The primary aim of this study was to describe changes in disability and pain scores of people referred to hospital clinics with back pain, over a 12-month period from the time of referral. Secondary aims were to describe the demographic and clinical profile of patients referred to hospital services for back pain and to explore characteristics associated with disability at 12-months.
A longitudinal cohort study was conducted with 101 patients with back pain who were referred to either a public hospital neurosurgery or physiotherapy clinic. Participants completed a self-reported pre-assessment questionnaire online or via telephone, and outcome measures including disability (Roland Morris Disability Questionnaire (0-24)) and pain intensity (0-10) were measured at baseline and 12-months. Changes in pain and disability over 12-months were compared using the Wilcoxon signed ranks test (p 0.05). Participant demographics including age, sex, height and weight, primary language, employment status and comorbidities, along with clinical characteristics including pain and paraesthesia distribution were collected and reported using descriptive statistics. A multivariate linear regression was used to determine factors associated with 12-month disability scores.
At 12-months from the time of referral, disability improved by 2 points (12.6 to 10.6) and pain score improved by 0.8 points (6.9 to 6.1). Although these changes were statistically significant (p 0.003 and p 0.007 respectively), they were not clinically meaningful. Baseline disability, Short-Form Örebro Musculoskeletal Pain Questionnaire (ÖMPQ-SF) scores and age were associated with 12-month disability score. At time of referral most patients had chronic back pain with high average pain (7/10) and OMPQ-SF scores (>50). Patients were mostly female with an average age of 53 years, overweight or obese, with multiple co-morbidities (0-9). The majority of patients had sought care from their general practitioner, with fewer having seen specialist or allied health practitioners.
Patients referred to hospital clinics with back pain do not show meaningful change in disability over 12-months from the time of referral. Baseline disability and age are associated with 12-month disability. Evaluation of any service changes implemented is now possible with pre-change baseline outcome measure data now available.z
As part of a larger re-design project this study provides baseline data to measure the effect of re-design on service and patient outcomes. There is demonstrated scope to examine ways of changing current services to improve health outcomes for patients who are referred to these services. This study is primarily concerned with evaluation at a local level, and while the results may not be reflective of all hospital services, the translatable nature of the study design is generalisable to other health settings.
health outcomes
hospital outpatient clinic
