Among the many ‘revolutions’ in contemporary medicine and science, the idea behind Evidence-Based Medicine (EBM) is possibly the most remarkable one. People should receive only those interventions that work (i.e. those that are most likely to do more good than harm) and physicians should try to adopt those behaviours that are most consistent with the best available scientific information.

The burden of musculoskeletal conditions is growing in most developed and third world countries. The importance of the problems we study has been recognized by the United Nations by declaring the decade 2000–2010 the ‘Bone and Joint Decade’.

Despite the many great achievements in the last century, clinical research in the field of muscoloskeletal disorders has not always been flawless: this has been already pointed out by many methodologists in the past decades, even before the outburst of systematic reviews. However, and not surprisingly, the mission statement of the Decade could have been taken from an EBM textbook: This symposium will present different aspects of EBM applied to musculoskeletal disorders. Hopefully it will serve as a source of knowledge but, even more, as a source of inspiration to continuous research in the field and, most of all, as an invitation to join the rapidly growing EBM movement.

After a first international meeting in Ferrara in April 2001 ( e_Musk1) we are setting up an e_Musk Coordinating Centre at the University of Teesside in Middles-brough, UK. It is becoming a forum for like minded people to network and interact, whose long-term goal are patient-centeredness and bringing down the professional barriers. We are organizing a 2nd e_Musk meeting for June 18th–19th 2003.

Aim of many surgical operations on the spine is very often to achieve a solid fusion between two or more vertebrae (arthrodesis). Describing lumbar spine mobility radiographically has been determined to be very imprecise with measurement errors of three to six mm in the sagittal plane. Using roentgen stereophotogrammetric analysis (RSA) it is possible to perform clinical kinematic lumbar studies with high accuracy. Many experimental studies have presented basic data on the stabilising implant effect in human cadaver lumbar spines, but no study compared the in vivo stabilising effect in different types of implant.

The RSA was performed in a radiographic set-up with two 40° angulated roentgen tubes with simultaneous exposures. A combined reference plate and calibration device with 0.8 mm tantalum balls at known positions was situated between the patient and the uniplanar film cassette, enabling simultaneous calibration and patient examination. At each RSA the patients were examined in supine and erect positions without corset. The translatory movements, induced by the change in position, of the 0.8 mm tantalum balls implanted into the fused vertebrae were calculated by computed data processing. These translations visualised the movements of the most proximal vertebra of the fusion in relation to the most distal.

The present study has demonstrated the in vivo stability of lumbar fusion augmented with transpedicular screws to be adequate. Sagittal translation seems to be easier to elicit than movements along the other three-dimensional axes. A widely decompressed and destabilised vertebra without screw fixation increases the risk for persisting intervertebral translations. The RSA technique described seems to be a good way for comparing the in vivo behaviour of different implant systems

There is no consensus regarding the best method of assessing outcomes after total knee arthroplasty. There are now many questionnaires in the literature, well constructed and validated in the original language. Dawson’s questionnaire (1998) is designed as a 12-item self-administered instrument, and has undergone a complete validation procedure in its original English version.

Aim of this paper is to present the procedure of cultural adaptation and some data from the validation process of the Italian version of the questionnaire.

Two independent translations into Italian and back-translations into English were obtained, from specialised and general translators. The material was then evaluated in a multidisciplinary panel including elderly patients. A provisional version was obtained and tested in a pilot study. Results and comments were reviewed within the panel again which came up with the final version.

The questionnaire was administered to 100 patients scheduled for knee replacement. Other outcomes collected included a general health questionnaire, in its validated Italian version (SF-36), and several objective and radiographic parameters.

The burden on the patient and comprehension’s difficulties were registered. Validation included the assessment of internal consistency, construct and content validity. Correlation between different parameters were investigated. Test-retest reliability was assessed on 20 patients. Comparisons with the data presented in the original paper were performed.

The questionnaires were accepted favourably by the patients, even though the combination with the SF-36 increased the amount of time required for completion. Some difficulties were registered with the comprehension of the answering method, as well as of the meaning of single items. Results of the validation process were substantially equivalent to those of the original paper.