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Musculoskeletal Conditions

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Introduction

Musculoskeletal (MSK) conditions are the largest single cause of disability in the UK accounting for around a third of the entire burden of disability, as measured by life years lived with a disability (YLDs)1. The top five leading causes of YLDs in the United Kingdom are low back pain, falls, major depressive disorder, neck pain, and other musculoskeletal disorders.

Musculoskeletal conditions include:

    • Joint diseases such as osteoarthritis and rheumatoid arthritis
    • Back and neck pain
    • Osteoporosis and fragility fractures
    • Trauma and musculoskeletal injuries resulting from accidents

MSK conditions have a substantial influence on health and quality of life, and are associated with significant social costs. These conditions cause pain, physical disability and loss of personal and economic independence and account for 422 of all reported cases of work-related ill health. The economic cost to society in sickness absence due to MSK conditions is £7.4 billion a year and 50% of people on incapacity benefit suffer from MSK problems3.

Facts and figures

It's not possible to determine the exact prevalence of MSK disorders as there are no systems to capture the overall numbers with MSK conditions, therefore the level of need in the population is estimated from national research4. These should be interpreted with caution as they may under or overestimate the overall burden of MSK disorders in Blackpool due to the makeup of the local population, as well as other factors such as social deprivation and lifestyle factors. Given the level of deprivation in the borough together with higher rates of modifiable risk factors such as obesity, it is likely estimates based on national research will underestimate levels locally. Nevertheless it gives a useful indication of total population prevalence.

It is estimated that over 22,000 people in Blackpool have a MSK condition. This equates to 1 in 7 men and 1 in 5 women, with conditions becoming more prevalent with age.

Figure 1 - Estimated prevalence (number) of musculoskeletal conditions in Blackpool
 MalesFemales
Condition0-1415-2425-4445-6465-7475+All ages0-1415-2425-4445-6465-7475+All ages
Rheumatoid arthritis

-

1

3

113

85

113

249

-

5

27

317

181

213

659

Childhood arthritis

4

1

1

1

0

0

-

5

1

2

1

0

0

-

Ankylosing spondylitis

0

3

12

23

1

1

40

0

0

3

4

1

0

8

Gout

0

2

67

241

154

133

501

0

0

5

30

35

73

116

SLE*

0

0

1

1

1

0

3

0

3

12

13

8

1

36

Scleroderma

-

0

0

2

0

0

2

0

0

2

7

2

1

13

Osteoarthritis

0

1

28

470

429

452

1050

0

2

46

715

700

916

1929

Back pain

42

187

788

1211

396

280

2721

60

284

966

1395

511

487

3496

Polymyalgia rheumatica

0

0

0

10

39

69

80

0

0

1

30

72

138

187

Osteoporosis (of hip only)

-

-

-

677

385

814

1534

-

-

-

1452

1892

3840

6535

Disablement mHAQ>0.5+pain)

-

147

1326

3245

892

961

7938

-

208

1558

2726

1425

2391

8182

All (MSK)

460

678

2142

3862

1902

1554

9381

438

874

2696

5103

2575

2814

13141

*SLE-Systemic lupus erythematosus

 Source: Arthritis Research UK, A Heavy Burden: the occurence and impact of musculoskeletal conditions in the UK today, 2011

As the table indicates, arthritis, back pain and osteoporosis are the most prevalent conditions. Osteoporosis is much more prevalent in females than males but still affects significant numbers of men. Both back pain and arthritis (osteo and rheumatoid) are also more prevalent in women.

It is estimated that over a fifth (21%) of the population consults a GP about a musculoskeletal condition each year5 and over the next 20 years as the population ages a significant increase in MSK symptoms would be expected.

Self-reported data from the GP Patient Survey shows approximately a third more people in Blackpool report having a long term back problem and/or arthritis or long-term joint problem than the national average.

Figure 2 - % reporting long term back problem and/or arthritis or joint problem: 2013/14

Figure1
Source: GP Patient Survey

Musculoskeletal pain (eg osteoarthritis)

The Musculoskeletal Calculator provides estimates of the number of people with osteoarthritis of the hip and knee (both total and severe) and shows that of the 66,422 people in Blackpool aged over 45, 8,074 have hip osteoarthritis. There are some significant risk factors in relation to musculoskeletal conditions, the most significant of which are obesity and physical activity. In Blackpool the level of obesity is 29.5%, above the national average of 23.1%. 19,596 of people in Blackpool are classed as sedentary.

Figure 3 - Number of people with Osteoarthritis
 Total number of people with osteoarthritisNumber of people with severe* osteoarthritis
EnglandNorth westBlackpoolEnglandNorth westBlackpool
Hip

2,463,378 (10.9%)

341,695 (11.2%)

8,074 (12.2%)

1,432,927 (6.4%)

201,379 (6.6%)

4,536 (6.8%)

Knee

4,107,851 (18.2%)

573,790 (18.8%)

13,577 (20.4%)

1,373,693 (6.1%)

197,894 (6.5%)

4,796 (7.2%)

*Severe pain most of the time/unable to walk ¼ mile unaided/previously undergone hip or knee replacement due to arthritis
Source: Arthritis Research UK Musculoskeletal Calculator

Rheumatoid arthritis

Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints. The hands, feet and wrists are commonly affected, but it can also cause problems in other parts of the body. There were 1,181 people in Blackpool with diagnosed rheumatoid arthritis in 2013/14, a prevalence rate of 0.8%, higher than the national average of 0.7%.

Osteoporosis and fragility fractures

Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. It's a fairly common condition that affects around three million people in the UK. More than 300,000 people receive hospital treatment for fragility fractures (fractures that occur from standing height or less) every year as a result of osteoporosis.

Data from GP Practice Quality Outcomes Framework (QOF) registers provides us with the number of people aged 50 and over with a record of a fragility fracture and a diagnosis of osteoporosis. There were 323 Blackpool patients on the register in 2013/14, a prevalence rate of 0.5%; slightly higher than the national average of 0.4%.

Falls and fall related injury (hip fractures)

Falls are a significant public health problem and much health and social care activity results from people who have fallen and fall-related injuries. Young children and older people are the two groups most likely to require healthcare treatment for falls. This is likely to continue to increase with an ageing population, unless falls prevention strategies are uniformly and effectively implemented.

Data from the Projecting Older People Population Information System (POPPI) provides an estimate of the number of people aged 65 and over predicted to be admitted to hospital as the result of a fall and in Blackpool the number of admissions is predicted to rise by almost 30% over the next fifteen years from 592 in 2014 to 761 in 2030.

Figure 4 - Blackpool residents aged 65 and over predicted to be admitted to hospital as a result of fall, by age, projected to 2030
Age Group20142015202020252030
People aged 65-69

46

46

38

43

48

People aged 70-74

61

62

73

62

69

People aged 75 and over

486

493

530

607

644

All people aged 65 and over

592

601

641

711

761

Source: Projecting Older People Population Information System

A hip fracture is the most important immediate consequence of falls and pre-existing osteoporosis among older people. It can result in a loss of independence, decreased quality of life, a need for more support in the community or admission to residential care - only 1 in 3 sufferers return to their former levels of independence and 1 in 3 end up leaving their home and moving to long-term care.6 Women are more likely than men to sustain a hip fracture and the incidence rises with age; associated with the decrease in oestrogen production after the menopause which accelerates bone loss.

Hip fractures are given as the most common reason nationally for admission onto an orthopaedic ward and there are an average of 170 admissions in Blackpool for fractured neck of femur in people aged over 65 every year6. Hip fractures can happen at any age but are most common amongst the elderly and about two thirds of the admissions are women.

Figure 5 - Hip Fractures in People aged 65 and over by Local Authority: 2013/14

Figure2
Source: Public Health Outcomes Framework

National and local strategies

Risks

Disability resulting from musculoskeletal disorders is increasing due to ageing of the population and to increased obesity and lack of physical activity. Prevention of longer term disability is possible through a range of currently available interventions such as accident prevention, modern treatment of arthritis and musculoskeletal injuries, and rehabilitation. The growing burden of these conditions can be controlled if priority and resources are given to ensure access to these interventions.

Figure 6 - Factors contributing to musculoskeletal health
 Conditions of musculoskeletal pain (eg osteoarthritis)Osteoporosis and fragility fracturesInflammatory conditions (eg rheumatoid arthritis)
Age Rare in the young Affects mainly older people Affects any age
Progression Gradual onset Silent and gradual weakening of bone, sudden fracture Often rapid onset
Prevalence Very common (more common in women) Very common Less common
Impact Affects the joint and pain system Hip, wrist and spinal bones are most common sites of fractures Internal organs can be affected
Interventions Treated with physical activity and pain management Medication to strengthen bones, falls prevention, fracture treatment Treated by suppressing the immune system
Risk factors Age (late 40's onwards), physical injury, obesity, gender, previous joint illness or injury, genetic factors. Smoking, alcohol, genetics, inflammatory disorders, poor nutrition, low physical activity Genetics, smoking
Source: Musculoskeletal Health - a public health approach, Arthritis Research UK

Like other long-term conditions, obesity and physical activity are major avoidable risk factors for developing musculoskeletal conditions. Our aging population, rising obesity and reduced levels of physical activity will increase the prevalence of these conditions. Yet conditions such as arthritis and back pain are commonly perceived to be unavoidable, and too few people with these conditions are aware of the benefits of physical activity and maintaining healthy body weight to improve their symptoms.

Key recommendations

    • Local and national population health assessments must include musculoskeletal health (in particular in JSNAs and JHWS)
    • Programmes targeting lifestyle factors such as obesity and physical activity should explicitly include impact on musculoskeletal health
    • Health promotion messages should emphasise the benefits of physical activity to people with musculoskeletal conditions
    • Public health activity must be underpinned by high-quality data about musculoskeletal health

[1] GBD Profile UK Global Burden of Disease Study 2010, Institute for Health Metrics and Evaluation (IHME)

[2] Health and Safety Executive (2013/14). Health & Safety Statistics, Annual Report for Great Britain

[3] Chartered Society of Physiotherapy, February 2012, MSK focused HSC Bill - Lords Report Stage briefing

[4] Parsons S, et al. 2011. A Heavy Burden: the occurrence and impact of musculoskeletal conditions in the United Kingdom today

[5] Arthritis in the UK - facts and statistics, Arthritis Research UK

[6] Public Health England, Health Profiles, 2015