Prediction of healthcare utilization following an episode of physical therapy for musculoskeletal pain

Abstract

BackgroundIn the United States, value-based purchasing has created the need for healthcare systems to prospectively identify patients at risk for high healthcare utilization beyond a physical therapy episode for musculoskeletal pain. The purpose of this study was to determine predictors of pain-related healthcare utilization subsequent to an index episode of physical therapy for musculoskeletal pain.MethodsThis study assessed data from the Optimal Screening for Prediction of Referral and Outcome (OSPRO) longitudinal cohort study that recruited individuals with a primary complaint of neck, low back, knee or shoulder pain in physical therapy (n = 440). Demographics, health-related information, review of systems, comorbidity and pain-related psychological distress measures were collected at baseline evaluation. Baseline to 4-week changes in pain intensity, disability, and pain-related psychological distress were measured as treatment response variables. At 6-months and 1-year after baseline evaluation, individuals reported use of opioids, injection, surgery, diagnostic tests or imaging, and emergency room visits for their pain condition over the follow-up period. Separate prediction models were developed for any subsequent care and service-specific utilization.ResultsSubsequent pain-related healthcare utilization was reported by 43% (n = 106) of the study sample that completed the 12-month follow-up (n = 246). Baseline disability and 4-week change in pain intensity were important global predictors of subsequent healthcare utilization. Age, insurance status, comorbidity burden, baseline pain, and 4-week changes in pain intensity, disability and pain-related psychological distress predicted specific service utilization.ConclusionIn those completing follow up measures, risk of additional pain-related healthcare utilization after physical therapy was best predicted by baseline characteristics and 4-week treatment response variables for pain intensity, disability and pain-related psychological distress. These findings suggest treatment monitoring of specific response variables could enhance identification of those at risk for future healthcare utilization in addition to baseline assessment. Further study is required to determine how specific characteristics of the clinical encounter influence future utilization.

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

“…Based on previously conducted studies [10,11], potential predictors of healthcare utilization from the following four health domains were included:…”

“…To investigate if the potential predictors contributed independently to the prediction of healthcare utilization, analyses were adjusted for the following known non-modifiable prognostic factors [11]: 1) Age, 2) gender, 3) duration of pain (based on baseline questionnaire), which was dichotomized into under/ over 3 months and 4) comorbidity (patients were asked at the first consultation if they had other health problems), which was dichotomized into comorbidity or no comorbidity.…”

“…Thus, identifying predictors of healthcare utilization in both primary and secondary care could help allocate limited healthcare resources towards patients who are most in need. In the general population musculoskeletal pain and disability, as well as psychological factors, have shown to be predictive of both primary and secondary healthcare utilization [9][10][11][12][13][14][15]. Nevertheless, predictors of healthcare utilization among musculoskeletal physiotherapy patients are less well studied as research in this field mainly have focused on clinical outcomes such as pain or disability [16,17].…”

“…Nevertheless, predictors of healthcare utilization among musculoskeletal physiotherapy patients are less well studied as research in this field mainly have focused on clinical outcomes such as pain or disability [16,17]. A newly published study however concluded that baseline and 4-week changes in pain intensity, disability and pain-related psychological distress predicted self reported use of painkillers, injections, surgery, diagnostic testing and emergency room visits among physiotherapy patients [11]. The challenge with self reported survey data is that the results can be biased due to recall or loss to follow up [18].…”

An international study of analgesic dependence among people with pain in the general population

“…This composite is an alternative to using the single rating of pain 'at its worst' as the measure of pain intensity (Cleeland & Ryan, 1994). The composite score might understate pain intensity compared with the single rating of pain 'at its worst', but it has better reliability and validity (Jensen et al, 1993;, and has been used in many other recent studies of chronic pain (eg., Lentz et al, 2018;Wilson et al, 2019).…”