THE PREVALENCE OF SERIOUS PATHOLOGY IN MUSCULOSKELETAL PHYSIOTHERAPY PATIENTS – A NATIONWIDE REGISTER-BASED COHORT STUDY

C.R. Budtz^1,2, R.P. Hansen³, J.N.L. Thomsen⁴, D.H. Christiansen^1,2

Background: Musculoskeletal conditions are the single largest contributor to years lived with disability worldwide. Most musculoskeletal conditions are benign and therefore can be treated and managed in primary care. However, a small proportion of these patients may have symptoms of a serious disease masquerading as a benign musculoskeletal disorder. Although the general practitioner usually performs initial screening for serious pathology, evaluation and treatment by physiotherapists are often part of the treatment pathway. It is however unclear, how many patients in primary care physiotherapy have symptoms caused by serious pathology.

Purpose: To estimate the prevalence of neoplasm, cauda equina syndrome, spinal fracture, infection and inflammatory pathology among patients referred for musculoskeletal physiotherapy.

Methods: The study was a prospective nationwide register-based cohort study. We identified all referrals for primary care musculoskeletal physiotherapy in the Danish National Health Insurance Service Register from 2014 to 2017. Records of hospital contacts were extracted from the Danish National Patient Register within 180 days from first physiotherapy contact, identifying all diagnoses of serious pathology. Prevalence estimates of the serious pathology categories were reported.

Results: A total of 1,568,704 courses of treatment were included in the analysis. The overall prevalence of serious pathology was 2.30%. The prevalence of neoplasm was 2.11%, cauda equina syndrome 0.01%, fractures 0.13%, infections 0.01% and inflammatory pathology 0.06%. Higher prevalence's were observed among patients with a previous history of serious pathology, aged above 50 and more comorbidity.

Conclusion(s): This is the first study to investigate serious pathology among patients with a broad range of musculoskeletal conditions as opposed to more spine specific conditions. Although serious pathology among musculoskeletal physiotherapy patients is rare, the present study found an overall prevalence of serious pathology which exceeded the guideline endorsed prevalence estimates.

Implications: The neoplasm estimate of 2.11% is the largest contributor to the overall estimate of 2.30%. This indicates that screening for serious pathology in physiotherapy practise perhaps could benefit from concentrating more on screening for neoplasm. Also, all the included patients in the present study had been referred by the GP, meaning the GP had screened for serious pathology as a natural part of their consultation. Despite that, 2.3% of the patients were diagnosed with serious pathology within 180 days from their first contact. Although we cannot assume that all of these patients would have had symptoms of serious pathology, it remains certain that the physiotherapists cannot solely rely on the initial screening from the GP, because these serious conditions may cause symptoms that develop over time.

Funding, acknowledgements: The Assocation of Danish Physiotherapists, The Central Denmark Region and  Aarhus University.

Keywords: Serious pathology, Primary care physiotherapy, Musculoskeletal conditions

Topic: Musculoskeletal

Did this work require ethics approval? No

Institution: The National Committee on Health Research Ethics

Committee: Act on Research Ethics Review of Health Research Projects, October 2013

Reason: Under Danish law this study did not need ethics approval