Characteristics of Older Adults with Back Pain Associated with Choice of First Primary Care Provider: A Cross-sectional Analysis from the BACE-N Cohort Study
SOURCE: BMJ Open 2021 (Sep 17); 11 (9): e053229
Ørjan Nesse Vigdal, Kjersti Storheim, Rikke Munk Killingmo, Milada Cvancarova Småstuen, and Margreth Grotle
Department of Physiotherapy,
Oslo Metropolitan University,
Objectives: To describe characteristics of older adults with back pain in primary care, and to assess associations between patient characteristics and type of first primary care provider (general practitioner (GP), physiotherapist (PT) or chiropractor).
Design: Cross-sectional analysis from the Back Complaints in the Elders-Norway cohort study.
Setting: Norwegian GP, PT and chiropractic primary care centres.
Participants: Patients aged ≥55 years seeking Norwegian primary care with a new episode of back pain were invited to participate. Between April 2015 and February 2020, we included 452 patients: 127 first visited a GP, 130 first visited a PT and 195 first visited a chiropractor.
Primary and secondary outcome measures: For the first objective, the outcome measure was descriptive statistics of patient characteristics, covering the following domains: sociodemographic, general health, current and previous back pain, psychological and clinical factors. For the second objective, first primary care provider was the outcome measure. Associations between patient characteristics and visiting a GP or PT compared with a chiropractor were assessed with multiple multinomial regression analyses.
Results: Median (IQR) age was 66 (59-72) years. Levels of back-related disability was moderate to severe, with a median (IQR) Roland-Morris Disability Questionnaire (range 0-24) score of 9 (5-13). Recurring episodes were common, 301 (67%) patients had monthly or yearly recurrences. Patients with worse back-related disability, longer duration of symptoms, lower expectations for full recovery and worse physical performance measured with the Back Performance Scale had higher odds of visiting a GP or PT compared with a chiropractor (p<0.05).
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Conclusion: Older back pain patients in primary care had moderate to severe levels of back-related disability, and most had recurring episodes. Our results suggest that older adult’s choice of first primary care provider was associated with important patient characteristics, which highlights the need for caution with generalisations of study results across primary care populations.
Trial registration number: ClinicalTrials.gov NCT04261309
Keywords: back pain; geriatric medicine; primary care; rehabilitation medicine.