Trajectories of Musculoskeletal Healthcare Utilization of People with Chronic Musculoskeletal Pain - A Population-Based Cohort Study

Søren Mose; Peter Kent; Anne Smith; Johan Hviid Andersen; David Høyrup Christiansen

doi:10.2147/CLEP.S323903

Trajectories of Musculoskeletal Healthcare Utilization of People with Chronic Musculoskeletal Pain - A Population-Based Cohort Study

Clin Epidemiol. 2021 Sep 17:13:825-843. doi: 10.2147/CLEP.S323903. eCollection 2021.

Authors

Søren Mose^{1

2}, Peter Kent^{3

4}, Anne Smith³, Johan Hviid Andersen¹, David Høyrup Christiansen¹

Affiliations

¹ Department of Occupational Medicine, Danish Ramazzini Centre - University Research Clinic, Herning, Denmark.
² School of Physiotherapy, VIA University College, Holstebro, Denmark.
³ Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
⁴ Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.

Abstract

Background and aim: Chronic musculoskeletal pain is common and associated with more general healthcare-seeking. However, musculoskeletal-related healthcare utilization is under-explored. This study aimed to explore, describe and profile trajectories of long-term musculoskeletal healthcare for people reporting chronic musculoskeletal pain.

Methods: This exploratory prognostic cohort study combined survey and national health register data from a representative group of adult Danes reporting chronic musculoskeletal pain (N = 2929). Trajectories of long-term musculoskeletal healthcare use were generated using latent class growth analysis. Types of healthcare-seeking, individual, sociodemographic, health, belief and work-related factors were used to describe and profile identified trajectories.

Results: We identified five distinct trajectories of long-term musculoskeletal healthcare utilization (low stable, low ascending, low descending, medium stable and high stable). The low stable trajectory group (no or almost no annual contacts) represented 39% of the sample, whereas the high stable trajectory group (consistent high number of annual contacts) represented 8%. Most healthcare-seeking was in primary healthcare settings (GP/physiotherapy/chiropractor). Opioid consumption was primarily in the high stable trajectory group, and surgery was rare. There were statistically significant differences across the five trajectory groups in individual, sociodemographic, health, belief and work-related profiles.

Conclusion: Long-term use of musculoskeletal healthcare services varied in this chronic musculoskeletal pain population. Almost 40% coped without seeking care, whereas 8% had consistent high use of healthcare services. Chronic musculoskeletal pain was mostly managed in primary care settings, which aligns with musculoskeletal guidelines, as did the use of pain medication and surgery. People with different musculoskeletal healthcare trajectories had different individual, sociodemographic, health, belief and work-related profiles.

Keywords: chronic musculoskeletal pain; healthcare registers; healthcare utilization; latent class growth analysis; musculoskeletal.

Grants and funding

This study is a part of a PhD project financially supported by VIA University College, Health Research Foundation of Central Denmark Region, the Danish Rheumatism Association, NIDO |Denmark and the Health Foundation. None of the authors received any specific grants for this publication.