Abstract
BackgroundThere are large variations in symptoms and prognostic factors among patients sharing the same musculoskeletal (MSK) diagnosis, making traditional diagnostic labelling not very helpful in informing treatment or prognosis. Recently, we identified five MSK phenotypes across common MSK pain locations through latent class analysis (LCA). The aim of this study was to explore the one-year recovery trajectories for pain and functional limitations in the phenotypes and describe these in relation to the course of traditional diagnostic MSK groups.MethodsWe conducted a longitudinal observational study of 147 patients with neck, back, shoulder or complex pain in primary health care physiotherapy. Data on pain intensity and function were collected at baseline (week 0) and 1, 2, 3, 4, 6, 8, 12, 26 and 52 weeks of follow up using web-based questionnaires and mobile text messages. Recovery trajectories were described separately for the traditional diagnostic MSK groups based on pain location and the same patients categorized in phenotype groups based on prognostic factors shared among the MSK diagnostic groups.ResultsThere was a general improvement in function throughout the year of follow-up for the MSK groups, while there was a more modest decrease for pain intensity. The MSK diagnoses were dispersed across all five phenotypes, where the phenotypes showed clearly different trajectories for recovery and course of symptoms over 12 months follow-up. This variation was not captured by the single trajectory for site specific MSK diagnoses.ConclusionPrognostic subgrouping revealed more diverse patterns in pain and function recovery over 1 year than observed in the same patients classified by traditional diagnostic groups and may better reflect the diversity in recovery of common MSK disorders.
Highlights
There are large variations in symptoms and prognostic factors among patients sharing the same musculoskeletal (MSK) diagnosis, making traditional diagnostic labelling not very helpful in informing treatment or prognosis
Traditional MSK diagnostic labelling by pain location does not reflect the heterogeneity and multiplicity of symptoms often seen in these patients, and provide limited guidance in differentiating patients and inform clinical management, within the same diagnostic group
Secondary analyses of individual patient data from seven randomized controlled trials investigating a range of interventions across different regional MSK pain complaints showed similar patterns of improvement in pain and function regardless of pain location, whereas the magnitude of improvement varied by pain location [9]
Summary
There are large variations in symptoms and prognostic factors among patients sharing the same musculoskeletal (MSK) diagnosis, making traditional diagnostic labelling not very helpful in informing treatment or prognosis. Secondary analyses of individual patient data from seven randomized controlled trials investigating a range of interventions across different regional MSK pain complaints showed similar patterns of improvement in pain and function regardless of pain location, whereas the magnitude of improvement varied by pain location [9] This variation was explained by prognostic factors, such as age, type of work (manual vs non-manual), pain duration, mood (anxiety and depression), and widespread pain [9]. Labelling patients and targeting treatment on prognostic factors rather than the location of pain, i.e., back pain, is supported by a study of Hill et al [10], where treatment targeting prognostic factors proved superior to usual care in improving primary care efficiency [10] On this background, leading researchers have argued to focus on prognostic factors rather than diagnostic accuracy to improve clinical practice and patient outcome [8, 11]. We are not aware of any studies of MSK pain patients that have compared prognostic trajectories with patients grouped by their prognostic capacity at baseline as opposed to their current pain location (MSK diagnosis)
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