Proefschrift 'Musculoskeletal Medicine in The Netherlands'
In The Netherlands, a group of physicians has specialised in Musculoskeletal (MSK) Medicine. These physicians are organised in their own professional organisation, the Dutch Association for Musculoskeletal Medicine (Nederlandse Vereniging voor Artsen Muskuloskeletale Geneeskunde, NVAMG). MSK physicians are mainly concerned with pain and function of the locomotor system, with special attention for complaints of spinal origin. In 2000 the prevalence of musculoskeletal complaints in the Dutch general population was evaluated. Almost three-quarter of the Dutch population reported any musculoskeletal complaint during the past 12 months, most frequently low back pain (43.9%), neck pain (31.4%), and shoulder pain (30.3%), but also knee pain (21.9%), pain in the higher back (18.8%) and pain in the wrist or hand (17.5%)(1). The prevalence of musculoskeletal complaints is high, especially complaints of spinal origin that constitute a large part of the patient population consulting MSK physicians. Over the past decade, the educational programme to become registered as MSK physician has gradually been expanded with more extensive knowledge of neurologic and orthopaedic diagnostic and treatment possibilities, diagnostic imaging, and with invasive treatment options such as applying injections in the spine under X-ray guidance. A key part of the educational programme concerns the use of Spinal Manipulative Treatment (SMT). SMT is a well-known treatment option for spinal/musculoskeletal disorders, but is generally associated with manual therapists and chiropractors. The fact that there are medical doctors professionally concerned with SMT is less known. Primary care guidelines mention SMT as a possible treatment option for conditions such as low back pain, lumbosacral radiculopathies, neck pain and cervicogenic headache(2-4). Other possible treatment options include reassurance and the advice to stay active, exercise treatment, postural corrections, clinical massage, but also medical interventions, such as medication, pain intervention or surgery. The guidelines of the Dutch Federation of Medical Specialists suggest epidural steroid injections, facet denervation or surgery as a treatment option for patients with low back pain and or lumbar radiculopathies(5, 6). The decision as to which treatment options are used is influenced by the clinical background and the specific expertise of the health care professional consulted(7). With their medical background and specific post-graduate education it is likely that MSK physicians treat different patient populations, and use different treatment strategies than other professionals concerned with disorders of the locomotor system. A lot of research has been conducted in the fields of physiotherapy, manual therapy and chiropractic, but there are no studies yet that have addressed MSK medicine. There is a need, therefore, to study the characteristics of MSK physicians and their preferences concerning possible treatment options, to evaluate the characteristics of their patients, and to study the course of patients’ complaints after consulting MSK physicians. We studied the characteristics of MSK physicians with a survey distributed to all registered 6 Introduction members of the NVAMG, and we studied patient characteristics and the course of patients 1 complaints in a large observational cohort study. The study was funded almost entirely by the Dutch Association for Musculoskeletal Medicine itself, and was facilitated by the former EMGO research institute of the VU medical centre.