Neck and back pain: Differences between patients treated in primary and specialist health care.

Abstract

ObjectiveTo describe and compare patients with neck or back pain treated by physiotherapists in primary healthcare (PHC) and in departments for physical medicine and rehabilitation in specialist healthcare (SHC) in Norway.DesignCross-sectional study using data from the FYSIOPRIM (FP) database in PHC and the Norwegian Neck and Back Registry (NPR) in SHC. Neck and back pain patients in the period 2014–18 aged ≥ 18 years were included. Demographics, lifestyle and clinical factors were investigated.ResultsA total of 8,125 patients were included: 584 in PHC and 7,541 in SHC. Mean age was 47.1 and 45.5 years, respectively, with more females in PHC (72% vs 56%). Low levels of education and physical activity, high workload and receiving social benefits were associated with treatment in SHC. Treatment in SHC was most common among patients with pain duration 3 to 12 months. Higher pain intensity and lower health-related quality of life were found in patients treated in SHC, no differences were found for psychological distress.ConclusionThis is the first study comparing register data in patients with neck or back pain treated in PHC and SHC. Differences were found in pain and health-related quality of life, but levels of psychological distress were similar between patients treated in PHC and those treated in SHC.LAY ABSTRACTPatients with neck or back pain have high levels of healthcare utilization, both in primary and specialist healthcare. The aim of this study was to investigate patients referred and treated by physiotherapists in primary healthcare and by specialists in specialist healthcare in Norway, to evaluate differences in the demographics, lifestyle and clinical factors of patients treated in each healthcare setting. Included patients had been diagnosed with neck or back pain from 2014 to 2018, and were aged ≥18 years. Patients in specialist care had more pain and lower health-related quality of life, but similar levels of psychological distress to those treated in primary healthcare. Furthermore, patients treated in specialist healthcare had lower socioeconomic status (education, workload, social benefits) compared with those treated in primary healthcare.