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Moving towards evidence-based healthcare for musculoskeletal injuries: featuring the work of the Cochrane Bone, Joint and Muscle Trauma Group

Centre for Rehabilitation Sciences, School of Health and Social Care, University of Teesside, Parkside West, Middlesbrough, Tees Valley, TS1 3BA, UK, h.handoll{at}tees.ac.uk

William John Gillespie, MB

Hull York Medical School, University of Hull, Cottingham Road, Hull HU6 7RX, UK, Bill.Gillespie{at}hyms.ac.uk

Lesley Diane Gillespie, RGN

Department of Health Sciences, Area 3, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK, lesley.gillespie@yahoo. co.nz

Rajan Madhok, FRCS, FFPH

Evidence for Population Health Unit, Division of Epidemiology and Health Sciences, University of Manchester, 2nd Floor, Stopford Building, Oxford Road, Manchester M13 9PT, UK, rajan.madhok@ manchester.ac.uk

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.

Key Words: Cochrane Reviews • evidence-based • fractures • musculoskeletal injuries • soft-tissue injuries

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