Pub Date : 2002-10-01DOI: 10.1080/000164702760379576
Gustavo Zanoli, Björn Strömqvist, Bo Jönsson, Roberto Padua, Emilio Romanini
One of the crucial issues of clinical research in musculo-skeletal disorders is outcome measurement. This has been the central question of the Outcomes Movement, and has occupied many researchers in all musculo-skeletal specialties: which outcomes should we measure? Rheumatologists, Rehabilitation Physicians, Traumatologists and Orthopeadic Surgeons have tried to answer this question from different points of view, very often isolated from each other and without interpolating efforts. One good example of a multidisciplinary subject is low-back pain (LBP). It is not a disease, but a symptom, and a common experience in the life of almost every human being, as well as a growing cause of direct and indirect costs for the social systems in many industrialized countries. From a medical point of view, it is a multifaceted syndrome: causes and clinical presentations vary widely. Psychological, social and economic status of the patient seem to play a role in the history of LBP, and many different specialists and disciplines are involved in the treatment. To compare results, we would need a simple and standardised outcome measure that accounts for different clinical presentations, interactions, and therapeutic approaches (Deyo et al. 1998). Unfortunately, as in most musculoskeletal disorders, very rarely simple dichotomous outcomes can be used in evaluating results of treatment alternatives for LBP. Patients rarely are totally ill or completely disease-free, but very often uctuate between better or worse health status. Pain in low-back pain
{"title":"Pain in low-back pain. Problems in measuring outcomes in musculoskeletal disorders.","authors":"Gustavo Zanoli, Björn Strömqvist, Bo Jönsson, Roberto Padua, Emilio Romanini","doi":"10.1080/000164702760379576","DOIUrl":"https://doi.org/10.1080/000164702760379576","url":null,"abstract":"One of the crucial issues of clinical research in musculo-skeletal disorders is outcome measurement. This has been the central question of the Outcomes Movement, and has occupied many researchers in all musculo-skeletal specialties: which outcomes should we measure? Rheumatologists, Rehabilitation Physicians, Traumatologists and Orthopeadic Surgeons have tried to answer this question from different points of view, very often isolated from each other and without interpolating efforts. One good example of a multidisciplinary subject is low-back pain (LBP). It is not a disease, but a symptom, and a common experience in the life of almost every human being, as well as a growing cause of direct and indirect costs for the social systems in many industrialized countries. From a medical point of view, it is a multifaceted syndrome: causes and clinical presentations vary widely. Psychological, social and economic status of the patient seem to play a role in the history of LBP, and many different specialists and disciplines are involved in the treatment. To compare results, we would need a simple and standardised outcome measure that accounts for different clinical presentations, interactions, and therapeutic approaches (Deyo et al. 1998). Unfortunately, as in most musculoskeletal disorders, very rarely simple dichotomous outcomes can be used in evaluating results of treatment alternatives for LBP. Patients rarely are totally ill or completely disease-free, but very often uctuate between better or worse health status. Pain in low-back pain","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/000164702760379576","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-10-01DOI: 10.1080/000164702760379530
Björn Strömqvist
Lumbar spine surgery has for a long time been mainly authority based but during the last decade, much interest has focused on outcome evaluation, exempli ed by a very high number of outcome instruments developed (Zanoli et al. 2000) and this development re ects a paradigm shift within spinal surgery. For lumbar spine surgery to develop and to be based on clinical experience, pilot studies, prospective randomised studies and broad, preferably national, registrations are required. This will be re ected in the following presentation which, however, mainly focuses on problems and bene ts with the Swedish National Lumbar Spine Register.
{"title":"Evidence-based lumbar spine surgery. The role of national registration.","authors":"Björn Strömqvist","doi":"10.1080/000164702760379530","DOIUrl":"https://doi.org/10.1080/000164702760379530","url":null,"abstract":"Lumbar spine surgery has for a long time been mainly authority based but during the last decade, much interest has focused on outcome evaluation, exempli ed by a very high number of outcome instruments developed (Zanoli et al. 2000) and this development re ects a paradigm shift within spinal surgery. For lumbar spine surgery to develop and to be based on clinical experience, pilot studies, prospective randomised studies and broad, preferably national, registrations are required. This will be re ected in the following presentation which, however, mainly focuses on problems and bene ts with the Swedish National Lumbar Spine Register.","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/000164702760379530","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-10-01DOI: 10.1080/000164702760379495
William J Gillespie, Lesley D Gillespie, Helen H G Handoll, Rajan Madhok
Science and technology relevant to orthopaedic practice have expanded rapidly in the last fty years. This has been accompanied by information overload. The number of journals in which relevant material might be found is now numbered in hundreds; individual practitioners cannot read and make sense of all the material. Also, much of that material, although informative in other ways, does not help practitioners to make informed choices between alternative approaches. This poses challenges, not only for health professionals, but for health care planners and funders, who look to these professionals for advice on what services should be provided and how. Over the last decade, various initiatives have been established in most developed countries to identify clinically effective health care interventions. Many of these are collaborating internationally to prevent duplication, given the scale of the agenda. One important international effort to promote effective health care is the Cochrane Collaboration. This paper brie y describes the work of the Cochrane Musculoskeletal Injuries Group (CMSIG), draws attention to a range of electronic and other evidence sources which are also relevant to orthopaedic practice, and discusses some issues around the conduct of surgical trials.
{"title":"The Cochrane Musculoskeletal Injuries Group.","authors":"William J Gillespie, Lesley D Gillespie, Helen H G Handoll, Rajan Madhok","doi":"10.1080/000164702760379495","DOIUrl":"https://doi.org/10.1080/000164702760379495","url":null,"abstract":"Science and technology relevant to orthopaedic practice have expanded rapidly in the last fty years. This has been accompanied by information overload. The number of journals in which relevant material might be found is now numbered in hundreds; individual practitioners cannot read and make sense of all the material. Also, much of that material, although informative in other ways, does not help practitioners to make informed choices between alternative approaches. This poses challenges, not only for health professionals, but for health care planners and funders, who look to these professionals for advice on what services should be provided and how. Over the last decade, various initiatives have been established in most developed countries to identify clinically effective health care interventions. Many of these are collaborating internationally to prevent duplication, given the scale of the agenda. One important international effort to promote effective health care is the Cochrane Collaboration. This paper brie y describes the work of the Cochrane Musculoskeletal Injuries Group (CMSIG), draws attention to a range of electronic and other evidence sources which are also relevant to orthopaedic practice, and discusses some issues around the conduct of surgical trials.","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/000164702760379495","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-10-01DOI: 10.1080/000164702760379512
Rajan Madhok, John Stothard
Orthopaedic surgery is a high volume and high cost specialty. The global disease burden from musculo-skeletal conditions is increasing and this spurred the World Health Organisation to declare the 2000–2010 as the Bone and Joint Decade. Simultaneously, there are concerns about provision of adequate services to meet the musculoskeletal needs of the population. Long waiting times for access to elective procedures such as joint replacements have been of concern to policy makers, professionals and the public in many parts of Europe. Questions have been raised about the quality of some of the interventions also. For example, the number and variety of implants used for total hip replacement in the UK have been questioned and the lack of evidence of superiority of newer and more expensive implants over older designs highlighted (Murray et al. 1995, National Audit Of ce 2000). Standards of care of patients with hip fractures have shown striking variation in both, process and outcome (Todd et al. 1995). Since the early 1990s there has been a growing interest, worldwide, in evidence based medicine (EBM) which seeks to integrate individual clinical expertise with best available clinical evidence from systematic research (Sackett et al 1997). Many clinicians have embraced the principles of EBM and there is considerable support from policymakers and health care managers who see EBM helping to provide effective health care and to increase ef ciency. In this paper, we describe our experiences of promoting evidence based orthopaedic surgery (EBOS) in Teesside, England and share future planned developments. Promoting evidence based orthopaedic surgery
{"title":"Promoting evidence based orthopaedic surgery. An English experience.","authors":"Rajan Madhok, John Stothard","doi":"10.1080/000164702760379512","DOIUrl":"https://doi.org/10.1080/000164702760379512","url":null,"abstract":"Orthopaedic surgery is a high volume and high cost specialty. The global disease burden from musculo-skeletal conditions is increasing and this spurred the World Health Organisation to declare the 2000–2010 as the Bone and Joint Decade. Simultaneously, there are concerns about provision of adequate services to meet the musculoskeletal needs of the population. Long waiting times for access to elective procedures such as joint replacements have been of concern to policy makers, professionals and the public in many parts of Europe. Questions have been raised about the quality of some of the interventions also. For example, the number and variety of implants used for total hip replacement in the UK have been questioned and the lack of evidence of superiority of newer and more expensive implants over older designs highlighted (Murray et al. 1995, National Audit Of ce 2000). Standards of care of patients with hip fractures have shown striking variation in both, process and outcome (Todd et al. 1995). Since the early 1990s there has been a growing interest, worldwide, in evidence based medicine (EBM) which seeks to integrate individual clinical expertise with best available clinical evidence from systematic research (Sackett et al 1997). Many clinicians have embraced the principles of EBM and there is considerable support from policymakers and health care managers who see EBM helping to provide effective health care and to increase ef ciency. In this paper, we describe our experiences of promoting evidence based orthopaedic surgery (EBOS) in Teesside, England and share future planned developments. Promoting evidence based orthopaedic surgery","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/000164702760379512","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-10-01DOI: 10.1080/000164702760379567
A Toni, S Stea, B Bordini, F Traina
Patients undergoing hip arthroplasty are frequently lost to follow-up due to the generally good outcome of surgery. The lost to follow-up rate in local registers ranges from 5% (Berry et al. 1997) to 15% (Fender et al 2000). In survival analysis it is commonly assumed that ‘lost to follow-up patients’ have the same outcome as those regularly checked. This hypothesis ts well with National Registers (Havelin 1999, Herberts and Malchau 2000, Lucht 2000), where the percentage of lost to follow-up is close to zero, but can be debated when applied to local registers. The hypothesis was for the rst time proposed by Dorey (Dorey and Amstutz 1989), but other authors did not agree, as they proved that patients lost to follow-up had an inferior outcome than those that continue to be assessed (Murray et al. 1997), also in different orthopaedic scenarios such as shoulder surgery. (Wildner 1995). At Rizzoli Orthopaedic Institute there is a register of all total hip arthroplasty (THA) operations that goes back to 1990 (Stea et al. 2001). The register was set up in 1997, and data was collected retrospectively from 1990. Since then the register has been kept up to date. The data collected for each operation include personal information, essential clinical data, antibiotic and antithromboembolic prophylaxis, main data on surgery and complications, stick-label-based description of implant components and xation. Both primary and revision operations are registered. In 11 years’ practice, the percentage of lost to follow-up has been very high (51.1% patients or 50.3% hips). This is mainly due to two reasons: Lost to follow-up in a hip prosthesis register
{"title":"Lost to follow-up in a hip prosthesis register. Experience of R.I.P.O.","authors":"A Toni, S Stea, B Bordini, F Traina","doi":"10.1080/000164702760379567","DOIUrl":"https://doi.org/10.1080/000164702760379567","url":null,"abstract":"Patients undergoing hip arthroplasty are frequently lost to follow-up due to the generally good outcome of surgery. The lost to follow-up rate in local registers ranges from 5% (Berry et al. 1997) to 15% (Fender et al 2000). In survival analysis it is commonly assumed that ‘lost to follow-up patients’ have the same outcome as those regularly checked. This hypothesis ts well with National Registers (Havelin 1999, Herberts and Malchau 2000, Lucht 2000), where the percentage of lost to follow-up is close to zero, but can be debated when applied to local registers. The hypothesis was for the rst time proposed by Dorey (Dorey and Amstutz 1989), but other authors did not agree, as they proved that patients lost to follow-up had an inferior outcome than those that continue to be assessed (Murray et al. 1997), also in different orthopaedic scenarios such as shoulder surgery. (Wildner 1995). At Rizzoli Orthopaedic Institute there is a register of all total hip arthroplasty (THA) operations that goes back to 1990 (Stea et al. 2001). The register was set up in 1997, and data was collected retrospectively from 1990. Since then the register has been kept up to date. The data collected for each operation include personal information, essential clinical data, antibiotic and antithromboembolic prophylaxis, main data on surgery and complications, stick-label-based description of implant components and xation. Both primary and revision operations are registered. In 11 years’ practice, the percentage of lost to follow-up has been very high (51.1% patients or 50.3% hips). This is mainly due to two reasons: Lost to follow-up in a hip prosthesis register","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/000164702760379567","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-10-01DOI: 10.1080/000164702760379585
P Peloschek, K Bögl, J Sailer, M Wick, W Graninger, S Robinson, F Lomoschitz, P Böhm, F Kainberger, H Imhof
Departments of 1 Diagnostic Radiology, Section Osteology, 2 Internal Medicine 3, Section Rheumatology, and 3 Medical Computer Sciences, University of Vienna, Austria. Correspondence: Dr. Philipp Peloschek, Section Osteoradiology, Department of Diagnostic Radiology, University of Vienna, General Hospital Vienna, Währinger Gürtel 18-20, A-1090 Vienna Fax: +43 1 40 400 3777. E-mail: philipp.peloschek@univie.ac.at
{"title":"The RoentgenCoach-Rheumatology--a novel tool to enhance efficacy of radiological scoring of rheumatoid arthritis. Results of experimental scoring of 72 cases.","authors":"P Peloschek, K Bögl, J Sailer, M Wick, W Graninger, S Robinson, F Lomoschitz, P Böhm, F Kainberger, H Imhof","doi":"10.1080/000164702760379585","DOIUrl":"https://doi.org/10.1080/000164702760379585","url":null,"abstract":"Departments of 1 Diagnostic Radiology, Section Osteology, 2 Internal Medicine 3, Section Rheumatology, and 3 Medical Computer Sciences, University of Vienna, Austria. Correspondence: Dr. Philipp Peloschek, Section Osteoradiology, Department of Diagnostic Radiology, University of Vienna, General Hospital Vienna, Währinger Gürtel 18-20, A-1090 Vienna Fax: +43 1 40 400 3777. E-mail: philipp.peloschek@univie.ac.at","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/000164702760379585","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-10-01DOI: 10.1080/000164702760379468
Lars Lidgren
The importance of quality assurance for evaluating the treatment of musculo-skeletal disorders became obvious in the 70-ies when the new “joint implants” were rapidly introduced and the operations widely spread. The rst multicenter register with standardized follow-up were started in Switzerland by Maurice Müller, on hip arthroplasty, and in Sweden Göran Bauer on knee arthroplasty in the mid 70-ies www.ort.lu.se/knee, www.jru.orthop.gu.se. It took almost 25 years before central documentation in joint registries were regarded as feasible and accepted among orthopedic surgeons. It is now becoming imperative that orthopedic surgeons have evidence-based information on techniques, materials and risk factors on joint implants in non-selected clinics in a general population. At the moment implant registers have been developed in a number of countries like United Kingdom, Australia, New Zealand, Norway, Denmark, Finland and Canada and it is on its way in several other countries. A joint register is now initiated by the National Institute of Health in Italy. A consensus has however still not been reached in many major countries on mandatory and even voluntary participation. Evidence based musculo-skeletal treatment
{"title":"Evidence based musculo-skeletal treatment.","authors":"Lars Lidgren","doi":"10.1080/000164702760379468","DOIUrl":"https://doi.org/10.1080/000164702760379468","url":null,"abstract":"The importance of quality assurance for evaluating the treatment of musculo-skeletal disorders became obvious in the 70-ies when the new “joint implants” were rapidly introduced and the operations widely spread. The rst multicenter register with standardized follow-up were started in Switzerland by Maurice Müller, on hip arthroplasty, and in Sweden Göran Bauer on knee arthroplasty in the mid 70-ies www.ort.lu.se/knee, www.jru.orthop.gu.se. It took almost 25 years before central documentation in joint registries were regarded as feasible and accepted among orthopedic surgeons. It is now becoming imperative that orthopedic surgeons have evidence-based information on techniques, materials and risk factors on joint implants in non-selected clinics in a general population. At the moment implant registers have been developed in a number of countries like United Kingdom, Australia, New Zealand, Norway, Denmark, Finland and Canada and it is on its way in several other countries. A joint register is now initiated by the National Institute of Health in Italy. A consensus has however still not been reached in many major countries on mandatory and even voluntary participation. Evidence based musculo-skeletal treatment","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/000164702760379468","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22229706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-10-01DOI: 10.1080/000164702760379477
G Zanoli, E Romanini, R Padua, G C Traina, L Massari
(2002). EBM in musculoskeletal diseases: where are we? Acta Orthopaedica Scandinavica: Vol. 73, No. sup305, pp. 4-7.
{"title":"EBM in musculoskeletal diseases: where are we?","authors":"G Zanoli, E Romanini, R Padua, G C Traina, L Massari","doi":"10.1080/000164702760379477","DOIUrl":"https://doi.org/10.1080/000164702760379477","url":null,"abstract":"(2002). EBM in musculoskeletal diseases: where are we? Acta Orthopaedica Scandinavica: Vol. 73, No. sup305, pp. 4-7.","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/000164702760379477","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-10-01DOI: 10.1080/000164702760379549
S Stea, B Bordini, A Sudanese, A Toni
On the basis of outstanding results obtained by Scandinavian arthroplasty registers(Herberts and Malchau 2000, Havelin 1999, Lucht 2000, Paavolainen et al 1991), a similar local register was set up at Rizzoli Institute, in Italy. It began in 1997, with a retrospective analysis of all total hip replacements performed at the Institute since 1990; since then it has been continuously updated with all hip prosthetic surgeries. Rizzoli Institute is the only orthopaedic unispecialistic research hospital in Italy. It is composed of 10 wards, some of them mainly specialized in joint replacement. Patients of the Institute come from all over the country either for primary or for revision surgery. In particular the most complex diseases are treated at our institute (sequelae of congenital hip dysplasia, secondary arthritis, revision surgery). Rizzoli Institute is in Emilia-Romagna, a region in the north of Italy with about 4 million inhabitants (of whom 1,100.000 are over 60 years old). Based on the experience acquired at our institute, in the last two years our register has been extended to more than 50 hospitals and private clinics of the region, which combined carry out about 3,500 total hip replacements per year.
{"title":"Registration of hip prostheses at the Rizzoli Institute. 11 years' experience.","authors":"S Stea, B Bordini, A Sudanese, A Toni","doi":"10.1080/000164702760379549","DOIUrl":"https://doi.org/10.1080/000164702760379549","url":null,"abstract":"On the basis of outstanding results obtained by Scandinavian arthroplasty registers(Herberts and Malchau 2000, Havelin 1999, Lucht 2000, Paavolainen et al 1991), a similar local register was set up at Rizzoli Institute, in Italy. It began in 1997, with a retrospective analysis of all total hip replacements performed at the Institute since 1990; since then it has been continuously updated with all hip prosthetic surgeries. Rizzoli Institute is the only orthopaedic unispecialistic research hospital in Italy. It is composed of 10 wards, some of them mainly specialized in joint replacement. Patients of the Institute come from all over the country either for primary or for revision surgery. In particular the most complex diseases are treated at our institute (sequelae of congenital hip dysplasia, secondary arthritis, revision surgery). Rizzoli Institute is in Emilia-Romagna, a region in the north of Italy with about 4 million inhabitants (of whom 1,100.000 are over 60 years old). Based on the experience acquired at our institute, in the last two years our register has been extended to more than 50 hospitals and private clinics of the region, which combined carry out about 3,500 total hip replacements per year.","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/000164702760379549","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-10-01DOI: 10.1080/000164702760379503
Low back pain is a tremendous health care and socioeconomic problem (van Tulder et al. 1995). Utilization of limited resources available at an early point in time may prevent the development of unnecessary suffering and related costs. Several approaches to the prevention of back pain have been reported in the literature, but there still is a lack of clarity regarding which types of interventions are employed as well as the effectiveness of them (Linton and van Tulder 2001). Prevention of the occurrence of low back pain and prevention of chronic low back pain and disability are major challenges. Non-speci c low back pain represents a large majority of cases (Deyo and Weinstein 2001) and there is great variability in its clinical management. Low back pain is most commonly treated in primary health care settings. The diagnostic and therapeutic management of patients with acute as well as chronic low back pain seems to vary substantially among health care providers (e.g., general practitioners, medical specialists, physical therapists, chiropractors, osteopaths, manual therapists) within European countries. However, there are also considerable discrepancies in the management of low back pain between countries in Europe and elsewhere, so there is a need to increase consistency in the management of low back pain across professions and countries. European guidelines for the management of low back pain
{"title":"European guidelines for the management of low back pain.","authors":"","doi":"10.1080/000164702760379503","DOIUrl":"https://doi.org/10.1080/000164702760379503","url":null,"abstract":"Low back pain is a tremendous health care and socioeconomic problem (van Tulder et al. 1995). Utilization of limited resources available at an early point in time may prevent the development of unnecessary suffering and related costs. Several approaches to the prevention of back pain have been reported in the literature, but there still is a lack of clarity regarding which types of interventions are employed as well as the effectiveness of them (Linton and van Tulder 2001). Prevention of the occurrence of low back pain and prevention of chronic low back pain and disability are major challenges. Non-speci c low back pain represents a large majority of cases (Deyo and Weinstein 2001) and there is great variability in its clinical management. Low back pain is most commonly treated in primary health care settings. The diagnostic and therapeutic management of patients with acute as well as chronic low back pain seems to vary substantially among health care providers (e.g., general practitioners, medical specialists, physical therapists, chiropractors, osteopaths, manual therapists) within European countries. However, there are also considerable discrepancies in the management of low back pain between countries in Europe and elsewhere, so there is a need to increase consistency in the management of low back pain across professions and countries. European guidelines for the management of low back pain","PeriodicalId":75404,"journal":{"name":"Acta orthopaedica Scandinavica. Supplementum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/000164702760379503","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22211852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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