there were 264 million lost work-days due to back and neck pain alone, resulting in $131.8 billion annual earnings lost (USBJI, 2014b). Projections based on NHIS 2010–2012 data estimate that by 2040 one in four adults (78 million) will have doctor-diagnosed arthritis and, of those with arthritis, an estimated 44 percent will report arthritis-attributable activity limitations (CDC, 2019a). In addition, people with OA lost $71.3 billion in annual earnings, and those with RA lost $7.9 billion. In 2013, there were 62.8 million health care visits for low back pain and 6.4 million hospitalizations for arthritis and other rheumatic conditions (USBJI, 2014a).
CROSS-CUTTING ISSUES FOR MUSCULOSKELETAL DISORDERS
This section discusses issues that are common to each of the musculoskeletal disorders being discussed in this chapter. The issues include the types of medical professionals typically associated with the care of people with musculoskeletal disorders, the settings involved in that care, and, finally, the issue of pain and restricted mobility that may result from these disorders.
Medical Professionals Associated with Care
A wide range of professionals may be associated with the care of people with musculoskeletal disorders. Most musculoskeletal conditions are initially diagnosed and treated in primary care, where family medicine and general internal medicine are the specialties providing most primary care for adults. Additionally, physical medicine and rehabilition physicians also diagnose and treat musculoskeletal disorders. Occupational medicine physicians may be involved in the diagnosis and treatment when a musculoskeletal disorder is associated with work-related injury or impairment. Physical medicine and rehabilitation physicians (i.e., physiatrists), physical therapists, and occupational therapists are often involved in the management of patients with functional limitations due to musculoskeletal conditions Musculoskeletal, Metabolic And Multi System Health Dysfunctions.
Patients with potential inflammatory joint or connective tissue diseases or autoimmune disorders are often referred to rheumatologists for diagnosis and, if indicated, treatment with disease-modifying antirheumatic drug therapy. Patients with advanced joint destruction, whether from OA, inflammatory disease, or trauma are typically referred to orthopedic surgeons for surgical treatment, including joint replacement. Patients with inflammatory arthropathies complicated by extra-articular disease manifestations may benefit from additional specialist consultation (e.g., patients with RA-associated interstitial lung disease benefit from consultation with a pulmonologist).
Patients with disabling chronic pain may receive care from multidisciplinary teams that include physiatrists or pain physicians (who may have a variety of medical specializations) collaborating with psychologists, rehabilitation therapists, and other health professionals. Team-based care may include care managers (often nurses or social workers) or health coaches (who may be health professionals or lay persons).
Treatment Settings
Care for people with musculoskeletal disorders most often occurs in outpatient office-based settings; however, care may be given in ermergency departments and/or urgent care. Exercise therapies are commonly delivered or supervised by physical therapists, but they may be accessed in the community or integrative health settings as well. Studies have shown that initial triaging to physical therapists at primary health care centers has advantages regarding efficiency in the work environment and in the use of health care (Bornhoft et al., 2019). A wide range of exercise approaches have been shown to benefit patients with chronic low back pain, including strength/resistance, coordination/stabilization, aquatics, cycling, and walking (VA/DoD, 2017). Surgical care may occur in hospitals or standalone surgical centers. Rehabilitation care may be provided in offices, in the hospital following surgery, in rehabilitation centers, or in skilled nursing facilities Musculoskeletal, Metabolic And Multi System Health Dysfunctions.
Research on Musculoskeletal Disorders
Considering the population prevalence and public health burden of musculoskeletal conditions, research on these conditions is funded at a lower rate than for other chronic conditions. Gereau et al. (2014) estimated that in 2012 the National Institutes of Health (NIH) spent $4 per U.S. person affected by chronic pain, compared with $41 for diabetes and $431 for cancer. The gap in research funding is most dramatic for chronic back pain, the most common cause of disability in the United States and word-wide (Mokdad et al., 2018). According to publicly reported NIH estimates of funding for various disease or condition categories, back pain was not tracked as a condition category until 2016, and annual expenditures for fiscal years 2016–2018 were only $23 million to $30 million, compared with $1.039 billion to $1.108 billion for diabetes and $5.389 billion to $6.335 billion for cancer (NIH, 2019). This dearth of research funding has resulted in important limitations in our understanding of the disease mechanisms, prognosis, and treatments for chronic back pain and for musculoskeletal disorders in general Musculoskeletal, Metabolic And Multi System Health Dysfunctions.
