DIAHORI'ppt

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• Research Programme
• Musculoskeletal Disorders
• Co-ordinators Riekie de Vet
• Joost Dekker

Institute for Research in Extramural Medicine VU
University Medical Center Amsterdam
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Musculoskeletal disorders

• 1. Target disorders common complaints in general
  practice non-specific back and neck pain,
  repetitive strain injury, knee pain
• 2. Complaints characterised by pain and
  disability
• 3. High burden to society
• - prevalence is high 3 out of 16 million people
• - many health care visits
• - costs of illness are high because of work
  disability

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Objectives

• 1. Development and maintenance of healthy
  musculoskeletal system during course of life
• 2. Evidence based medicine of clinical management
  of common disorders in extramural care
• 3. Clinimetrics
• 4. Minor ailments in primary care

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Healthy musculoskeletal system

• Development Amsterdam Growth and Health
  Longitudinal Study
• Schoolchildren aged 12/13 years are followed
  during 23 years
• Determinants physical activity, nutrition
• Maintenance Longitudinal Aging Study Amsterdam
• Bone mineral density
• Prevention of osteoporosis and falls
• Effects of vitamin D in elderly and non-Western
  migrants
• Determinants physical activity, hormones,
  genetic factors
• Sarcopenia
• Occurrence and consequences
• Determinants physical activity, hormones,
  genetic factors

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Evidence Based Medicine in Extramural Care

• Occurrence and clinical course
• Diagnosis and prognostic factors
• Effectiveness of common treatments
• Cost-effectiveness

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Evidence Based Medicine in Primary Care

• Back and neck pain, tennis elbow, shoulder
  complaints, carpal tunnel syndrome, focus on
  complaints instead of diseases
• Studies on clinical course, prognostic factors in
  longitudinal studies
• Studies of cost-effectiveness in RCTs and
  systematic reviews
• Involvement in guidelines committees

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Evidence Based Medicine in Occupational Medicine

• Back and neck pain, repetitive strain injury
• Focus on reduction of sickleave and work
  disability
• Prognostic studies, RCTs and systematic reviews
• Cost effectiveness analyses
• Involvement in guidelines committees

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Evidence Based Medicine in Rehabilitation Medicine

• Osteoarthritis, Stroke, Parkinsons disease,
  Traumatic brain injury, Multiple sclerosis and
  others
• Longitudinal studies clinical course and
  prognostic factors
• Focus on validation of measurement instruments

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Clinimetrics

• (Development and) Evaluation of measurement
  instruments
• Determination of Minimal Clinical Important
  Changes
• Systematic reviews of validation of measurement
  instruments
• Methodology of systematic reviews of trials and
  diagnostic studies
• Applications on musculoskeletal diseases but
  extensions to other fields

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Minor Ailments in Primary Care

• Fatigue, abdominal pain, abnormal menstrual
  bleedings
• Not life threatening, but bothersome
• Similarities with musculoskeletal diseases in
  terms of risk factors, prognosis and
  interventions.
• Diagnosis of unexplained fatigue

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New developments

• Infrastructure
• - Academic networks of general practices
• - Academic centres for Occupational Medicine
• - Collaborative reseach activities in various
  Rehabilitation centers
• Sports medicine and physical activity promotion
• Research Centre for Disability Assessment

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Funding of research

• Netherlands Organisation for Health Research and
  Development
• Health Care Insurance Council
• Dutch Arthritis Association
• GP Fund for minor ailments
• NOC-NSF

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Expectations

• Difficulty in funding of research
• Number of new projects will decrease, but quality
  will remain high
• Diversity of the programme, because, more and
  more, funding will guide the subjects

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Opportunities for Collaboration

• Start similar studies and pool the results
• Examples
• - Sherbrooke trial in Canada and Amsterdam
• - trial on treatments for tennis elbow (EMGO -
  Keele University)
• Exchange of data-sets
• - use for other purposes
• - if one of the organisations has a research
  fellow, the other has data

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Reasons for Collaboration

• Size of the studies
• Funding might be easier
• Combining the expertise
• International collaboration leads to higher
  citation indices

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