0

Chronic Degenerative Arthritic Syndrome (CDAS)

Chronic Degenerative Arthritic Syndrome (CDAS)

and The Quantification and Use of Its Results

“The Chiropractic-Corporate Connection”

 
By Eric K. Groteke, D.C., Matt E. Erickson, D.C., Mark W., Scinico, M.D.

Groteke, E., Erickson, M., Scinico, M. (2007). Chronic Degenerative Arthritic Syndrome (CDAS) and The Quantification and Use of Its Results. “The Chiropractic-Corporate Connection.”  Michigan Association of Chiropractors Journal, Nov/Dec, 40-41.

Introduction

The mounting prevalence and cost burden of musculoskeletal pain are increasingly recognized as a major health issue in the U.S. and internationally (i, ii, iii). The World Health Organization’s U.S. global initiative, known as International Bone and Joint Decade 2000-2010, reports that musculoskeletal conditions are the most common cause of severe long-term pain and the most costly of all disease categories, accounting for one-fourth of the total global cost of illness (iv). It is further recognized that the vast majority of occupational injuries and illnesses are due to musculoskeletal injuries (v).

The economic burden of musculoskeletal conditions is plaguing employers worldwide in the form of direct and indirect costs.  Medical care and pharmaceuticals are examples of direct costs. Indirect costs include short-term disability, reduced health and safety, and lost productivity in the form of absenteeism and presenteeism.  Presenteeism is defined as “the decrement in performance associated with remaining at work while impaired by risk factors or health problems (vi).” It is estimated that presenteeism accounts for about 60 percent of an employer’s total direct and indirect health costs and 84 percent of lost productivity costs (vii). The total annual cost of lost productive time due to pain among active workers in the U.S. is estimated at $61.2 billion (viii). This represents a major opportunity for the Chiropractic profession to demonstrate monetary-clinical benefits to this corporate dilemma.

The clinical value of chiropractic care has been well documented in the treatment of musculoskeletal conditions in established peer-reviewed journals. However, this value has not been adequately communicated and quantified to corporate America as savings potential in the form of Return-On-Investment. What if the chiropractic profession could quantify treatment success for an individual company or an employee in the form of dollars and cents? How many companies or employees could we help?

As the American workforce ages, regional biomechanical dysfunctions become more problematic as signs and symptoms of arthritis begin to reduce performance. After studying thousands of records of functional data correlating musculoskeletal risk factors, we have developed a scale that quantifies one’s risk for developing and the worsening of a chronic degenerative condition known as Chronic Degenerative Arthritic Syndrome (CDAS).  The benefit of quantifying one’s risk is that it can be used to show the clinical efficacy of manual therapy to the chiropractor, while concurrently demonstrating the monetary value of this clinical efficacy to the corporation in terms of presenteeism and productivity.

CDAS represents a variety of chronic physical degenerative conditions resulting from the long-term neglect of musculoskeletal risk factors. Risk factors include subjective and objective physical findings, personal, family history, medications, treatment history, exercise, and activities of daily living. 

At various stages, degenerative arthritic conditions create a direct impact on the joint involved, which, as the condition progresses with time, the resultant effect is appreciated in adjacent soft tissue structures of the body. Degenerative arthritis is not the result of a single factor, but rather of a host of various risk factors that accumulate, causing a cascade of biomechanical and physiological faults that directly lead to the development of this syndrome. It is well established in the literature that most degeneration begins in the second decade of life. Although these changes may be minimal in certain subsets of the population, biomechanical alterations have the potential to create a significant impact from a preclinical perspective. Extrinsic risks are modifiable, including BMI, body habitus (predisposition), aerobic level of conditioning, cigarette smoking and co-morbid (unrelated disease or pathological processes that occur concurrently) medical conditions. Intrinsic risks relate to a genetic predisposition.  Extrapolating, a person with established degenerative changes inherently will have more significant biomechanical alterations that may cross the line to be expressed symptomatically as pain, as well as stiffness and paresthesia.

Thus, it is not only important to identify risk factors following an event when a person is injured, such that an appropriate treatment plan can be devised, but it is also important to identify various modifiable risks at a time when a person is subclinical, or asymptomatic with physical findings, e.g., poor posture, inflexibility, and/or obesity. 

As pain is the single most common motivating factor for people to seek treatment for a musculoskeletal condition, traditional medicine treats the symptomatology of these conditions, rarely addressing underlying causes. Therefore, treatment is often costly, and usually doesn’t address biomechanical and physiologic risk factors associated with CDAS.

Dividing the body into four separate regions to quantify the impact of individual risk factors on a scale from low, medium, and high, allows us to stratify a person’s risk of developing CDAS. This also serves to establish a baseline to predict future progression by region, while giving the individual the knowledge to address personal risk and intervene before deterioration or worsening deterioration takes place.

With a greater and more prolonged risk, there is an increased predisposition for a musculoskeletal injury leading to the development of a degenerative process or further progression of pre-existing degenerative conditions, which ultimately can result in CDAS. 

Direct and Indirect Risk Factors useful in detecting a person’s risk of developing CDAS include the following:

Direct risk factors:

  1. Postural Dysfunctions (both static and dynamic) (ix, x)
  2. Biomechanical Stress due to:
        a.  ADL Repetitious Activity (xi) in the workplace, home related activities and Load/Strain Forces (xii, xiii, xiv),
             combined with

                i.  BMI in weight bearing structures (xv, xvi
               ii.  Hypoflexibility and Asymmetry (xvii)
              iii.  Vibration

Indirect risk factors:

Complicating the recovery from musculoskeletal injuries include:

  1. Smoking
  2. Cardiovascular Disorders (xviii, xix) and Diabetes
  3.  A Focused Musculoskeletal History of:
         a.  Past Treatment (Surgical vs. Non-Surgical)
         b.  Quality of Symptoms
         c.  Radiation of Symptoms
         d.  Site/Severity of Symptoms (xx, xxi)
         e.  Timing of Symptoms
         f.  VAS Rating
         g.  Chronicity of Complaints
  4. Arthritic Profile-Past History (xxii)
  5. Type of Pharmacologic Intervention and Frequency of Use

High-risk regions are those areas with symptoms and pain.  Individuals in the low risk and low medium range comprise those without pain and symptoms. This real time assessment allows the examiner to correlate the consistency between subjective and objective findings, in order to better manage a person’s musculoskeletal findings for the purpose of treatment and/or prevention. Additionally, the organization of positive historical, ADL’s, work, home, sports or activity related events to physical findings provides a clinical snapshot, enabling the examiner to correlate, educate, and better manage and prioritize an individual’s regional or whole person intervention plan.

References:

i.  Brooks PM. The burden of musculoskeletal disease – a global perspective. Clin Rheumatol. 2006;25:778-81
ii.  Harkness EF, Macfarlane GJ, Silman AJ, McBeth J. Is musculoskeletal pain more common now than 40 years ago?: Two population-based cross-sectional studies. Rheumatology (Oxford)). 2005;44:890-95
iii. Murray JL, Lopez AD, eds. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factor in 1990 and projected to 2020. Published by Harvard School of Public Health on behalf of WHO and the World Bank. Cambridge, MA: Harvard University Press. 1996
iv.  Dreinhöfer, KE. The Bone and Joint Decade 2000-2010 – how far have we come? European Musculoskeletal Review. 2006;12-16.
v.  Boswell RT, McCunney RJ. Musculoskeletal Review Disorders. Chapter 22 in McCunney, RJ. A Practical Approach to Occupational and Environmental Medicine. 3rd Edition. Lippincott Williams & Wilkins. 2003:314-31
vi.  Edington DW, Burton WN. Health and Productivity. Chapter 11 in McCunney, RJ. A Practical Approach to Occupational and Environmental Medicine. 3rd Edition. Lippincott Williams & Wilkins. 2003:140-52
vii.  Burton WN, Chen CY, Conti DJ, Schultz AB, Edington DW. The association between self-reported health risks and presenteeism. J Health Productivity. 2006;1:9-15
viii.  Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003; 290(18):2443-54
ix.  Orloff, Heidi A. PhD; Rapp, Catherine M. BS, The Effects of Load Carriage on Spinal Curvature and Posture. Spine, 29(12):1325-1329, June 15, 2004
x.  Lennon J, Shealy N, Cady RK, Matta W, Cox R, Simpson WF. Postural and respiratory modulation of autonomic function, pain, and health. Am J Pain Mgmt, 1994; 4(1):36-9
xi.  Biundo, J. J., R. W. Irwin, and E. Umpierre. “Sports and Other Soft Tissue Injuries Tendonitis, Bursitis, and Occupation-related Syndromes.” Current Opinion in Rheumatology 13 2 (2001): 146-149. National Center for Biotechnology Information. National Library of Medicine. 3 Dec. 2004 <PMID: 11224739>
xii.  McGill, S, 1991, Electromyographic activity of the abdominal and low back musculature during generation of isometric and dynamic axial trunk torque: implications for lumbar mechanics. Journal of Orthopedic Research, 9, 91-103
xiii.  Kumar, S, 1987, Arm lift strength variation due to task parameters, in P. Buckle (ed.), Musculoskeletal disorders at work. (London, Taylor & Francis), 37-42
xiv.  Kumar, S, Cumulative load as a risk factor for low back pain. Spine 1990, 15, 1311-1316.
xv.  Zimmerman, R. L. “The Obesity Epidemic in America.” Clinics in Family Practice 4 2 (2002): 229-229
xvi.  Klein, S., and J. A. Romijn. “Obesity.” Williams Textbook of Endocrinology. Eds. R. H. Williams and Reed P. Larsen. 10th ed. Philadelphia: Elsevier, Inc., 2003. 1419-1635
xvii.  Noonan, T.J., and W. E. Garrett. “Muscle Strain Injury: Diagnosis and Treatment.” Journal American Academy Orthopedic Surgery 7 4 (1999): 262-269
xviii.  Kozisek, Peter. “Arteriosclerotic Heart Disease.” Five Minute Clinical Consult. 19 May 2005 http://www.5mcc.com/Assets/SUMMARY/TP0083.html
xix.  Oparil, S. “Arterial Hypertension.” Cecil Textbook of Medicine. Eds. Lee Goldman and J. Claude Bennett. 21st ed. Philadelphia: W.B. Saunders, 2000. 259-264
xx.  Laslett, M, Oberg B, Aprill CB, McDonald B. Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power. The Spine J 2005; 5; 370-380
xxi.  Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain; a predictor of symptomatic discs and annular competence. Spine 1997; 115-22
xxii.  “Arthritis.” Centers for Disease Control and Prevention. 22 Apr. 2004. U.S. Department of Health and Human Services. 22 Dec. 2004 http://www.cdc.gov/nccdphp/arthritis/index.htm

Related Posts


Fatal error: Call to undefined function yarpp_sql() in /home/content/03/9594103/html/wp-content/themes/freedom/single.php on line 86