Common Musculoskeletal Problems: A Handbook

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Furthermore, at least a third of these people also reported other peripheral joint pain sites. Finally, in a Spanish study, people aged 65 and over had on average four MSK pain sites [ 75 ]. Unfortunately, it is not possible to determine how many of these suffered from multiple pain sites. The prevalence of MSK conditions remains high even in old age regardless of the type of complaint. The prevalence of MSK complaints typically drops slightly in the oldest age group i. In this review a great variation in prevalence of MSK disorders in older people were found.

The most likely reasons for these differences are: 1 different pain definitions, 2 different prevalence periods, 3 different age intervals, and 4 the prevalence estimates were either divided by gender or only reported as a total prevalence estimate. Thus, it is impossible to determine any overall estimates on the prevalence of MSK problems in the elderly population. Nevertheless, some general observations can be drawn from this review that needs to be discussed.

Pain mechanisms in the older population are poorly understood, but it is generally believed that pain at younger ages continues in the older ages [ ]. Thus, pain in the elderly should be regarded as a continuum of pain from earlier years [ ]. Women tend to report MSK pain significantly more often than men in almost all studies.

This gender difference in pain reporting is well known, but the reason for this is probably multifactorial with both biological and psychosocial underlying mechanisms. These different pain mechanisms are beyond the scope of this paper to discuss in detail, but are presented in a review by Fillinghim et al. There is a general trend that prevalence estimates either remain fairly constant with increasing age or that they drop slightly in the oldest people, typically from 80 years of age and onwards. An exception from this is OP, where a steady increase is reported with increasing age.

There are several potential explanations for this decline in pain reporting with age. It may simply be a general birth cohort effect which may reflect both cultural and public health related differences between for example 40 year olds and 80 year olds [ ]. This potential cohort effect may be more pronounced in cross-sectional studies, which were the only included studies in this review.

A parallel to this may be that pain is accepted by the elderly as part of becoming old [ ]. In other words, pain becomes a natural part of their life and therefore become less disturbing or simply ignored. It is also known that pressure pain decreases with age [ ]. However, MSK pain itself does not lead to premature mortality per se [ — ]. Finally, there is a considerable degree of overlapping MSK symptoms as approximately every second or third elderly have widespread MSK pain.

This trend is most likely part of a continuum from widespread pain at younger ages as previously mentioned [ ]. To our knowledge, no previous systematic literature reviews on a broader range of MSK conditions in elderly populations exist. However, a few reviews on some of our MSK conditions in the elderly populations were identified. In all four MSK diseases, the same age related increase in prevalence was found in their review, except for LBP where it remained fairly constant. A literature review on LBP before found only 12 prevalence estimates specifically on elderly populations, but the authors were unable to make any general estimates mainly because of the different or lack of LBP definitions as well as the varying age intervals [ ].

Due to the heterogeneity of these studies and the aim of their review, no attempt was made to provide any general LBP prevalence estimates. Luime et al. Dagenais et al. It is impossible to compare our results with the abovementioned reviews, as they too fail to provide pooled estimates due to the high degree of heterogeneity across the included studies. Nevertheless, a general increase in prevalence with age and a gender difference were reported in all reviews, which is in accordance with our own findings.

The heterogeneity of pain definitions is already a well known problem, but undoubtedly, researchers have many good reasons for why they use a specific and perhaps unique pain definition. Unfortunately, this makes it impossible to draw any general conclusions based on the currently available literature. However, it would be recommendable if authors would at least report one or two additional standardised measures, such as the questions from the standardised Nordic questionnaire on musculoskeletal pain [ ]. Such tables could include valuable information on gender specific and total prevalence estimates for future reviews to calculate pooled prevalence estimates.

It also needs mentioning that nearly twice as many prevalence estimates could have been obtained from 82 additional studies, if only authors had reported age specific estimates.

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So, just like the standardisation of pain definitions is warranted, standardisation of age interval reporting would also be preferable. This way, more information on age related changes from the current literature could easily have been obtained. In this review, we found that many authors state that their results are representative of the general population. However, only few actually document this. While many do their best at obtaining a random and representative target sample from the background population, an actual non-response analysis is rarely performed.

In other words, the external validity of these studies is questionable, which is essential in epidemiological studies.

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Just like our included studies, our review has also some limitations that need to be addressed. We only included one electronic database Pubmed and thus, may have missed some relevant articles. Based on other reviews on similar MSK conditions, who have included other electronic databases i. However, given the large heterogeneity and therefore lack of proper summary prevalence estimates, we doubt any missed articles would have had any major impact on our results.

Our search strategy was also limited to the elderly population through MeSH terms. This may have lead to exclusion of some studies if for some reason they were not properly indexed in Pubmed. As only English language articles were included, any articles published in national non-English medical journals are missing in our literature review. Finally, the selection of articles was only conducted by one author, thus, there is a risk of missing potentially relevant articles. According to Edwards et al.

Thus, on average we may have missed approximately 8 articles. The results from the included epidemiological studies must be viewed in light of the quality of these studies which depends on both the internal validity and if the results can be extrapolated to the background population i. The risk of bias assessment on randomised clinical trials is also recommended by the Cochrane Collaboration [ 8 ] and recently a set of risk of bias items were developed by Viswanathan et al.

However, assessing the risk of bias demands a high degree of judgement, is more time consuming, and may result in greater variability of interpretations of the studies [ 9 , ]. Therefore, no attempt at adjusting the prevalence estimates based on the risk of bias judgment was made. Instead, we leave it up to the readers to decide on how to utilise our risk of bias judgments. Because MSK pain may be reported as part of a larger health related publication and because a wide set of MSK conditions were included in our review, it was necessary to have rather broad search strategy.

Common Musculoskeletal Problems

This in turn, resulted in a very large number of hits that had to be perused to seek for any potentially relevant articles. While the search may have been fairly sensitive in catching relevant articles it cannot be considered to be very specific. Another limitation is the choice of only investigating the prevalence of MSK disorders among elderly people and, hence, excluding information on burden and cost-of-illness of these MSK conditions. Clearly, the presence of pain does not reflect how MSK problems affect older people on a daily basis. Finally, with increasing OP, there is a high risk of fracture incidences.

As most MSK conditions remain fairly common in the elderly populations and as the number of elderly people increases in the future, the socioeconomic burden of MSK in the elderly population will also increase. Thus, there will be a further need for health care professionals to deal with chronic MSK conditions among the elderly people. This review has looked at the prevalence of a series of musculoskeletal conditions in the elderly population and will serve not only as a reference for future studies, but also as a guide for clinicians in general. Firstly, a larger population of geriatric patients must be expected in the future and thus calls for more attention on developing optimal geriatric patient management protocols.

Secondly, it is important for a person to maintain a sufficient functional capacity in order to maintain an active life at older age [ 3 ]. In other words, political programmes as well as primary and secondary health care programmes accommodated to the future needs are necessary in order to maintain or ideally improve the quality of life in the elderly population. No overall estimate on the prevalence of MSK problems in the elderly population can be determined due to the heterogeneity of the studies. There is a general trend that prevalence estimates either remain fairly constant or increase slightly with increasing age.

Finally, many elderly people report multiple MSK pain sites. Bulletin of the World Health Organization. Woolf AD: The bone and joint decade — Ann Rheum Dis. J Clin Epidemiol. Rheumatology Oxford. Hanova P, Pavelka K, Dostal C, Holcatova I, Pikhart H: Epidemiology of rheumatoid arthritis, juvenile idiopathic arthritis and gout in two regions of the Czech Republic in a descriptive population-based survey in — Clin Exp Rheumatol.

Laiho K, Tuomilehto J, Tilvis R: Prevalence of rheumatoid arthritis and musculoskeletal diseases in the elderly population. Rheumatol Int. Arthritis Rheum. J Rheumatol. National Health and Nutrition Examination Survey, — Am J Phys Med Rehabil. BMC Musculoskelet Disord. J Korean Med Sci. Osteoarthr Cartil. J Orthop Sci. J Bone Miner Metab. Osteoporos Int. Am J Epidemiol. Insufficienza Cardiaca negli Anzizni Residenti a Dicomano. Med J Aust. J Clin Densitom. Br J Radiol. J Am Geriatr Soc. Prev Chronic Dis. Joint Bone Spine. Croat Med J.

Werner P: Self-reported prevalence and correlates of osteoporosis: results from a representative study in Israel.

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Arch Gerontol Geriatr. World Health Organization: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Spine Phila Pa Spine J.

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Arch Intern Med. Arthritis Care Res Hoboken. Eur J Pain. Acta Orthop Scand. Hartvigsen J, Christensen K, Frederiksen H: Back and neck pain exhibit many common features in old age: a population-based study of 4, Danish twins 70— years of age. Eur Spine J. Hartvigsen J, Christensen K: Pain in the back and neck are with us until the end: a nationwide interview-based survey of Danish year-olds.

Meyer T, Cooper J, Raspe H: Disabling low back pain and depressive symptoms in the community-dwelling elderly: a prospective study. Fam Pract. Clin J Pain.

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  6. Semin Arthritis Rheum. Int J Rheum Dis. J Fam Pract. Disabil Rehabil. A prospective study. Foot Edinb. Natvig B, Bruusgaard D, Eriksen W: Localized low back pain and low back pain as part of widespread musculoskeletal pain: two different disorders? A cross-sectional population study. J Rehabil Med. J Pain.

    Exton-Smith AN: Epidemiological studies in the elderly: methodological considerations. Am J Clin Nutr. Data from the Mini-Finland Health Survey. Rejuvenation Res. A systematic review of the literature. A systematic review. Age Ageing. Scand J Rheumatol. Clin Orthop Relat Res. Appl Ergon. Stat Med. Download references. RF planned the design of the study, conducted the literature search and wrote the initial draft of the manuscript. AR cross checked the extracted data including the risk of bias assessments. Both authors participated in writing the final manuscript.

    This article is published under license to BioMed Central Ltd. Reprints and Permissions. Search all BMC articles Search. Systematic review Open Access Published: 24 September What is the prevalence of musculoskeletal problems in the elderly population in developed countries? Abstract Background The proportion of older people will be tripled by the year Submit Search. Successfully reported this slideshow. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads.

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