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

Abstract

ObjectivesTo 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).DesignCross-sectional analysis from the Back Complaints in the Elders-Norway cohort study.SettingNorwegian GP, PT and chiropractic primary care centres.ParticipantsPatients 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 measuresFor 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.ResultsMedian (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).ConclusionOlder 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 numberNCT04261309.

Modifiable prognostic factors of high costs related to healthcare utilization among older people seeking primary care due to back pain: an identification and replication study

“…Thus, the risk of selection bias is present. To compensate for this limitation and assess representativeness of the BACE-N sample, key sociodemographic variables have been compared with a large population study on older people; The Norwegian study on life course, ageing and generation (NORLAG) [ 64 , 65 ]. A subsample of the NORLAG (NORLAG MSK) was used, which is expected to be a representative sample of people aged ≥55 years with musculoskeletal complaints.…”

“…A subsample of the NORLAG (NORLAG MSK) was used, which is expected to be a representative sample of people aged ≥55 years with musculoskeletal complaints. Characteristics of the two samples were largely comparable, though BACE-N had more men, and more with higher education level [ 65 ]. Previous studies have shown that women [ 14 , 28 , 29 ] are more likely to seek care for their back pain as are people with lower education level [ 28 , 32 , 41 ].…”

The one-year clinical course of back-related disability and the prognostic value of comorbidity among older adults with back pain in primary care

“…This was because it was unlikely that the 3 provider groups were mutually exclusive during the follow-up year, and potential differences could falsely be interpreted as “the effect” of seeing a certain primary care provider, when these potential differences could be explained by the heterogeneity in case-mix seen by the different primary care providers. 68 Consequently, there was no need to assess the clinical course with a linear mixed model, so we used descriptive statistics only. Third, we did not add first primary care provider as a covariate for the adjusted analyses of comorbidity because it did not fit our prerequisite of being a known prognostic factor.…”

“…We have previously reported that the BACE-N sample may be overrepresented by men and those with higher education. 68 A third limitation is the use of self-report in measuring comorbidity. Even though SCQ uses simple language that requires no medical knowledge, this may lead to misclassification of comorbidities.…”

Healthcare utilization and related costs among older people seeking primary care due to back pain: findings from the BACE-N cohort study

“…Due to limited resources and practical reasons related to recruitment from a broad network of clinicians, it was not possible to record information on all eligible participants during the data collection period. To compensate for this limitation and assess the representativeness of the BACE-N sample, it has previously been compared on key sociodemographic variables with a subsample from a longitudinal population study: ‘The Norwegian study on life course, ageing and generation (NORLAG)’ 80 81. The subsample (NORLAG MSK) is expected to be a representative sample of people aged ≥55 years with musculoskeletal complaints.…”