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Published in: BMC Musculoskeletal Disorders 1/2015

Open Access 01-12-2015 | Research article

How much do rheumatologists and orthopaedists doctors’ modalities impact the cost of arthritis in Cyprus?

Authors: Despena Andrioti, Kypros Kyprianou, George Charalambous

Published in: BMC Musculoskeletal Disorders | Issue 1/2015

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Abstract

Background

Osteoarthritis is one of the primary causes of long-term functional disability. With an estimated 13.5 % prevalence in the general population contributes to a significant financial burden both for patients and healthcare systems. The purpose of this research is to highlight the direct annual cost of the disease to the private healthcare sector of Nicosia.

Methods

A questionnaire based on Greek and international research was completed between 10/1/2012 and 11/30/2012, with a sample of 20 doctors specialists in orthopaedics and rheumatology (50 % of practising physicians in the private sector). An assessment of the annual cost of medical procedures and tests, pharmacologic therapies (modalities) and supplies per patient followed, based on current costs. Direct costs were assessed through the micro-costing “bottom-up” approach. We isolated and separately priced the original diagnosis, followed by each stage of the disease.

Results

The cost for the six predominant medical tests to establish a diagnosis and exclude mainly RA such as ESR, CPR, and X-ray as well as a physician’s office visit was 150€ per patient. The average direct cost per patient during stages 1, 2 and 3 of the disease was 280.54€, 1,834.64€ and 5,641.72€ annually, respectively, with an annual average of 2,573€ per patient.

Conclusions

Even though during the period of the study, the country had not yet established clinical guidelines, the participating physicians followed international practices. Significant rise in the cost in each stage of the disease was found, with additional increases in the following years as a result of the expected increased prevalence of the disease. It is noted here that uninsured patients, as well as those who qualified for free medical care, they seek these services in the private sector, and had to pay out of pocket money for examination and treatment. These patients, thus, contended with a serious financial burden. Therefore, it is important to inform them very extensively regarding evidence-based management of the disease to aid them in coping with this chronic illness.
Literature
1.
go back to reference CDC. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation. MMWR. 2010;59:39. CDC. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation. MMWR. 2010;59:39.
4.
go back to reference Blagojevic M, Jinks C, Jeffery A, et al. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2010;18:24–33.CrossRefPubMed Blagojevic M, Jinks C, Jeffery A, et al. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2010;18:24–33.CrossRefPubMed
6.
go back to reference European Commission. Musculoskeletal Problems and Functional Limitation. Oslo: The Great Public Health Challenge for the 21st Century; 2003. European Commission. Musculoskeletal Problems and Functional Limitation. Oslo: The Great Public Health Challenge for the 21st Century; 2003.
7.
go back to reference Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum. 1998;41:1343–55.CrossRefPubMed Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum. 1998;41:1343–55.CrossRefPubMed
9.
go back to reference Arthritis Care. Living with osteoarthritis. London: Arthritis Care; 2011. Arthritis Care. Living with osteoarthritis. London: Arthritis Care; 2011.
10.
go back to reference Symmons D, Colin Mathers C, Pfleger B. Global burden of osteoarthritis in the year 2000. In: WHO global burden of disease. 2003. Symmons D, Colin Mathers C, Pfleger B. Global burden of osteoarthritis in the year 2000. In: WHO global burden of disease. 2003.
11.
go back to reference Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62:1145–55.CrossRefPubMedPubMedCentral Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62:1145–55.CrossRefPubMedPubMedCentral
12.
go back to reference Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther KP, et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2005;64:669–81.CrossRefPubMed Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther KP, et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2005;64:669–81.CrossRefPubMed
13.
go back to reference Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16:137–62.CrossRefPubMed Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16:137–62.CrossRefPubMed
14.
go back to reference McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014;22:363–88.CrossRefPubMed McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014;22:363–88.CrossRefPubMed
15.
go back to reference Alshami A. Knee osteoarthritis related pain: a narrative review of diagnosis and treatment. Int J Health Sci. 2014;8:85–104.CrossRef Alshami A. Knee osteoarthritis related pain: a narrative review of diagnosis and treatment. Int J Health Sci. 2014;8:85–104.CrossRef
16.
go back to reference Dickson J, Hosie G. Your Questions Answered, Osteoarthritis. Edinburgh: Churchill Livingstone; 2003. Dickson J, Hosie G. Your Questions Answered, Osteoarthritis. Edinburgh: Churchill Livingstone; 2003.
17.
go back to reference Fries JF, Spitz P, Kraines G, Halsted H. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23:137–45.CrossRefPubMed Fries JF, Spitz P, Kraines G, Halsted H. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23:137–45.CrossRefPubMed
18.
go back to reference Ng NT, Heesch KC, Brown WJ. Strategies for managing osteoarthritis. Int J Behav Med. 2012;19:298–307.CrossRefPubMed Ng NT, Heesch KC, Brown WJ. Strategies for managing osteoarthritis. Int J Behav Med. 2012;19:298–307.CrossRefPubMed
19.
go back to reference Smink AJ, van den Ende CH, Vliet Vlieland TP, Swierstra BA, Kortland JH, Bijlsma JW, et al. Beating osteoARThritis: development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis. Clin Rheumatol. 2011;30:1623–9.CrossRefPubMed Smink AJ, van den Ende CH, Vliet Vlieland TP, Swierstra BA, Kortland JH, Bijlsma JW, et al. Beating osteoARThritis: development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis. Clin Rheumatol. 2011;30:1623–9.CrossRefPubMed
20.
go back to reference Walsh NE, Hurley MV. Evidence based guidelines and current practice for physiotherapy management of knee osteoarthritis. Musculoskeletal Care. 2009;7:45–56.CrossRefPubMed Walsh NE, Hurley MV. Evidence based guidelines and current practice for physiotherapy management of knee osteoarthritis. Musculoskeletal Care. 2009;7:45–56.CrossRefPubMed
21.
go back to reference Goode A, Shi X, Gracely R, Renner J, Jordan J. Associations between pressure–pain threshold, symptoms, and radiographic knee and hip osteoarthritis. Arthritis Care Res. 2014;66:1513–9. doi:10.1002/acr.22321.CrossRef Goode A, Shi X, Gracely R, Renner J, Jordan J. Associations between pressure–pain threshold, symptoms, and radiographic knee and hip osteoarthritis. Arthritis Care Res. 2014;66:1513–9. doi:10.​1002/​acr.​22321.CrossRef
22.
go back to reference National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults. London: NICE; 2008. National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults. London: NICE; 2008.
23.
go back to reference Andrianakos A, Kontelis L, Karamitsos D, Aslanidis S, Georgountzos A, Kaziolas G, et al. Prevalence of symptomatic knee, hand, and hip osteoarthritis in Greece. ESORDIG Study J Rheumatol. 2006;33:2507–14.PubMed Andrianakos A, Kontelis L, Karamitsos D, Aslanidis S, Georgountzos A, Kaziolas G, et al. Prevalence of symptomatic knee, hand, and hip osteoarthritis in Greece. ESORDIG Study J Rheumatol. 2006;33:2507–14.PubMed
24.
go back to reference Murphy L, Helmick CG. The impact of osteoarthritis in the United States: a population-health perspective. Am J Nurs. 2012;112 Suppl 1:13–9.CrossRef Murphy L, Helmick CG. The impact of osteoarthritis in the United States: a population-health perspective. Am J Nurs. 2012;112 Suppl 1:13–9.CrossRef
25.
go back to reference Gabriel SE, Crowson CS, Campion ME, O’ Fallon WM. Direct medical costs unique to people with arthritis. J Rheumatol. 1997;24:719–25.PubMed Gabriel SE, Crowson CS, Campion ME, O’ Fallon WM. Direct medical costs unique to people with arthritis. J Rheumatol. 1997;24:719–25.PubMed
26.
go back to reference Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41:778–99.CrossRefPubMed Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41:778–99.CrossRefPubMed
27.
go back to reference Murphy LB, Helmick CG, Cisternas MG, Yelin EH. Estimating medical costs attributable to osteoarthritis in the US population: comment on the article by Kotlarz et al. Arthritis Rheum. 2010;62:2566–7. doi:10.1002/art.27514.CrossRefPubMed Murphy LB, Helmick CG, Cisternas MG, Yelin EH. Estimating medical costs attributable to osteoarthritis in the US population: comment on the article by Kotlarz et al. Arthritis Rheum. 2010;62:2566–7. doi:10.​1002/​art.​27514.CrossRefPubMed
28.
29.
go back to reference Harrold LR, Yood RA, Straus W, Andrade SE, Cernieux J, Lewis BE, et al. Challenges of estimating health service utilization for osteoarthritis patients on a population level. J Reumatol. 2002;29:1931–6. Harrold LR, Yood RA, Straus W, Andrade SE, Cernieux J, Lewis BE, et al. Challenges of estimating health service utilization for osteoarthritis patients on a population level. J Reumatol. 2002;29:1931–6.
30.
go back to reference Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and therapeutic criteria. Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039–49.CrossRefPubMed Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and therapeutic criteria. Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039–49.CrossRefPubMed
31.
go back to reference Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34:505–14.CrossRefPubMed Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34:505–14.CrossRefPubMed
32.
go back to reference Arnold W, Fullerton D, Holder S, May C. Viscosupplementation: managed care issues for osteoarthritis of the knee. JMCP Suppl. 2007;13:3–19.CrossRef Arnold W, Fullerton D, Holder S, May C. Viscosupplementation: managed care issues for osteoarthritis of the knee. JMCP Suppl. 2007;13:3–19.CrossRef
33.
go back to reference Morris S, Devlin N, Parkin D. Economic Analysis in Health Care. London: John Willey and sons; 2009. Morris S, Devlin N, Parkin D. Economic Analysis in Health Care. London: John Willey and sons; 2009.
34.
go back to reference CDC. Estimated number of US population with physician-diagnosed osteoarthritis, 1990. Atlanta: Centers for Disease Control and Prevention; 1995. CDC. Estimated number of US population with physician-diagnosed osteoarthritis, 1990. Atlanta: Centers for Disease Control and Prevention; 1995.
35.
go back to reference Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly: the Framingham osteoarthritis study. Arthritis Rheum. 1987;30:914–18.CrossRefPubMed Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly: the Framingham osteoarthritis study. Arthritis Rheum. 1987;30:914–18.CrossRefPubMed
36.
go back to reference Elders MJ. The increasing impact of arthritis on public health. J Rheumatol Suppl. 2000;60:6–8.PubMed Elders MJ. The increasing impact of arthritis on public health. J Rheumatol Suppl. 2000;60:6–8.PubMed
37.
go back to reference Zochling J, March LM, Lapsley H, Cross M, Tribe K, Brooks P. Use of complementary medicines for osteoarthritis—a prospective study. Ann Rheum Dis. 2004;63:549–54.CrossRefPubMedPubMedCentral Zochling J, March LM, Lapsley H, Cross M, Tribe K, Brooks P. Use of complementary medicines for osteoarthritis—a prospective study. Ann Rheum Dis. 2004;63:549–54.CrossRefPubMedPubMedCentral
39.
go back to reference Antonopoulou M, Antonakis N, Hadjipavlou A, Lionis C. Patterns of pain and consulting behaviour in patients with musculoskeletal disorders in rural Crete. Greece Family Practice. 2007;24:209–16.CrossRefPubMed Antonopoulou M, Antonakis N, Hadjipavlou A, Lionis C. Patterns of pain and consulting behaviour in patients with musculoskeletal disorders in rural Crete. Greece Family Practice. 2007;24:209–16.CrossRefPubMed
40.
go back to reference Bitton R. The economic burden of osteoarthritis. Am J Manag Care. 2009;15 Suppl 8:230–5. Bitton R. The economic burden of osteoarthritis. Am J Manag Care. 2009;15 Suppl 8:230–5.
41.
go back to reference Hochberg M, Altman R, Toupin K, Benkhalti M, Guyatt G, Mcgowan J, et al. Recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. American College of Rheumatology 2012. Arthritis Care Res. 2012;64:465–74.CrossRef Hochberg M, Altman R, Toupin K, Benkhalti M, Guyatt G, Mcgowan J, et al. Recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. American College of Rheumatology 2012. Arthritis Care Res. 2012;64:465–74.CrossRef
42.
go back to reference Landon BE, Reschovsky J, Reed M, Blumenthal D. Personal, organizational, and market level influences on physicians’ practice patterns: results of a national survey of primary care physicians. Med Care. 2001;39:889–905.CrossRefPubMed Landon BE, Reschovsky J, Reed M, Blumenthal D. Personal, organizational, and market level influences on physicians’ practice patterns: results of a national survey of primary care physicians. Med Care. 2001;39:889–905.CrossRefPubMed
43.
go back to reference Kievit W, van Hulst L, van Riel P, Fraenkel L. Factors that influence rheumatologists’ decisions to escalate care in rheumatoid arthritis: results from a choice-based conjoint analysis. Arthritis Care Res. 2010;62:842–7.CrossRef Kievit W, van Hulst L, van Riel P, Fraenkel L. Factors that influence rheumatologists’ decisions to escalate care in rheumatoid arthritis: results from a choice-based conjoint analysis. Arthritis Care Res. 2010;62:842–7.CrossRef
44.
go back to reference Contreras-Hernández I, Mould-Quevedo JF, Torres-González R, Goycochea-Robles MV, Pacheco-Domínguez RL, Sánchez-García S, et al. Cost-effectiveness analysis for joint pain treatment in patients with osteoarthritis treated at the Instituto Mexicano del Seguro Social. Comparison of nonsteroidal anti-inflammatory drugs (NSAIDs) vs. cyclooxygenase-2 selective inhibitors. Cost Eff Resour Alloc. 2008;6:21.CrossRefPubMedPubMedCentral Contreras-Hernández I, Mould-Quevedo JF, Torres-González R, Goycochea-Robles MV, Pacheco-Domínguez RL, Sánchez-García S, et al. Cost-effectiveness analysis for joint pain treatment in patients with osteoarthritis treated at the Instituto Mexicano del Seguro Social. Comparison of nonsteroidal anti-inflammatory drugs (NSAIDs) vs. cyclooxygenase-2 selective inhibitors. Cost Eff Resour Alloc. 2008;6:21.CrossRefPubMedPubMedCentral
45.
go back to reference Snijders GF, den Broeder AA, van Riel PL, Straten VH, de Man FH, van den Hoogen FH, et al. Evidence-based tailored conservative treatment of knee and hip osteoarthritis: between knowing and doing. Scand J Rheumatol. 2011;40:225–31.CrossRefPubMed Snijders GF, den Broeder AA, van Riel PL, Straten VH, de Man FH, van den Hoogen FH, et al. Evidence-based tailored conservative treatment of knee and hip osteoarthritis: between knowing and doing. Scand J Rheumatol. 2011;40:225–31.CrossRefPubMed
46.
go back to reference Xie F, Thumboo J, Li SC. True difference or something else? Problems in cost of osteoarthritis studies. Semin Arthritis Rheum. 2007;37:127–32.CrossRefPubMed Xie F, Thumboo J, Li SC. True difference or something else? Problems in cost of osteoarthritis studies. Semin Arthritis Rheum. 2007;37:127–32.CrossRefPubMed
47.
go back to reference Gupta S, Hawker GA, Laporte A, Croxford R, Coyte P. The economic burden of disabling hip and knee osteoarthritis (OA) from the perspective of individuals living with this condition. Rheumatology. 2005;44:1531–7.CrossRefPubMed Gupta S, Hawker GA, Laporte A, Croxford R, Coyte P. The economic burden of disabling hip and knee osteoarthritis (OA) from the perspective of individuals living with this condition. Rheumatology. 2005;44:1531–7.CrossRefPubMed
48.
go back to reference CDC. National and state medical expenditures and lost earnings attributable to arthritis and other rheumatic conditions in USA in 1997. MMWR. 2003;52:1124–7. CDC. National and state medical expenditures and lost earnings attributable to arthritis and other rheumatic conditions in USA in 1997. MMWR. 2003;52:1124–7.
49.
go back to reference Loza E, Lopez-Gomez JM, Abasolo L, Maese J, Carmona L, Batlle-Gualda E. Economic burden of knee and hip osteoarthritis in Spain. Arthritis Care Res. 2009;61:158–65.CrossRef Loza E, Lopez-Gomez JM, Abasolo L, Maese J, Carmona L, Batlle-Gualda E. Economic burden of knee and hip osteoarthritis in Spain. Arthritis Care Res. 2009;61:158–65.CrossRef
50.
go back to reference Leardini G, Salaffi F, Caporali R, Canesi B, Rovati L, Montanelli R. Direct and indirect costs of osteoarthritis of the knee. Clin Exp Rheumatol. 2004;22:699–706.PubMed Leardini G, Salaffi F, Caporali R, Canesi B, Rovati L, Montanelli R. Direct and indirect costs of osteoarthritis of the knee. Clin Exp Rheumatol. 2004;22:699–706.PubMed
51.
go back to reference Le Pen C, Reygrobellet C, Gerentes I. Financial cost of osteoarthritis in France: the “COART” France study. Joint Bone Spine. 2005;72:567–70.CrossRefPubMed Le Pen C, Reygrobellet C, Gerentes I. Financial cost of osteoarthritis in France: the “COART” France study. Joint Bone Spine. 2005;72:567–70.CrossRefPubMed
52.
go back to reference Maetzel A, Li LC, Pencharz J, Tomlinson F, Bombardier C. The economic burden associated with osteoarthritis, rheumatoid arthritis, and hypertension: a comparative study. Ann Rheum Dis. 2004;63:395–401.CrossRefPubMedPubMedCentral Maetzel A, Li LC, Pencharz J, Tomlinson F, Bombardier C. The economic burden associated with osteoarthritis, rheumatoid arthritis, and hypertension: a comparative study. Ann Rheum Dis. 2004;63:395–401.CrossRefPubMedPubMedCentral
53.
go back to reference Chen, A Gupte G, Akhtar, Smith P Cobb J. The global economic cost of osteoarthritis: how the UK compares. Arthritis (Hidawi) 2012, article ID 698706, doi:10.1155/2012/698709. Chen, A Gupte G, Akhtar, Smith P Cobb J. The global economic cost of osteoarthritis: how the UK compares. Arthritis (Hidawi) 2012, article ID 698706, doi:10.​1155/​2012/​698709.
54.
go back to reference The Royal Australian College of General Practitioners. Guideline for the non-surgical management of hip and knee osteoarthritis. Australia: The National Health and Medical Research Council; 2009. The Royal Australian College of General Practitioners. Guideline for the non-surgical management of hip and knee osteoarthritis. Australia: The National Health and Medical Research Council; 2009.
55.
go back to reference Levy E, Ferme A, Perocheau D, Bono I. Socioeconomic costs of osteoarthritis in France. Rev Rhum. 1993;60(Suppl):63–7. Levy E, Ferme A, Perocheau D, Bono I. Socioeconomic costs of osteoarthritis in France. Rev Rhum. 1993;60(Suppl):63–7.
56.
go back to reference Theodorou M, Charalambous C, Petrou C, Cylus J. Health Systems in Transition. Cyprus: World Health Organization on behalf of the European Observatory on Health Systems and Policies; 2012. Theodorou M, Charalambous C, Petrou C, Cylus J. Health Systems in Transition. Cyprus: World Health Organization on behalf of the European Observatory on Health Systems and Policies; 2012.
Metadata
Title
How much do rheumatologists and orthopaedists doctors’ modalities impact the cost of arthritis in Cyprus?
Authors
Despena Andrioti
Kypros Kyprianou
George Charalambous
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2015
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-015-0643-x

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