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Association between health care utilization and musculoskeletal pain. A 21-year follow-up of a population cohort
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi. (Fysioterapi)ORCID-id: 0000-0001-9806-6793
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi.ORCID-id: 0000-0002-7999-6087
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Livsstil och rehabilitering vid långvarig sjukdom.
Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, Göteborgs universitet; Spenshult Research and Development Centre, Halmstad, Sweden.
(Engelska)Ingår i: Artikel i tidskrift (Refereegranskat) Submitted
Abstract [en]

Background: Few studies have reported the long-term impact of pain on health care utilization. The aim of this study was to describe and predict health care utilization associated with chronic pain in a 21-year follow-up of a population cohort and to identify and describe different trajectories over time.                                                                              Methods: A prospective cohort design was used that included five measurement time points. A representative sample of 3928 subjects (age 20-74) from the south of Sweden was selected. Data were collected by self-reported questionnaires, and the response rate was n=2425 (62%). Three time points of 1995, 2007 and 2016 were included in the study. The associations between baseline variables and health care utilization in 2016 were calculated based on logistic regression analysis. Different trajectories for health care utilization were compared and described.                                                             Results: The response rate in 2016 was n=1184 (63%) of the eligible participants. Predictors for high health care utilization at the 21-year follow-up was chronic widespread pain (OR: 3.2, CI: 1.9-5.1), chronic regional pain (OR:1.8, CI: 1.2-2.6), female gender and high age. Trajectory for high health care utilization over the entire period was characterized by high prevalence of chronic pain at baseline and female gender.                                                                                                                     Conclusions: Chronic pain, which may reflect poorer general health, had implications in health care utilization over a 21-year period. A stable high health care utilization trajectory was identified among a small group of the general population characterized by chronic widespread pain and female gender, indicating that treatment of this group has not been successful.

Nyckelord [en]
Musculoskeletal pain, health care utilization, chronic pain, pain prevalence
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Medicinsk vetenskap
Identifikatorer
URN: urn:nbn:se:uu:diva-328402OAI: oai:DiVA.org:uu-328402DiVA, id: diva2:1135324
Tillgänglig från: 2017-08-22 Skapad: 2017-08-22 Senast uppdaterad: 2017-08-23
Ingår i avhandling
1. Long-term perspectives on musculoskeletal pain: Health care utilization and integration of behavioral medicine treatment into physical therapy
Öppna denna publikation i ny flik eller fönster >>Long-term perspectives on musculoskeletal pain: Health care utilization and integration of behavioral medicine treatment into physical therapy
2017 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

There are currently no effective methods for treating and preventing chronic pain. The aim of this thesis was to study prognostic factors for health care utilization, and the long-term outcomes of tailored behavioral medicine treatment for patients with musculoskeletal pain. Another aim was to increase knowledge about physical therapists’ assessment and analysis of patients’ pain conditions and to investigate the potential of subgrouping patients based on prognostic factors.

Methods: In Study I, a prospective population-based cohort was followed over 21 years. Data from three measure points were analyzed: 1995 (n=2425), 2007 (n=1582) and 2016 (n=1184). Study II was a 10-year follow-up of randomized controlled trial (n=97), comparing tailored behavioral medicine treatment and exercise-based physical therapy. In Study III, a descriptive and explorative design was applied, using data from video-recordings of 12 physical therapists. In study IV, assignment to three subgroups based on the Örebro Musculoskeletal Pain Screening Questionnaire was validated against reference instruments, and the stability between two points of measurement was investigated in patients (n=40) who were seeking primary health care due to musculoskeletal pain.

Results: Chronic pain, female gender and high age predict high health care utilization over 21 years, and a trajectory of stable high health care utilization over the entire period. The differences between groups in favor for tailored behavioral medicine treatment reported at post-treatment and after two years, were not maintained at the 10-year follow-up. A majority of the physical therapists assessed factors for poor prognosis. The analyses were mainly based on biomedical assessments and none of the physical therapists included behavioral factors. Subgroup assignment according to the Örebro Musculoskeletal Pain Screening Questionnaire appears to be valid and stable over time.

Conclusion: Prognostic factors such as chronic pain and female gender need to be considered when allocating health care resources and planning treatment to improve long-term outcomes. The treatment should also be tailored based on individual functional behavioral analyses of key behaviors and on patient´s biomedical and psychosocial condition, including strategies for maintenance of behavioral changes. Evidence-based methods for integrating behavioral medicine treatment into physical therapy need to be further evaluated and improved. 

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2017. s. 83
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1360
Nyckelord
Chronic pain, health care utilization, behavioral medicine, stratified treatment, prognostic factors, physical therapy, primary care
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Medicinsk vetenskap
Identifikatorer
urn:nbn:se:uu:diva-328363 (URN)978-91-513-0044-3 (ISBN)
Disputation
2017-10-13, A7:107a, Biomedicinsk centrum, Husargatan 3, Uppsala, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2017-09-21 Skapad: 2017-08-22 Senast uppdaterad: 2017-10-17

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