Moving towards evidence-based healthcare for musculoskeletal injuries: featuring the work of the Cochrane Bone, joint and Muscle Trauma Group.
Due to their high incidence and associated morbidity and mortality, musculoskeletal injuries place an enormous burden on society. For example, in the 2004 to 2005 period 62,000 people with hip fracture accounted for 2.9% of the total number of hospital bed days in England. Between 12% and 37% of people with hip fracture die in the first year. Of the survivors, most are less mobile and many lose their independence. Soft-tissue joint injuries during sports and exercise-related activities in young adults constitute another important group. Of these, ankle sprain is the most common single injury and it predisposes people to further recurrence. Members of the Cochrane Bone, Joint and Muscle Trauma Group prepare systematic reviews (Cochrane Reviews) of the evidence for interventions used in the prevention and management of musculoskeletal injuries. These reviews serve to facilitate evidence-based decision making by policy makers, healthcare professionals and consumers, and to guide future research. This article focuses on two major groups of injuries: osteoporotic fractures and soft-tissue joint injuries, and discusses some of the fundamental issues and questions associated with the prevention and management of these. Drawing insights from relevant Cochrane Reviews, this article examines the different approaches used for preventing, and the role of surgery and immobilisation for treating, these injuries. Brief illustrations of the inherent complexity of rehabilitation are also provided. This article also gives examples of how these reviews are helping to inform healthcare choices and practice, and guide research in this area.
Handoll
Helen Hanora Georgina
HH
Centre for Rehabilitation Sciences, School of Health and Social Care, University of Teesside, Parkside West, Middlesbrough, Tees Valley TS1 3BA, UK. h.handoll@tees.ac.uk
Gillespie
William John
WJ
Gillespie
Lesley Diane
LD
Madhok
Rajan
R
D017281:Cost of Illness; D019317:Evidence-Based Medicine; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology; D014943:Global Health; D006801:Humans; D007596:Joints / Q000293:injuries; D009140:Musculoskeletal Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D009141:Musculoskeletal System / Q000293:injuries*; D010024:Osteoporosis / Q000150:complications / Q000453:epidemiology; D012196:Review Literature as Topic; D018570:Risk Assessment; D017695:Soft Tissue Injuries / Q000453:epidemiology / Q000517:prevention & control