P0506PATTERNS AND OUTCOMES OF GLOMERULAR DISEASES IN ADULTS PRESENTING TO MANSOURA UNIVERSITY HOSPITAL: A SINGLE-CENTER PROSPECTIVE STUDY

Abstract Background and Aims Glomerular diseases (GDs) impose a substantial burden on patients and health care systems, and they are considered a major cause of end-stage renal disease (ESRD) worldwide. Morbidity and mortality have shown to be substantially higher in patients with GDs than in the general population. In Egypt, there is yet no available national registry for GDs, and GDs outcome is not adequately studied. Therefore, it is of considerable interest to study patterns and outcomes of GDs in our locality. Method Patients with features suggesting GDs presenting to Mansoura nephrology and dialysis unit (MNDU) were recruited in this study between 1 July 2017 and 30 June 2018, and those with biopsy-proven GDs were prospectively followed up for a minimum of 6 months or until either death or reaching ESRD. ESRD was defined as initiation of long-term dialysis or eGFR persistently <15 ml/min per 1.73 m2 during follow up visits. Enrolled patients were subjected to through history taking and clinical examination. Biopsies were independently examined by two pathologists blinded to the clinical data. The study outcomes were to identify the GDs subtype frequencies, and to identify the frequency of those achieving either renal recovery, progression to ESRD or death from all-cause mortality. Logistic regression analysis was carried out to identify the potential predictors for renal recovery. Results Sixty-six patients (21 males and 45 females) with biopsy-proven GDs were included and completed the required period of follow up. The median age of the studied patients was 32 years (IQR 23 - 46.45). Fifty percent of the cases had hypertension and only one patient had was diabetic. The main indications for renal biopsy were unexplained kidney function decline (62%) followed by subnephrotic (23%) and nephrotic presentation (15%). Diffuse proliferative GN followed by MPGN and sclerosing GN were the most frequently encountered histopathological patterns. Primary and secondary GDs constituted 30.3% and 69.7% respectively. Lupus nephritis (LN) was the most common cause of secondary GDs and class IV LN was the most frequently encountered class accounting for 16 cases (51.6%) of patients with lupus. By the end of 6-month follow up, renal recovery was achieved in 30 patients (45.5%), 21 patients (31.8%) progressed to ESRD and 7 patients (10.6%) had died. Urban residency and total renal chronicity score were the most significant predictors of renal recovery. Conclusion Diffuse proliferative GN is the most common histopathological pattern, and secondary GDs, particularly those related to lupus, are more frequently encountered than primary GDs in our center. Unfortunately, quick complete recovery is not the rule and is possibly predictable by less chronic changes in biopsy.

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J 5 — A Data Processing System for Medical Information

Methods of Information in Medicine ◽

10.1055/s-0038-1636653 ◽

1967 ◽

Vol 06 (01) ◽

pp. 1-6

Author(s):

P. Hall ◽

Ch. Mellner ◽

T. Danielsson

Keyword(s):

Medical Records ◽

Medical Information ◽

Health Care Systems ◽

Processing System ◽

Linear Pattern ◽

Flexible Form ◽

Care Systems ◽

Pattern Recognition Analysis ◽

Numeric Information

A system for medical information has been developed. The system is a general and flexible one which without reprogramming or new programs can accept any alphabetic and/or numeric information. Coded concepts and natural language can be read, stored, decoded and written out. Medical records or parts of records (diagnosis, operations, therapy, laboratory tests, symptoms etc.) can be retrieved and selected. The system can process simple statistics but even make linear pattern recognition analysis.The system described has been used for in-patients, outpatients and individuals in health examinations.The use of computers in hospitals, health examinations or health care systems is a problem of storing information in a general and flexible form. This problem has been solved, and now it is possible to add new routines like booking and follow-up-systems.

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MO282EARLY RENAL RECOVERY AFTER A FIRST FLARE OF PAUCI IMMUNE GLOMERULONEPHRITIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab104.0040 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Jeremy Zaworski ◽

Cyrille Vandenbussche ◽

Pierre Bataille ◽

Eric Hachulla ◽

Francois Glowacki ◽

...

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Interstitial Fibrosis ◽

Univariate Analysis ◽

Renal Recovery ◽

Neurological Involvement ◽

Factors Associated ◽

Stage Renal Disease ◽

End Stage

Abstract Background and Aims Renal involvement is a severe manifestation of ANCA-associated vasculitis. Patients often progress to end-stage renal disease. The potential for renal recovery after a first flare has seldom been studied. Our objectives were to describe the evolution of the estimated glomerular filtration rate (eGFR) and identify factors associated with the change in eGFR between diagnosis and follow-up at 3 months (ΔeGFRM0–M3) in a cohort of patients with a first flare of pauci-immune glomerulonephritis. Methods This was a retrospective study over the period 2003–2018 of incident patients in the Nord-Pas-de-Calais (France). Patients were recruited if they had a first histologically-proven flare of pauci immune glomerulonephritis with at least 1 year of follow up. Kidney function was estimated with MDRD-equation and analysed at diagnosis, 3rd, 6th and 12th months. The primary outcome was ΔeGFRM0–M3. Factors evaluated were histological (Berden classification, interstitial fibrosis, percentage of crescents), clinical (extra-renal manifestations, sex, age) or biological (severity of acute kidney injury, dialysis, ANCA subtype). Results One hundred and seventy-seven patients were included. The eGFR at 3 months was significantly higher than at diagnosis (mean ± standard deviation, 40 ± 24 vs 28 ± 26 ml/min/1.73 m2, p < 0.001), with a ΔeGFRM0–M3 of 12 ± 19 ml/min/1.73 m2. The eGFR at 12 months was higher than at 3 months (44 ± 13 vs 40 ± 24 ml/min/1.73m2, p = 0.003). The factors significantly associated with ΔeGFRM0–M3 in univariate analysis were: sclerotic class according to Berden classification, percentage of interstitial fibrosis, percentage of cellular crescents, acute tubular necrosis, neurological involvement. The factors associated with ΔeGFRM0–M3 in multivariate analysis were the percentage of cellular crescents and neurological involvement. The mean increase in eGFR was 2.90 ± 0.06 ml/min/1.73m2 for every 10-point gain in the percentage of cellular crescents. ΔeGFRM0–M3 was not associated with the risks of end-stage renal disease or death in long-term follow-up. Conclusions Early renal recovery after a first flare of pauci-immune glomerulonephritis occurred mainly in the first three months of treatment. The percentage of cellular crescents was the main independent predictor of early renal recovery.

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Separating the wheat from the chaff – COVID-19 in a German emergency department: A Case-control study

10.21203/rs.3.rs-37052/v2 ◽

2020 ◽

Author(s):

David Fistera ◽

Dirk Pabst ◽

Annalena Härtl ◽

Benedikt Michael Schaarschmidt ◽

Lale Umutlu ◽

...

Keyword(s):

Emergency Department ◽

Health Care Systems ◽

University Hospital ◽

Nasopharyngeal Swab ◽

Workflow Model ◽

Manchester Triage System ◽

Efficient Management ◽

Care Systems ◽

To Come ◽

The University

Abstract Background: COVID-19 pandemia is a major challenge to worldwide health care systems. Whereas the majority of disease presents with mild symptoms that can be treated as outpatients, severely ill COVID-19 patients and patients presenting with similar symptoms cross their ways in the Emergency Department. Especially the variety of symptoms is challenging with primary triage. Are there parameters to distinguish between proven COVID-19 and without before? How can a safe and efficient management of these inpatients be achieved?Methods: We conducted a retrospective analysis of 314 consecutive inpatient patients who presented with possible symptoms of COVID-19 in a German emergency department between March and April 2020 and were tested with a SARS-Cov-2 nasopharyngeal swab. Clinical parameters, Manchester Triage System categories and lab results were compared between patients with positive and negative test results for SARS-Cov-2. Furthermore, we present the existing COVID-19 workflow model of the university hospital in Essen which proved to be efficient during pandemia.Results: 43 of the 314 patients (13.7%) were tested positive for COVID-19 by SARS-Cov-2 nasopharyngeal swab. We did not find any laboratory parameter to distinguish safely between patients with COVID-19 and those with similar symptoms. Dysgeusia was the only clinical symptom that was significantly more frequent among COVID-19 patients. Conclusion: Dysgeusia seems to be a typical symptom for COVID-19, which occurred in 14% of our COVID-19 patients. However, no valid parameters could be found to distinguish clinically between COVID-19 and other diseases with similar symptoms. Therefore, early testing, a strict isolation policy and proper personal protection are crucial to maintain workflow and safety of patients and ED staff for the months to come.Trial registration: URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021675

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Five-year survival after elective open and endovascular aortic aneurysm repair

Scandinavian Journal of Surgery ◽

10.1177/14574969211048707 ◽

2021 ◽

pp. 145749692110487

Author(s):

Jüri Lieberg ◽

Karl G. Kadatski ◽

Mart Kals ◽

Kaido Paapstel ◽

Jaak Kals

Keyword(s):

Aortic Aneurysm ◽

Survival Data ◽

Endovascular Aneurysm Repair ◽

National Registry ◽

University Hospital ◽

Current Evidence ◽

Term Survival ◽

All Cause Mortality ◽

Aneurysm Repair

Background and objective: Current evidence suggests short-term survival benefit from endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) in elective abdominal aortic aneurysm (AAA) procedures, but this benefit is lost during long-term follow-up. The aim of this study was to compare short- and mid-term all-cause mortality in patients with non-ruptured aneurysm treated by OSR and EVAR; and to assess the rate of complications and reinterventions, as well as to evaluate their impact on survival. Methods: The medical records of the non-ruptured AAA patients undergoing OSR or EVAR between 1 January 2011 and 31 December 2019 at Tartu University Hospital, Estonia, were retrospectively reviewed. We gathered survival data from the national registry (mean follow-up period was 3.7 ± 2.3 years). Results: A total of 225 non-ruptured AAA patients were treated operatively out of whom 95 (42.2%) were EVAR and 130 (57.8%) were OSR procedures. The difference in estimated all-cause mortality between the OSR and EVAR groups at day 30 was statistically irrelevant (2.3% vs 0%; p = 0.140), but OSR patients showed statistically significantly higher 5 year survival compared with EVAR patients (75.3% vs 50.0%, p = 0.002). Complication and reintervention rates for the EVAR and OSR groups did not differ statistically (26.3% vs 16.9%, p = 0.122; 10.5% vs 11.5%, p = 0.981, respectively). Multivariate analysis revealed that greater aneurysm diameter (p = 0.012), EVAR procedure (p = 0.016), male gender (p = 0.023), and cerebrovascular diseases (p = 0.028) were independently positively associated with 5-year mortality. Conclusions: Thirty-day mortality, and complication and reintervention rates for EVAR and OSR after elective AAA repair were similar. Although the EVAR procedure is an independent risk factor for 5-year mortality, higher age and greater proportion of comorbidities among EVAR patients may influence not only the choice of treatment modality, but also prognosis.

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Introducing teledermoscopy of possible skin cancers in general practice in Southern Denmark

Family Practice ◽

10.1093/fampra/cmaa041 ◽

2020 ◽

Vol 37 (4) ◽

pp. 513-518

Author(s):

Tine Vestergaard ◽

Sumangali C Prasad ◽

Annette Schuster ◽

Rasa Laurinaviciene ◽

Anette Bygum ◽

...

Keyword(s):

General Practice ◽

Diagnostic Accuracy ◽

Health Care Systems ◽

Final Diagnosis ◽

Skin Lesions ◽

University Hospital ◽

Predictive Values ◽

Face To Face ◽

Skin Cancers ◽

Care Systems

Abstract Background The increasing incidence of skin cancers poses a burden to health care systems. General practitioners (GPs) play an important role in triaging these diseases and referring relevant patients to specialists. It is challenging to distinguish benign from malignant skin lesions, and GPs may benefit from diagnostic support from teledermoscopy (TD). Objectives To assess whether the introduction of TD in general practice was feasible and might reduce the number of unnecessary referrals to specialists and to assess the diagnostic accuracy and confidence of participating GPs. Methods Fifty general practices in Southern Denmark participated. Adult patients presenting to their GP with suspected skin cancer could be included. Images including dermoscopy were taken by the GP and sent for evaluation by specialized dermatologists at a university hospital. Patients were simultaneously referred for a face-to-face evaluation at the university hospital. Diagnoses proposed by the GPs and by TD were compared to the final diagnoses obtained by histopathology or, if not available, face-to-face evaluation. Results Five hundred and nineteen patients with 600 suspected skin cancers were included. The final diagnosis was benign in 72.3%. The photo quality was good or fair in 90.5%. GPs reported uncertainty about their diagnoses in 41.5% of cases. The GPs’ positive predictive values for any malignancy and for malignant melanoma were 49.5% and 26.3%, respectively. On evaluation by TD, 31.5% of lesions did not need further in-person assessment. Conclusion Useful images of suspicious skin lesions were obtained from general practice, and GPs could benefit from TD to improve their diagnostic accuracy and confidence.

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P0181PERSISTENT C3 HYPOCOMPLEMENTEMIA AND MODERATE TUBULOINTERSTITIAL SCARRING AS EARLY PREDICTORS OF END-STAGE RENAL DISEASE IN LUPUS NEPHRITIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0181 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Giovanni Maria Rossi ◽

Francesco Peyronel ◽

Marco Delsante ◽

Avi Z Rosenberg ◽

Paride Fenaroli ◽

...

Keyword(s):

End Stage Renal Disease ◽

Regression Models ◽

Kidney Biopsy ◽

Cox Regression ◽

Activity Index ◽

Renal Recovery ◽

Early Predictors ◽

Stage Renal Disease ◽

End Stage

Abstract Background and Aims The prognosis of lupus nephritis (LN) has become progressively more favorable thanks to the introduction of cyclophosphamide and mycophenolate as the mainstay of induction of remission treatment regimens. However, 10-15% of patients still progress to end-stage renal disease (ESRD). Early predictors of ESRD, i.e. in the first six months between kidney biopsy and the completion of induction, are currently limited to few histological and clinical features: ≥ 25% interstitial fibrosis and tubular atrophy (IFTA), fibrinoid necrosis, fibrous crescents, and thrombotic microangiopathy (TMA) [Rijnink EC et al CJASN 2017; Song D Arthritis Res Ther 2013]; lack of decrease in proteinuria < 0.5 g/24-h at 3 and 6 months from kidney biopsy [Tamirou F Ann Rheum Dis 2016], baseline GFR ≤ 90 ml/min/1.73 m2, lack of decrease in urinary protein-to-creatinine ratio (UPCR) < 1 and anti-dsDNA positivity at the end of induction [Dall’Era M Lupus Sci Med 2015]. In this study we sought to identify further clinical and histological predictors of ESRD in LN. Methods Adult patients diagnosed with LN between 1995 and 2018 in two centers (NIAMS, Bethesda, Maryland, USA, and Nefrologia, AOU di Parma, Italy) were retrospectively identified. Patients with available serum C3 and C4 levels at the time of biopsy and 6 months thereafter, and a follow-up of at least 6 months, were included. Baseline and follow-up data (until March 2019) including age, sex, ethnicity, clinical, histological and laboratory findings were collected. Histology slides were reviewed by an experienced renal pathologist and biopsies re-scored using the ISN/RPS classification and NIH activity and chronicity indices. Distinct histological features were assessed individually (e.g. TMA). Persistent C3 hypocomplementemia was defined as decreased serum C3 levels at the time of biopsy and after 6 months (i.e. after the completion of induction), with concurrent normal serum C4 levels at 6 months. Early renal recovery was defined as either an increase in eGFR above 60 in those with a baseline eGFR < 60 ml/min/1.73 m2, or a 50% decrease in proteinuria in those with a baseline eGFR ≥ 60 ml/min/1.73 m2 and ≥ 0.5 g/24-h or g/g UPCR at the time of biopsy. Variables were tested for their predictive power of death-censored ESRD in univariate and multivariate Cox regression models. Results 74 patients (NIAMS n = 36; Parma n = 38) met our criteria. Median follow-up duration was 64 months (range 6-230). On univariate analysis, the following parameters predicted ESRD: Hispanic ethnicity; age at biopsy; persistent C3 hypocomplementemia; normalization of both C3 and C4; renal recovery after induction; NIH activity index; presence of TMA; ≥ 25% IFTA. Multivariate Cox regression models for ESRD were created considering statistically significant variables (p < 0.05). In a model including Hispanic ethnicity, age at biopsy, and persistent C3 hypocomplementemia, the latter predicted ESRD with an HR of 5.22 (95% CI [1.33, 20.58] p = 0.018) when adjusting for renal recovery after induction. Upon including histological features in the model, persistent C3 hypocomplementemia, TMA, and the NIH activity index lost significance, while ≥ 25% IFTA predicted ESRD with an HR of 27.26 (95% CI [2.12, 350.54], p = 0.011). Conclusion In patients with LN, ≥ 25% IFTA at baseline biopsy is a predictor of ESRD, allowing for early risk stratification with the potential of informing treatment strategies. Where percent IFTA is unavailable or its assessment unreliable (e.g. inadequate biopsy specimen for tubulointerstitial assessment), persistent C3 hypocomplementemia represents a reliable and reproducible early predictor of ESRD, irrespective of early renal recovery after induction.

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Economic impact and cost savings of teledermatology units compared to conventional monitoring at hospitals in southern Spain

Journal of Telemedicine and Telecare ◽

10.1177/1357633x20942044 ◽

2020 ◽

pp. 1357633X2094204

Author(s):

Antonio Lopez-Villegas ◽

Rafael Jesus Bautista-Mesa ◽

Miguel Angel Baena-Lopez ◽

Maria Luisa Alvarez-Moreno ◽

Jesus E Montoro-Robles ◽

...

Keyword(s):

Cost Saving ◽

Health Care Systems ◽

Cost Savings ◽

Public Health Care ◽

Retrospective Assessment ◽

Care Systems ◽

Cost Of Time ◽

One Year ◽

The Cost

Introduction Asynchronous teledermatology (TD) has undergone exponential growth in the past decade, allowing better diagnosis. Moreover, it saves both cost and time and reduces the number of visits involving travel and opportunity cost of time spent on visits to the hospital. The present study performed a cost-saving analysis of TD units and assessed whether they offered a cheaper alternative to conventional monitoring (CM) in hospitals from the perspective of public health-care systems (PHS) and patients. Methods This study was a retrospective assessment of 7030 patients. A cost-saving analysis comparing TD units to CM for patients at the Hospital de Poniente was performed over a period of one year. The TD network covered the Hospital de Poniente reference area (Spain) linked to 37 primary care (PC) centres that belonged to the Poniente Health District of Almeria. Results We observed a significant cost saving for TD units compared to participants in the conventional follow-up group. From the perspective of a PHS, there was a cost saving of 31.68% in the TD group (€18.59 TD vs. €27.20 CM) during the follow-up period. The number of CM visits to the hospital reduced by 38.14%. From the patients’ perspective, the costs were lower, and the cost saving was 73.53% (€5.45 TD vs. €20.58 CM). Discussion The cost-saving analysis showed that the TD units appeared to be significantly cheaper compared to CM.

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Body mass index and mortality in relation to age and follow-up of 30 years in large Austrian cohorts

European Journal of Public Health ◽

10.1093/eurpub/ckz185.147 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

G Nagel ◽

R S Peter ◽

B Föger ◽

H Concin

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Health Care Systems ◽

Generalized Additive Models ◽

Population Level ◽

Additive Models ◽

Calendar Time ◽

Care Systems ◽

Over Time

Abstract Background Obesity and its health consequences will dominate health care systems in many countries during the next decades. Prevention programs have been implemented. However, the optimum body mass index (BMI) in relation to all-cause mortality on population level is still a matter of debate. Material and Method Data 1/1989-6/2005 of the Vorarlberg Health Monitoring & Prevention Program (VHM&PP,) and 8/2005-12/2015 for Vorarlberg provided by the Main Association of Austrian Social Security Institutions were analyzed. In both cohorts, information was available on age, sex, measured height and weight as well as the date and cause of death. Generalized additive models were used to model the mortality rate as function of calendar time, age and follow-up. Results The VHM&PP cohort consisted of 85,488 men and 99,873 women and the later of 129,817 men and 152,399 women. In the second cohort, men (mean age 48 (SD16.9) vs. 45.3 (SD 15.5) and women (48.3 (SD 17.7) vs. 45.6 (SD 16.6) years) were slightly older than in the VHM&PP cohort. The average BMI was slightly higher in men (26.1 (SD4.0) vs. 25.7 (SD3.8) kg/m2) but not in women (24.6 (SD 4.8) vs. 24.7 (SD 4.9) kg/m2), respectively. In the VHM&PP cohort more ever smokers were found in both men (40.3 vs. 22.4%) and women (24.8 vs. 18.4%) than in the subsequent cohort. BMI optimum increased slightly between 1985 and 2015, from 24.9 (95%-CI: 24.0-25.9) to 26.4 (25.3-27.3) in men and from 22.4 (21.8-23.1) to 23.3 (22.5-24.5) kg/m2 in women. However, age and follow-up had major impact on the increase. In younger age the associations are quite stable, while in men over 50 years and in women over 60 years the BMI optimum decreased with length of follow-up. Conclusions Overall the BMI optimum increased slightly over time. However, age and follow-up had major impact on the association. These results suggest, that prognosis of obesity related diseases has improved over time. To detangle this further research is necessary. Key messages In Austria the BMI optimum increased slightly over time. Age and follow-up time had major impact on the association.

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Colonoscopy and flexible sigmoidoscopy for follow-up of patients with left-sided diverticulitis

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.0181 ◽

2020 ◽

Vol 102 (9) ◽

pp. 744-747

Author(s):

Z Abdulazeez ◽

N Kukreja ◽

N Qureshi ◽

S Lascelles

Keyword(s):

Computed Tomography ◽

Diverticular Disease ◽

Flexible Sigmoidoscopy ◽

Health Care Systems ◽

Acute Diverticulitis ◽

Western World ◽

Routine Surveillance ◽

New Findings ◽

Care Systems

Introduction The prevalence of diverticular disease has been increasing in the western world over the last few decades, causing a growing burden on health care systems. This study compared the uses of flexible sigmoidoscopy with colonoscopy as a follow-up investigation for patients diagnosed with acute left-sided diverticulitis and to evaluate the need for using either procedure. Materials and methods A retrospective study of 327 patients diagnosed with acute diverticulitis was carried out. Of this total, 240 patients with left-sided diverticulitis diagnosed via computed tomography were included. These patients were categorised into two equal groups: the first 120 patients underwent colonoscopy and the second 120 patients underwent flexible sigmoidoscopy. Results All colonoscopes and flexible sigmoidoscopes confirmed the computed tomography diagnosis of sigmoid diverticular disease with no major new findings. All colonoscopes and flexible sigmoidoscopes were reported as having no complications, with nine colonoscopes reported as being difficult compared with only three flexible sigmoidoscopes. All biopsies were reported as no malignancy. Full bowel preparation was required in all colonoscopes, compared with no preparation required for flexible sigmoidoscopes. Conclusions There is no evidence to support the routine use of endoscopic evaluation after an episode of left-sided diverticulitis diagnosed on computed tomography if no worrying radiological findings have been reported. This study supports similar findings from other studies and therefore we disagree with The Royal College of Surgeons of England (Association of Coloproctology of Great Britain and Ireland recommendations) commissioning guide, which advocates routine surveillance of the colon.

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Naprapathy Versus Orthopaedic Standard Care for Common Musculoskeletal Disorders: An 8-year Follow-up of a Pragmatic Randomized Controlled Trial in Sweden

10.21203/rs.3.rs-641470/v1 ◽

2021 ◽

Author(s):

Stina Lilje ◽

Andreas Eklund ◽

Anders Wykman ◽

Tobias Sundberg ◽

Eva Skillgate

Keyword(s):

Health Care ◽

Musculoskeletal Disorders ◽

Health Care Systems ◽

Controlled Trial ◽

Bodily Pain ◽

Control Group ◽

National Health Care ◽

Care Systems ◽

Experimental Group

Abstract Background: Musculoskeletal pain is among the most common reasons for seeking care, specialist competence for its treatment in primary care limited and waiting lists for orthopaedics often amongst the longest. Many referrals to orthopaedics do not concern disorders that benefit from surgery. Manual therapy is effective, yet not integrated in national health care systems, and there is a lack of research on other than neck and low back pain, and a lack of long-term follow-ups. The present study evaluates the long-term effects of a complementary therapy for common orthopaedic disorders.Methods: An 8-year follow-up (96 months) of a pragmatic randomized controlled trial of naprapathy (experimental group) versus standard orthopaedic care (control group) for non-surgical patients of working age with the most common musculoskeletal disorders on the waiting lists(n=78). Bodily pain, physical function (SF36), Quality of life (QoL; SF6D), and data on health care utilization were collected.Results: N=75 participants in the original study sample completed the 8-year follow-up. The differences in bodily pain (21,7 (95% CI: 9,1-34,3)), physical function (17,6(6,7-28,4)), and QoLs (0,823 (95% CI: 0.785-0.862) compared with 0,713 (95% CI: 0.668-0.758)) were statistically significantly in favor of the experimental group (p-values<0,01). After sensitivity analysis the experimental group had altogether 260 health care visits compared with 1 161 in the control group.Conclusions:Naprapathy is a continuously effective treatment. Together with earlier research our study suggests that specialized manual therapy should be considered when triaging patients with common non-surgical musculoskeletal disorders in national health care systems.Trial registration: Not applicable, as per information given by ClinicalTrials.gov.

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