de Vos Andersen N.-B.1, Kent P.2, Hjort J.3, Hoyrup Christiansen D.4
1Region Midtjylland, Koncern Kvalitet Primary Care, Viborg, Denmark, 2School of Physiotherapy and Exercise Science, Curtin University, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Perth, Australia, 3Aarhus University, Department of Clinical Medicine, HEALTH,, Aarhus, Denmark, 4Regional Hospital West Jutland-University Research Clinic, Department of Occupational Medicine, Herning, Denmark
Background: Danish patients with musculoskeletal disorders are commonly referred for primary care physiotherapy treatment but little is known about their general health status, pain diagnoses, clinical course and prognosis.
Purpose: The objectives of this study were to 1) describe the clinical course of patients with musculoskeletal disorders referred to physiotherapy, 2) identify predictors associated with a satisfactory outcome, and 3) determine the influence of the primary pain site diagnosis relative to those predictors.
Methods: This was a prospective cohort study of patients (n=2,706) newly referred because of musculoskeletal pain to 30 physiotherapy practices from January 2012 to May 2012. Data were collected via a web-based questionnaire 1-2 days prior to the first physiotherapy consultation (baseline) and at 6 weeks, 3 and 6 months, from clinical records (including primary musculoskeletal symptom diagnosis based on the ICPC-2 classification system), and from national registry data. The main outcome was the Patient Acceptable Symptom State (PASS). Potential predictors were analysed using backwards step-wise selection during longitudinal Generalised Estimating Equation (GEE) regression modelling. To assess the influence of pain site on these associations primary pain site diagnosis was added to the model.
Results: The percentage of patients reporting their symptoms as acceptable was 32% at 6 weeks, 43% at 3 months and 52% at 6 months. A higher probability of satisfactory outcome was associated with place of residence, being retired, no compensation claim, less frequent pain, shorter duration of pain, lower levels of disability and fear avoidance, better mental health and being a non smoker. Primary pain site diagnosis had little influence on these associations, and was not predictive of a satisfactory outcome.
Conclusion(s): Only half of the patients rated their symptoms as acceptable at 6 months. Although satisfactory outcome was difficult to predict at an individual patient level, there were a number of prognostic factors that were associated with this outcome.
Implications: These factors should be considered when developing generic prediction tools to assess the probability of satisfactory outcome in musculoskeletal physiotherapy patients because the site of pain did not affect that prognostic association.
Funding acknowledgements: The study was funded by the Practice Research Foundation of Danish Physiotherapists
Topic: Musculoskeletal
Ethics approval: Approved by the Danish Data Protection Agency (No. 2007-58-0010). According to Danish law, no need for ethics approval
All authors, affiliations and abstracts have been published as submitted.
