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| Module: Musculoskeletal healt status of the Swiss population
» Overview of Module Projects: | ||||
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| Swiss National Youth Bone Study (SNYBS), pilot study | ||||
| Osteoporosis has been identified as a major health problem that will increase over the coming decades as people live longer. The main complication of osteoporosis is bone fracture, particularly of the hip and spine, resulting in pain and disability and death. Bone strength is gained during childhood and throughout puberty until it reaches a plateau in early adulthood. Later in life bone strength is gradually lost and therefore the bone becomes more fragile. It follows that people who have not reached their optimal bone health during childhood and adolescence are more likely to develop osteoporosis and break their bones when they get older. It is well known that exercise and balanced nutrition are important in the development of bone and therefore prevent the development of osteoporosis. However, it is unclear with which technique the effect of changes in lifestyle on quality and strength of the bone can be precisely measured. The most commonly applied technique to measure bone density in adult (DXA) is inadequate. Results... | ||||
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| Swiss atlas of musculosceletal health-care. A small-area comparison of orthopedic surgery rates across Switzerland | ||||
| The frequency of orthopedic and other surgical and medical procedures is subject to a lot of variation between regions. Even regions bordering each other may present procedure rates widely apart. Differences in rates persist after adjusting for age, sex and race.
Reasons for such differences in rates stem from uncertainties inherent in medical practice, differences in practice style, difficulties in arriving at certain diagnosese, and patient/physician preferences. Diseases are mostly not clear cut yes-no-entities but rather lay on a continuous range of signs and symptoms from healthy to diseased.
Implications for health care resource planning are considerable as regions with high utilization of health care resources who will be granted further resources might further increase utilization. These leads to a vicious cycle and has led researchers to term this phenomenon "supply induced demand".
Physicians, researches, hospital administrators and health care officials need to be aware of the variation phenomenon and have to be supplied with sufficient data to base health care planning on. Results... | ||||
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| Module: New exogenus factors of musculoskeletal health and diseases
» Overview of Module Projects: | ||||
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| Bioenergetics of human osteoblast-like cells in vitro | ||||
| Creatine supplementation, first employed by athletes to enhance muscle mass, power and performance, is increasingly recognized as a potentially important adjuvant therapeutic agent for patients with different muscle diseases as well as other neuromuscular and neuro-degenerative diseases. Supplementation with this inexpensive natural body substance is envisaged to have a great socio-economic impact on musculo-skeletal health for the general public, as well as for a large number of different patients, e.g. for muscle maintenance and rehabilitation. Recently, we could show that creatine has a favorable effect on isolated bone forming cell by stimulating cell growth and calcification in cell culture. This could indicate that this intervention, thought as a safe and economical adjuvant treatment method, might also represent a potentially valid strategy for the prevention and treatment of osteoporosis. Results... | ||||
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| Low back pain in the Swiss popualtion | ||||
| Low back pain is very common in Switzerland as elsewhere in Europe. Low back pain is expensive for our health care system and for the working sphere. If we want to assess the success of a treatment for low back pain, we have to know its natural history. Today this knowledge is insufficient for a modern evaluation. In times of increasing cost pressure we should also define the financial impact of the natural history of low back pain. The cost analysis will make possible a sound evaluation about the effectiveness of therapeutic measures. References about the natural history of low back pain in relation to its costs were not found.
Based on a nationwide crossectional study we could define the number of low back pain patients in Switzerland. The longitudinal follow-up of these individuals will deliver the needed norm values. Results... | ||||
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| Neutralization of diet-induced acid and bone and muscle | ||||
| Ingestion of diets high in animal protein and wheat flour induces a chronic acid load. There is evidence that high acid loads leads to calcium loss from bone, stimulate bone resorption, inhibit bone formation and result in loss of skelettal muscle mass. Furthermore, high acid loads result in many endocrine and metabolic alterations with potentially detrimental effects on bone and muscle. Results... | ||||
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| Module: Genetic derminants factors of musculoskeletal health and diseases
» Overview of Module Projects: | ||||
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| Molecular genetic investigations in patients with muscle disorders associated with the ryanodine receptor | ||||
| Some defects (mutations) on the ryanodine receptor gene (RYR1) have been shown to be associated with muscle disorders such as malignant hyperthemia (MH) and central core disease (CCD). MH is a pharmacogenetic disease triggered in susceptible individuals by commonly used anesthetics. MH is dominantly inherited and therefore each child of a MH patient has a 50 % chance of inheriting the gene defect and also being MH susceptible. The anesthetized patient rapidly manifests an increase of CO2 production and develops a high fever and muscle rigidity. During this time, muscle tissue is destroyed and the urine may turn dark (myoglobinuria). Death can occur if specific and symptomatic treatment is not initiated immediately. Because MH susceptible (MHS) subjects may be safely anaesthetized using alternative anaesthetic techniques presymptomatic diagnosis is important.
The gold standard in MH diagnosis is the in vitro muscle contracture test (IVCT), which involves an open muscle biopsy. Muscle strips are exposed in vitro to either halothane or caffeine and the contracture response is measured. On the basis of contractile muscle contracture thresholds patients are diagnosed MHS or MH negative (MHN). However, this test is invasive, expensive and time-consuming and cannot be used for young children, handicapped subjects and elderly persons.
CCD is an inherited neuromuscular disorder characterized by muscle weakness and closely associated with MH. It has been found that the majority of CCD patients are susceptible to MH.
We have identified causative RYR1 mutations in 40% of Swiss MH families. Although this allows for molecular genetic testing for MH susceptibility in 40% of the families, the genetic cause of MH is unknown in the remaining 60%. Results... | ||||
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| Osteoporosis and genetics of chronic high urinary calcium excretion | ||||
| Osteoporosis is a debilitating disease leading to increased risk of fracture and subsequent complications, including chronic pain and increased morbidity. Environmental and genetic factors are relevant for this complex disease. Chronic high urinary calcium excretion, called hypercalciuria, is found in up to 38% of osteoporotic patients, is related to renal stone formation and has a strong genetic background. In addition, more than 50% of patients with recurrent renal calcium stone exhibit hypercalciuria and a reduced bone mass. Hypercalciuria results from several entities, further defined as
• absorptive hypercalciuria, resulting from hyper-absorption of calcium from the small intestine
• resorptive hypercalciuria, resulting from bone resorption and
• renal leak, resulting from renal defects causing calcium leak.
We hypothesise now that a substantial number of patients with recurrent calcium renal stone have a genetic defect accounting for a renal leak of calcium which in turn conduct to chronic negative bone balance and osteoporosis. Results... | ||||
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| Genomics, neurophysiology and psychological aspects of fibromyalgia | ||||
| Fibromyalgia (FM) is a chronic musculoskeletal condition, characterized by generalized pain, a predictable pattern of "tender points", stiffness, fatigue and disturbed sleep. FM patients often experience functional impairments, emotional distress and a resulting negative quality of life. Despite extensive research, the etiology and pathogenesis of FM remain unclear. This syndrome is not associated with any physical, radiologic, or biologic findings that are directly related to dysfunction, and patients generally appear to be well.
This study aims at expand knowledge on FM mechanisms. Data from the physiology of nerve functioning show that the increased sensitivity to pain in FM individuals may be related to a dysfunction of transmission in the central nervous system. This is indeed the case in more than 50% of FM patients.
There are endogenous substances in the brain that act against pain. Theses mechanisms may be dysfunctional in certain individiuals for innate or acquired reasons. This may be related to an enzymatic deficiency which may lead to an increased pain sensitivity.
Various psychosocial factors have been associated with FM. This is in particular the case of psychological co-morbidities and behavioural aspects, such as emotional distress and depression and their contribution to the health-care seeking behaviour in these patients. Psychological factors have been shown to influence pain severity in FM and they may modulate the severity of perceived distress. Results... | ||||
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| Familial aggregation of femoro-acetabular impingement of the 'cam' type: a pilot study | ||||
| Osteoarthritis is one of the leading musculoskeletal causes of pain and disability. A decreased anterior offset i.e. a decreased difference between the anterior contour of the head and the femoral neck may result in repetitive damage of the peripheral articular cartilage of the hip joint during flexion and internal rotation, a phenomenon referred to as femoro-acetabular impingement. Cam type impingement, which is usually seen in men, is caused by the presence of a femoral neck protuberance with a non-spherical femoral head. Impingement can subsequently lead to osteoarthritis. Although several risk factors for femoro-acetabular impingement have been identified (e.g. fractures, surgery) most of the patients with femoro-acetabular impingement seen in orthopedic surgery lack a history of known predisposing factors. Previous studies suggest that femoral head and neck abnormalities develop during organogenesis. Results... | ||||
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| Module: Intervention studies for persons at risk
» Overview of Module Projects: | ||||
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| Early rehabilitation after hip fracture: a randomized controlled trial comparing different vitamin D and physiotherapy programmes | ||||
| Hip fractures are the most common and most severe fractures in the elderly population and the risk increases exponentially with age. A recent meta-analysis on acute management of patients with hip fracture concluded that current research concerning management of falls, geriatric risk factors and fracture prevention in these patients are not adequately addressed. Results... | ||||
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| Etiology of primary osteoarthrititis of the hip | ||||
| Osteoarthritis (OA) of the hip is one of the major causes of pain and disability in the developed world. Resulting therapeutic interventions and socioeconomic expenditures pose a considerable burden on health and social services. Based on experimental and clinical studies, including in situ inspection in a series of 600 consecutive adolescents and young adults undergoing surgical dislocations of the hip, we propose femoro-acetabular impingement (FAI) to cause early OA in the non-dysplastic hip: morphologic deviations of the proximal femur with a decreased anterior head-neck offset (DAHO) may lead to repetitive trauma of the peripheral articular cartilage during flexion and internal rotation, particularly in individuals taking regular exercises. However, the diagnostic accuracy of clinical tests used to screen for DAHO and FAI is uncertain, reliable estimates of the prevalence of DAHO are lacking, and the prognostic relevance of DAHO for the development of early hip pain and OA is unclear. Results... | ||||
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| A new method for treatment outcome evaluation in shoulder pathology | ||||
| Nowadays, physicians have some tools to assess the efficacy of shoulder treatments. Among these tools, they have a lot of questionnaires, that each patient have to fill out, and which contain different items as for example questions on shoulder pain, range of motion or effects of the disease on their daily lives. These subjective data are very important but they lack an objective part in the assessment of the treatment outcome.
As for the doctors, they can assess the range of motion or the muscular power for example. However, they can't make a direct relationship between these data and the limitations patients have or the improvements patients will have with treatment in the activities of the daily lives.
Therefore, physicians currently lack a convenient and simple method to reliably assess the activity and the quality of life of their patients before and after shoulder treatment. Results... | ||||
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| Chronic eccentric exercise training for the elderly | ||||
| In addition, after falls, elderly people who have led independent lives often require permanent care and experience reduced quality of life. Results... | ||||
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| Myopathy associated with cholesterol-lowering therapy | ||||
| Cardiovascular diseases are the leading cause of death in developed countries and high serum cholesterol has been identified as one principal risk factor. However, muscle pain is a frequent side effect of lipid-lowering therapy. The most severe form is rhabdomyolysis, a potentially life threatening adverse event. Pain and weakness are clinical signs of potentially advanced damage of muscle cells, whose functional and structural integrity is critically dependent upon the stability of their cell membrane.
Our previous work has shown that the skeletal muscle cell membrane has a unique internal structure, rendering it vulnerable to cholesterol depletion. Preliminary experiments in rats demonstrate that the inhibition of an enzyme responsible for cholesterol biosynthesis (HMG CoA reductase) via statin treatment may elicite muscle damage resembling injuries reported in humans. Results... | ||||
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| Interdisciplinary intervention strategy for chronic MSDs | ||||
| Work-related musculoskeletal disorders are a persistent and expensive health challenge in all industrial countries including Switzerland. A recent European survey indicates that, among the working population, the three most common work health problems reported are: back pain (30%, increasing), stress (28%), muscular pain in arms or in legs (25%). The cost of work-related MSD in Switzerland has been estimated to about 2-4 Mia CHF per year. A relatively small group of patients causes relatively high health services costs and long absenteeism from work and furthermore show a high risk to loose workability.
Significant progresses have been made these last years in the understanding of the disorder occurrence and chronitisation. Despite of this, the management and successful rehabilitation of MSD suffering workers is still difficult. Recent reviews recommend an intervention strategy based on the bio-psycho-social model. Work hardening and work rehabilitation programs seek to achieve a balance between the physical and mental demands of the job and the individual’s abilities. In a pilot project, we developed and tested the needed instruments and protocols for a multi-disciplinary intervention strategy that takes both aspects into account. This involves the application of clinical and occupation medical skills (rheumatology, occupational medicine, work psychology, ergonomics). Results... | ||||
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| Repercussions of peripheral fractures in children and adolescents | ||||
| Childhood fractures are a major public health problem, 25 % of children consulting in emergency services having a broken bone. Before the end of puberty, half of adolescents reported a fracture and 15 to 25 % of them had more than one lesion. During growth, casting is the treatment of choice for limb fracture and his duration is dependant of callus formation. Immobilization is beneficial for local bone recovery , however it may conduct to general mineral loss. Bone mineral acquisition is high during adolescence and reaches a peak at the end of puberty. Fractures generally happens during this critical phase of growth and may lead to sub-optimal skeletal development and poor resistance to fracture. This has a clinical implication because a 10 to 15 % reduction in bone mineral mass at the end of puberty is associated with a 25 to 50 % increased osteoporosis fracture risk during adulthood. Results... | ||||
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| Costs of long term disability in patients with non-specific low back pain: Three year follow up of a randomized study | ||||
| In Switzerland CHF 5.5 Billion per year are paid for disability allowances. Musculoskeletal and psychiatric disorders constitute the largest subgroups. Disability due to low back pain is one of the important factors for a disability allowance in musculoskeleral disorders. We performed a randomized controlled trial in 174 in-patients with non-acute nonspecific low back pain and work-related disability comparing two treament regimens. Thereby Function Centred Treatment FCT significantly improved the number of days at work after one year (115 days at work), compared with Pain Centred Treatment PCT (75 days at work). At one-year follow-up, 32 of 87 patients in the FCT group and 38 of 87 patients in the PCT group received a disability allowance. Further we found a significant difference in the indirect costs favoring the FCT, but direct cost at one- year follow-up were the same. Results... | ||||
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| Module: Mechanims of chronic pain
» Overview of Module Projects: | ||||
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| Whiplash: new Aspects and detailed MR Imaging with therapeutic and preventative measures | ||||
| Symptomatic whiplash associated injury after a motor vehicle accident, with the main symptom of neck pain, may become chronic (for more than 6 months) in10% to 20%, with major consequences to the health of the individual and a major burden to insurance companies and health care resources. There is an annual incidence for the entire Swiss population of 0.44 per 1000. Ten thousand motor vehicle accidents associated with neck pain or potential neck pain are documented annually in Switzerland costing Personal Liability Insurance companies 0.5 billion Swiss Franks annually. With 10,000 injuries per annum, a minimum of 10% progressing, giving 1,000 new Swiss people per annum with chronic disease, costing insurance companies on average, 0.5 million Franks per person. Results... | ||||
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| Patients' perspective on the course of musculoskeletal pain | ||||
| The course of musculoskeletal disorders only partly depends on clinical signs and medical diagnosis. Scientific literature acknowledges the influence of psychosocial factors such as lifestyle, social status and gender, yet little is known on how they work exactly or how important they may be. This study will examine the effects of those factors in patients who recovered promptly from acute symptoms compared with those whose symptoms persisted.
We will interview a total of 48 patients with musculoskeletal pain that troubles the conduct of their everyday life. Half of them will have experienced prompt recovery, the other half will have persistent symptoms. Both groups will consist of an equal number of men and women. We will interview patients of different ages and social layers. General practitioners will help us recruit the interview candidates by providing names of patients with musculoskeletal disease that are willing to participate. In the interviews, we will ask all patients what helped, or would have helped in the course of recovery and what obstructed the process of healing. The interviews will be tape-recorded and written down in exact words. The texts will then be scientifically analysed. These analyses will lead to descriptions of favourable and risk constellations in patients with musculoskeletal disease. Results... | ||||
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| Psychosocial resources and risk factors with back pain: Development of a screening instrument for the physician | ||||
| In this project a questionnaire will be developed that in future will help physicians assess the psychosocial resources of patients with back pain. The aim in developing this screening instrument is to improve treatment and to help prevent chronification of back pain. Results... | ||||
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| Module: Strategies for the treatment of pain
» Overview of Module Projects: | ||||
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| Evaluation of muscular fat content using a new imaging method by MRI | ||||
| Chronic low back pain represents a major health challenge in western countries. Its origins are complex and include functional, biological, psychological and social elements. There is an urgent need to expand our knowledge of the relevant prognostic measures in the rehabilitation of chronic low back pain patients. Results... | ||||
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| Online enhanced self-management of cLBP (ONESELF) | ||||
| Patient information plays an important role in the management and treatment of a chronic pain condition like low back pain (cLBP). The way people deal with their subjective perception and manage their pain strongly depends on the kind of information that their doctors as well as their social environment (friends and relatives) and media (magazines and leaflets, television and internet) provide. Despite the huge amount of advice for patients how to approach their cLBP, there exists however, from the patient's point of view - an information gap between general knowledge on pain management on one side, and skills and understanding necessary to carry out related behaviours on the other side. Often, delivered information does not address specific difficulties of the patients. Results... | ||||
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| Ultrasound assessment of deep trunk muscle function in low back pain | ||||
| Low back pain (LBP) affects up to 80% of people at some point in their lives. Most people recover from a first episode within a few weeks. However, recurrences are common, and in some people (10-20%) the problem becomes long-lasting or «chronic» (cLBP).
There are many, widely varying treatments currently available for chronic, non-specific low back pain. Few of these treatments are successful in all patients, and one of the priorities in this challenging area of research concerns the question of «finding the right treatment for the right patient». Since the exact cause of the pain in a given individual often remains elusive, researchers are instead focusing on identifying patients who, on the basis of their medical history and functional and psychological status, best respond to a given type of treatment.
Dysfunction in the activation of the deep-lying trunk muscles is commonly observed in connection with LBP. It is believed to pose a threat to segmental stability and hence predispose to continuing/future episodes of pain. As such, «spine stabilisation exercises», aimed at restoring deep trunk muscle motor control, have become a popular concept in physiotherapy. Results... | ||||
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| On the evaluation of a group therapy program für Turkish men and women with chronic pain | ||||
| People with little knowledge of German, who work in physically demanding jobs, and who earn little money have a high risk of developing a chronic pain disorder, far greater than the average Swiss population. Typical treatment programs address a western mind in a western body. They refer to patients who are able to read and write and are capable of referring to their thoughts and emotions. More than a third of Turkisch women who ask for a treatment of their chronic pain condition are illiterate. To them and to a lesser extent to Turkisch men it is extremely difficult to make the above quoted self-referential statements, which on the other hand form the essential part of a typical pain management program. Results... | ||||
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| Non-invasive spinal motion analysis in the treatment of back pain | ||||
| Back pain is one of the most frequent, debilitating and costly health care issues facing western society. It has been estimated that there is a 50 – 85% chance of a person developing low back pain within their lifetime and at any given time, 14 - 42% of the population suffers from this condition. There is evidence of a biomechanical origin of back pain; i.e. back pain is associated with abnormal spinal posture and motion. However, the link between an individual patient’s spinal anatomy, spinal motion patterns and the resulting back pain has not been clearly established, and effective methods of identifying at-risk patients and choosing appropriate treatment strategies must be further developed. Current methods for the analysis of spinal motion are limited to conventional radiographs taken during individual static postures. Results... | ||||
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| Pain management in osteoarthritis: Network meta-analysis | ||||
| A multiplicity of drugs is used for the treatment of pain in osteoarthritis. Guidelines recommend paracetamol (e.g. Panadol®) as the first line drug, but until recently only a small number of trials was available to support its effectiveness. Recent trials suggest that nonsteroidal anti-inflammatory drugs such as diclofenac (e.g. Voltaren®) or naproxen (e.g. Apranax®) may be superior to paracetamol, but at the cost of increased rates of adverse events. Novel COX-2 selective anti-inflammatory drugs, such as Vioxx® or Celebrex®, have been increasingly used, but it is unclear whether these preparations are safer than traditional preparations. Results... | ||||
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| Meta-Base: Developing a data management software for systematic reviews and meta-analyses | ||||
| Carefully conducted systematic reviews and meta-analyses are the gold standard for establishing the effects of interventions. Consequently, they have to be performed in the same rigorous and systematic manner as clinical studies. The process of performing a systematic review and meta-analysis is complex. Usually, several people are involved and large amounts of data have to be managed. Database systems have the potential to help reviewers to manage the review process and to minimize errors. Results... | ||||
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