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The Journal of Musculoskeletal Medicine Vol 26 No 6

What Pay for Performance Means for Musculoskeletal Medicine

June 08, 2009

ABSTRACT: Pay for performance (P4P) is causing physicians to examine how they provide care individually and collectively within local health systems. It is the most recent attempt by Medicare and commercial payers to reduce the cost and improve the outcomes of health care. Understanding P4P and deciding how to manage the multiple programs being implemented by payers will challenge physicians' ethics and practice resources. Improving health care for musculoskeletal diseases will require cooperation among the specialties that share responsibility for this care and improved methods for coordinating and documenting it. (J Musculoskel Med. 2009;26:207-212)

Computer-aided diagnosis and Z-scores may lead to earlier RA intervention

June 06, 2009

Clinical use of computer-aided joint-space analysis (CAJSA) provides a reliable calculation of joint-space distances (JSD) at the metacarpophalangeal (MCP) joint for quantification of joint changes related to rheumatoid arthritis (RA). Calculation of a Z-score helps distinguish disease-related narrowing of JSD from age-related changes.

More straightforward ankle fracture classification suggested

June 06, 2009

The factor that determines the fracture pattern in the ankle may be a combination of the external rotational moment and the abduction moment. Counterexamples to the Lauge-Hansen classification system show that a short oblique fracture of the distal end of the fibula may occur with the foot in the pronated position before medial injury, the latter preceding or following posterior ligament rupture or avulsion fracture of the posterior malleolus, and that lateral forces applied to the foot affect fracture type.

Gout: An age-old problem remains a burden

June 06, 2009

Gout is associated with a high disease burden in older patients, probably translating into poor health-related quality of life (HRQOL) in addition to a higher rate of health care utilization and expenditures. The negative influence on HRQOL in these patients is attributable to the direct musculoskeletal manifestations and associated comorbidities, including the metabolic syndrome, renal failure, and cardiovascular and cerebrovascular disease.

Lyme vaccine not a major factor in the development of arthritis

June 06, 2009

Neither treatment-resistant Lyme arthritis HLA-DRB1 alleles nor any other HLA alleles are found with significantly greater frequency in persons in whom arthritis developed after they received the Lyme disease vaccine. Neither antibody nor T-cell responses to Borrelia burgdorferi outer surface protein A (OspA), the Lyme disease vaccine antigen, are significantly more common in arthritis, suggesting that in many cases, cross-reactivity between OspA and a human antigen probably is not a factor underlying the arthritis.

Socioeconomic factors affect physical activity and obesity in childhood

June 06, 2009

Levels of moderate-to-vigorous physical activity (MVPA) in adolescence-a factor often associated with obesity, as well as morbidity and mortality in adulthood-show consistent patterns of change in relation to patient age, sex, social class, and geographical area. In countries where the influence of social class is less strong, there may be a moderating effect of context in the development of PA habits acquired in childhood.

Pain management benefits from a collaborative approach

June 06, 2009

A collaborative primary care–based intervention for patients with chronic pain may be more effective than usual care. Many improvements are modest but meaningful for patients who are older and have long-standing pain, multiple medical problems, and high rates of disability.

New low back pain guideline features shared decision making

June 05, 2009

A new clinical practice guideline for low back pain (LBP) favors the use of noninvasive treatments over interventional procedures and suggests shared decision making between physicians and patients for better outcomes. Issued by the American Pain Society (APS), the guideline provides clinicians with several recommendations to help determine the best approaches to treating patients with LBP.

Gait retraining may prevent knee problems

June 04, 2009

The gait of runners whose kinematics place them at high risk for common running injuries and conditions may be retrained with the use of real-time feedback. Students in the University of Delaware's Biomechanics and Movement Science (BIOMS) program are conducting projects to determine how effective such retraining may be in preventing patellofemoral pain syndrome (PFPS), knee osteoarthritis (OA), and tibial fractures.

Taking steps to better posture

June 03, 2009

Poor posture can lead to loss of shoulder range of motion, chronic pain, walking deficits, neck-related headaches, and the inability to exercise, warns Greg Thielman, PT, EdD, assistant professor of physical therapy at the University of the Sciences in Philadelphia. In keeping with National Correct Posture Month in May, Dr Thielman offers the following tips to help patients improve their posture: