An early intervention program for subacute physical disability related to musculoskeletal diseases in the elderly: a pilot study.

To evaluate the efficacy of a program for subacute physical disability due to musculoskeletal disorders (MSD) in the elderly. We carried out a randomized controlled evaluator-blinded intervention study in a health district (October 2005 to April 2008). Subjects older than 64, starting a subacute MSD episode of physical disability-defined as moderate disability or higher in the Rosser classification-and identified by general practitioners, were randomized into standard care or an early specific program. The program was carried out by rheumatologists following detailed proceedings. Efficacy was defined as the difference between groups in the duration of episodes-time from onset until an improvement larger than a point in the Rosser classification). Hazard ratios (HR) to recovery of the program over standard care were obtained from Cox regression analyses. One hundred and twenty-three patients were included, generating 244 episodes of subacute MSD. Mean duration of episodes was 5 months; 14.5 % of them were chronically disabled throughout follow-up. The program was associated with shorter duration of episodes compared with CG analyzing just the ended ones (p = 0.004). The HR to recovery between groups did not achieve statistical differences. Nevertheless, recovery rate at 12 months and HR from those with moderate physical disability at the inclusion period (Rosser disability level 4, n = 84) were superior in the IG (HR 1.9, p = 0.03; HR 1.93; p = 0.03 respectively). An early intervention program for subacute MSD-related disability in elderly has partial efficacy; the program benefited patients with moderate physical disability and after a year of follow-up.

Incidence of physical disability related to musculoskeletal disorders in the elderly: results from a primary care-based registry.

OBJECTIVE: To estimate the incidence of musculoskeletal-related acute physical disability in the elderly (APDE). METHODS: A primary care-based registry was established in Madrid's Health Area 7 from October 1, 2005 to September 31, 2006. We included all persons age ≥65 years, who were non-institutionalized and covered by the health cards assigned to the participating general practitioners (GPs). A case of APDE was defined as a moderate mobility alteration in the disability level within the Rosser's Classification System, in the last 3 months, related to a musculoskeletal cause. Incidence rates (IRs) were estimated per 10,000 person-years by direct standardization with a 95% confidence interval (95% CI). RESULTS: Eight primary care centers and 23 GPs participated in the registry, covering 8,546 elderly patients. In the inclusion year, the GPs identified 147 new APDE cases in 106 patients. The annual estimated incidence of APDE was 331 cases per 10,000 person-years (95% CI 280-389) and the IR of new patients with an APDE episode was 239 (95% CI 196-288); the IR was higher in women (344 cases; 95% CI 279.8-423.0) than in men (207 cases; 95% CI 127.0-338.2). CONCLUSION: The incidence estimate of acute physical disability related to musculoskeletal disorders in the elderly should help us to determine the magnitude of this health problem, as well as the first step to establishing a specific practice for the recovery of cases and for the prevention of loss of functioning, mobility, and independence.

[Failure in the control of the number of traffic accident victims in Spain. Is this a result of the correct answer to the wrong question?]. / Fracaso en el control del número de víctimas por accidentes de tráfico en España. La repuesta correcta a la pregunta equivocada?

Although various measures have been implemented in Spain with the aim to modifying the behavior of motor vehicle users, it has not been observed a descending trend in traffic accident and injuries from traffic accident. This article considers the question of whether the measures taken to reduce motor vehicle crash-related injuries in Spain have targeted the causes that are truly responsible for this trend. Using several sources of data, beginning in 1990 it has been observed a significant reduction in traffic accidents and their consequences, but in the second half of the 90s the growth in motor vehicle crash-related injuries was similar to the increase observed in the 80s. Likewise per capita alcohol consumption shows a downward trend from 1980 while the number of injuries has been strong associated with the economic cycle during the last twenty years. We conclude pointing out that intervention measures to control this problem in Spain have focused mainly on modifying behaviour that increases the risk and severity of traffic accident injuries and have ignored the macro-economic determinants that explain the trend in the frequency of this health problem.

Fracaso en el control del número de víctimas por accidentes de tráfico en España. ¿La repuesta correcta a la pregunta equivocada? / Failure in the Control of Traffic Crash-Related Injuries in Spain: The Right Answer for the Wrong Question?

En España se han puesto en marcha diferentes medidas de intervención con el objeto de modificar la práctica de los conductores de vehículos de motor, sin embargo no se ha observado una tendencia descendente ni en la tasa de accidentes de tráfico ni en el número de víctimas relacionadas con los mismos. Este artículo se plantea el interrogante de si las medidas tomadas para reducir el número de víctimas por accidente de tráfico se han dirigido realmente hacia las causas responsables de esa tendencia. Utilizando diversas fuentes de datos se observa que en España al comienzo de los años noventa se produjo una importante reducción de la tasa de accidentes de tráfico y sus consecuencias, pero en la segunda mitad de la misma década el incremento en la tasa de lesiones por accidentes de tráfico fue similar al producido en los años ochenta. Igualmente se observa que desde 1980 el consumo per cápita de alcohol ha mostrado una tendencia descendente y que el número de lesiones por accidente de tráfico durante los últimos veinte años ha estado fuertemente asociado al ciclo económico. Se concluye señalando que las medidas para el control de este problema en España se han centrado principalmente en la modificación de la conducta que incrementa el riesgo y severidad de las lesiones por accidente de tráfico, pero se han ignorado los determinantes macroeconómicos que explican la tendencia de la frecuencia de este problema de salud (AU)