Current issues in case definitions for common musculoskeletal disorders in workers for clinical practice and research

Abstract

Background: Several reviews and attempts at meta-analysis have pointed out that comparisons between studies on work-related musculoskeletal disorders are problematic, since different studies use different case definitions. In a clinical setting, the case definition involves a detailed history, a physical examination, and laboratory testing.

Discussion and conclusions: When determining which tests should be included in a clinical examination, it is necessary to take into consideration the characteristics of clinical tests in terms of likelihood ratio for confirming and ruling out disease in addition to the pre-test probability of disease. If the different musculoskeletal symptoms and signs do not completely comply with the criteria for a disease, we recommend the choice of an ICD label (International Classification of Diseases - WHO) that focuses on the symptoms rather than the pathology. We suggest that the process for a new feasible case definition system for the neck and upper extremities should start with the creation of a consensus of criteria for diagnosis of common musculoskeletal disorders in primary care, developed by a panel consisting of researchers in the key disciplines. Furthermore, we suggest that in workers whose musculoskeletal function is crucial for employment, use of the International Classification of Function (ICF) may be one way to improve classification of health problems.