Turning Musculoskeletal Conditions into

manageable conditions:
What remains to be done to set up effective
systems at a national level?
Professor Anthony D Woolf
Chair, Bone and Joint Decade
Project Leader, eumusc.net
Royal Cornwall Hospital, Truro & Peninsula College of Medicine and
Dentistry

EUMUSC.NET In partnership with EULAR and 22

centres across Europe – supported by the EU
Community Action in the field of Health 2008-2013
 How to we effectively manage
musculoskeletal conditions and reintegrate
people into work and society?
Conditions affecting the musculoskeletal system
• Joint diseases
– Osteoarthritis
– Rheumatoid arthritis
– Gout
– Infections
• Back pain
• Regional musculoskeletal pain ARTHRITIS BACK PAIN
• Osteoporosis and low trauma fractures
• Bone infections
• Trauma and Injuries
• Work-related musculoskeletal disorders

INJURIES & TRAUMA OSTEOPOROSIS

22% of the population currently has, or
has experienced “long-term muscle, bone and joint problems
such as rheumatism and arthritis”

22%

Health in the European Union Eurobarometer Report 2007

Musculoskeletal conditions affect all ages

Age dependent
diseases & non-
age dependent
diseases

Age related
diseases

DMC3 study, The Netherlands Picavet, H S J et al. Ann Rheum Dis 2003;62:644-650
 The impact – the human and financial
consequences

Lower quality of life National economy

(pain, restriction of activities) Caregiver time

Health care system

Caregivers

Person
Work disability

Health care costs

Social support
Longstanding troubles with muscles, bones and joints (arthritis,
rheumatism) account for 1 in 4 on longterm treatment in Europe

2nd only to hypertension

Health in the European Union Eurobarometer Report 2007

Work and Musculoskeletal Conditions
• Musculoskeletal conditions
limit work capacity X
– e.g. osteoarthritis of the hip or
knee prevents many people over
50 yrs working
• Work causes musculoskeletal
disorders
– e.g. heavy work causes back pain,
repetitive work related to upper WORK
limb problems X
Effective treatments and strategies exist
European Bone and Joint Strategies Project (S12.304 598)

Recommendations for prevention and

management based on evidence made
for
– The whole population
– Those at risk
– Those with early disease
– Those with established conditions
Evidence taken from guidelines
developed by EULAR and others
Emphasis on early case finding /
diagnosis and treatment for all MSC
The problem
• Musculoskeletal conditions are the single biggest cause of physical disability in
the EU; major cause of healthcare and social support costs; and a major cause of
lost productivity
• Effective treatments and strategies for their use exist but not being implemented
effectively or with equity across Europe
• Reasons include
– lack of awareness and knowledge of the impact (epidemiology, costs etc.)
– lack of routinely collected indicators at national and European level that are
specifically relevant to monitoring musculoskeletal conditions and therefore
lack of knowledge of gaps and inequities in care
– lack of national health policies and strategies that prioritise rheumatic and
other musculoskeletal conditions
– standards of care and access to care are not similar across member states
Factors that influence health policy

Contextual
factors
Competing
Opportunities
priorities

Needs NGOs

HEALTH
Evidence Lobbying
POLICY
Commercial
What is interests
achievable

Expert Economic
Cost
opinion climate
effectiveness
Public
opinion
Factors that influence health policy

Contextual
factors
Competing
Opportunities
priorities

Needs NGOs

HEALTH
Evidence Lobbying
POLICY
Commercial
What is interests
achievable

Expert Economic
Cost
opinion climate
effectiveness
Public
opinion
Closing the Gap between what can and is being
achieved - the avoidable burden

IMPACT OF DISEASE

“STATE OF THE ART” UNAVOIDABLE

EFFECTS OF INTERVENTION BURDEN

EFFECTS IN CLINICAL
PRACTICE
AVOIDABLE
BURDEN
OF DISEASE
Bone and Joint Monitor Project
Health Needs Assessment of Musculoskeletal Conditions
What is needed?
• We have the evidence but how can we drive forward its
implementation?

How Can You Implement

Guidelines?
eumusc.net
• eumusc.net is optimising musculoskeletal health across Europe by
– Setting and monitoring standards for the provision of care of
arthritis
– Identifying and helping overcome barriers that may prevent
effectiveness
– Providing information on impact of musculoskeletal conditions
• eumusc.net is a health surveillance and information system that
will be embedded within EULAR.
eumusc.net
• Creating a network of institutions, researchers and individuals to
focus on increasing the knowledge base on musculoskeletal
problems and to contribute towards better understanding,
prevention, treatment and care of these conditions
• 3 year project but will be embedded within EULAR for sustainability
• Supported by European Community (EC Community Action in the
Field of Health 2008-2013)
• Supported by EULAR
• 22 partners across Europe
EUMUSC.NET will provide
• Agreed indicators of musculoskeletal health and identified sources of data that enable
good quality and comparable information, surveillance and identification of inequalities
of outcome.

• A sustainable health monitoring system

Incidence & prevalence of major musculoskeletal conditions
Impact on individuals
Impact on society
– Healthcare resource utilization
– Social consequence
– Work loss
Provision of care
– Human resources
– Physical resources
– Clinical management
Inclusion in routine national data collection and surveys (eg EHIS)
EUMUSC.NET deliverables

• Standards of care for people with major musculoskeletal conditions (initially osteoarthritis and
rheumatoid arthritis based on existing guidelines) which will be patient centred and state what a person
with these conditions should expect to ensure they have the best outcome eg access to early diagnosis
and appropriate treatment of RA.

• Health care quality indicators to enable systems of provision of care to be evaluated to ensure
they are providing care that meets the agreed standards.

• Evaluation of the current status of meeting these standards by surveys across Member States to
provide updated information on the care that people receive in clinical practice and identify inequities.

• Barriers and facilitators will be identified to facilitate implementation these standards will be
identified as well as examples of good practices to act as gold standards

• Dissemination of knowledge and best practice to enable the implementation of these

standards and the achievement of the indicators
Improving outcome of patient Care:
Quality cycle

REVIEW SET STANDARDS

STANDARDS

INTRODUCE OBSERVE PRACTICE

CHANGE

AGREE CHANGES COMPARE WITH

NEEDED STANDARDS
Actions needed for people to have timely access
to appropriate care
• Priority at a European and national level, recognising the importance of
musculoskeletal health and the needs of those with or at risk of musculoskeletal
conditions.

• Comprehensive European and national health strategies for health promotion,

prevention, treatment and rehabilitation of musculoskeletal conditions.

• Priority should be given at the European and national level to the research needs
of musculoskeletal conditions, that will lead to more effective prevention and
treatment.

• Programmes to prevent musculoskeletal problems and conditions should link with

existing priorities and activities where there are opportunities for mutual benefit.

• Data should be collected to monitor determinants for occurrence and impact of

musculoskeletal conditions in all European states in a standardised manner.