Clinical course and prognosis of musculoskeletal pain in patients referred for physiotherapy: does pain site matter?

Abstract

BackgroundDanish 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.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.MethodsThis 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 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. Potential predictors were analysed using backwards step-wise selection during longitudinal Generalised Estimating Equation regression modelling. To assess the influence of pain site on these associations, primary pain site diagnosis was added to the model.ResultsOf the patients included, 66% were female and the mean age was 48 (SD 15). 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.ConclusionOnly 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. 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1487-3) contains supplementary material, which is available to authorized users.

Socio-demographic, clinical and psychological predictors of healthcare utilization among patients with musculoskeletal disorders: a prospective cohort study

“…As physiotherapy contacts did not follow a normal distribution and to ease interpretation of the results, the total number of contacts (first consultation, individual treatment session or group exercise) was dichotomized into few (< 6 contacts) or many (≥ 6 contacts). The individual treatment sessions would most often include a combination of exercise therapy, manual therapy, instruction/advice on home exercise and to a limited extend physical modalities [8,34]. The chosen cut off level of 6 contacts were based on the median number of treatments in a previously conducted study in Danish primary care physiotherapy [8].…”

“…The individual treatment sessions would most often include a combination of exercise therapy, manual therapy, instruction/advice on home exercise and to a limited extend physical modalities [8,34]. The chosen cut off level of 6 contacts were based on the median number of treatments in a previously conducted study in Danish primary care physiotherapy [8].…”

“…The physiotherapy treatment should include physical examination, patient education, reassurance about a favourable prognosis, active management strategies and advice on returning to normal activities as well as exercise therapy [6]. Most of the patients treated in primary care physiotherapy will experience significant and clinically relevant improvements in outcomes such as pain intensity and disability within the first few weeks or months [7,8]. However, we have limited knowledge on the level of primary care physiotherapy utilization associated with such improvements.…”

The association of working alliance, outcome expectation, adherence and self‐efficacy with clinical outcomes for Achilles tendinopathy: A feasibility cohort study (the MAP study)

“…Whilst recognising that advancements in imaging techniques may yet contribute to improved outcome by enhancing diagnosis (Khan et al, ), current evidence suggests that clinical outcome for people with musculoskeletal conditions is influenced by similar factors across different musculoskeletal presentations (Mallen, Peat, Thomas, Dunn, & Croft, ). Factors such as pain intensity, association of psychological distress and high functional disability, appear of key influence and the addition of a specific structural diagnosis is not (Chester, Jerosch‐Herold, Lewis, & Shepstone, ; de Vos Andersen, Kent, Hjort, & Christiansen, ). As current strategies appear incomplete, the need to investigate factors beyond the specific effects of exercise on peripheral tissue appears to be one way of potentially optimising outcomes in AT.…”

Optimal Screening for Prediction of Referral and Outcome (OSPRO) for Musculoskeletal Pain Conditions: Results From the Validation Cohort

“…7 The influence of psychological symptoms on clinical outcomes as not being region dependent has been reported from other cohorts too. 11, 12 However, the regression imputed analyses did indicate a potential for differences in tool used based on disability measures that are specific to an anatomical region. For example, our analyses indicate slightly higher 12-month disability scores would be expected for shoulder pain compared to knee pain, given the same baseline OSPRO-YF score.…”