Musculoskeletal conditions: the case for better data

shutterstock_1889404Musculoskeletal conditions are a major contributor to multimorbidity and are more likely to develop with age. Amy Forbes, Policy Officer at Arthritis Research UK explores the health data issues around musculoskeletal conditions.

Musculoskeletal conditions have a substantial impact on individuals, the health service and society as a whole. A musculoskeletal condition can hinder someone’s ability to do normal activities, significantly affecting their quality of life and limiting independence: common symptoms include pain, stiffness and loss of mobility and dexterity.

Musculoskeletal conditions are a major contributor to multimorbidity. They are the single biggest cause of disability in the UK, accounting for 30.5% of all years lived with disability. Around 20% of the general population consult their GP about a musculoskeletal problem each year, and 82% of people with osteoarthritis have at least one other long term condition like cardiovascular disease, hypertension or depression.

MUSCULOSKELETAL STATISTICS

  • 42.5% of people over 65 have sought treatment for osteoarthritis.
  • One in three people over 65 fall at least once a year.
  • 91% of primary hip replacements and 97% of primary knee replacements are due to osteoarthritis.
  • By 2036, hip fractures could account for up to 140,000 hospital admissions in the UK each year, with care and treatment costs rising to £6 billion.

The risk of developing a musculoskeletal condition increases with age. The burden of these conditions is rising, largely because more people are living into the age groups at highest risk: the number of people over 65 with a musculoskeletal condition in England and Wales is predicted to increase by over 50% by 2030.

Data on musculoskeletal conditions

We know that musculoskeletal health is a data poor area. There’s very good data in orthopaedics on joint replacement surgery, but a general lack of data on care and treatment in primary care, community settings and outpatient departments. There’s also little data on even the prevalence of musculoskeletal conditions.

To help address these musculoskeletal data gaps, Arthritis Research UK has developed two tools:

  • Musculoskeletal health questionnaire (MSK-HQ)
  • Musculoskeletal calculator

Musculoskeletal health questionnaire (MSK-HQ)

So we have good data in orthopaedics, but the majority of people receiving care for a musculoskeletal condition don’t undergo surgery. Instead they might see their GP, a community physiotherapist or a rheumatologist in outpatients. How do we measure and monitor the health outcomes of these people?

Unlike other long term conditions like high blood pressure and diabetes, the health burden for someone with a musculoskeletal condition can’t be measured using biomarkers. But instead we can use patient reported outcome measures (PROMs) to understand how someone’s quality of life is affected.

We’ve developed a PROM called the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) – in partnership with Oxford University and our primary care research centre of excellence at Keele University.

The MSK-HQ is designed to take into account the changeable nature of musculoskeletal conditions, which typically fluctuate in their impact over the short and long term.

Rather than evaluating the effect of a single intervention like other PROMs, the MSK-HQ aims to be a broad multidimensional health status measure that captures the extent and impact of a musculoskeletal condition by monitoring someone’s health over extended periods of time.

We’re supporting the piloting phase of the MSK-HQ together with NHS England. Testing and validation of the tool is currently underway in three clinical settings: community physiotherapy, rheumatology outpatient clinics for people with early inflammatory arthritis, and orthopaedic surgery. A linked study will investigate how decisions on musculoskeletal health are made by commissioners based on this tool.

By capturing an overall rating of a person’s musculoskeletal health at any given time, the MSK-HQ enables patients and their clinicians to monitor progress over time and response to treatment. Routine use of the MSK-HQ has the potential to empower patients, support clinical decision making and drive forward quality improvement.

Musculoskeletal calculator

As well as a lack of data on care and treatment across clinical settings, data on the prevalence of musculoskeletal conditions is also poor. This is a significant limitation for local planning: musculoskeletal conditions are often overlooked when local authorities are planning the commissioning of services.

We’ve developed the musculoskeletal calculator, in collaboration with Imperial College London, to provide local prevalence estimates of the number of people with musculoskeletal conditions in England.

The calculator is an online tool providing accurate up-to-date health data estimates on the prevalence of four musculoskeletal conditions:

  • Osteoarthritis of the hip and knee
  • Back pain
  • Rheumatoid arthritis
  • High fracture risk (due to underlying osteoporosis).

Estimates for osteoarthritis of the hip and knee are now available. Estimates for the other three conditions will be available in phases over time.

The tool is the first of its kind to have prevalence estimates for all local authority areas in England, and is a huge step towards addressing the musculoskeletal data gap. You can assess how common conditions are in each area and make comparisons with other areas of the country – on a national, regional and local level.

You can find out more detailed information about the musculoskeletal calculator on our website.

And if you have any other questions, you can get in touch with Amy by email.

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