Health professionals’ referral practice and related healthcare utilization for people with low back pain in Singapore: A retrospective study

Abstract

Background: Low back pain is a common musculoskeletal disorder that can incur high financial burden. A significant proportion of this burden may be incurred from referrals to health services and subsequent healthcare usages. Patients’ overall experience of pain and its related life interferences may also have some relevance to this usage. Objective: This study aimed to examine the referral practices and subsequent health service utilization of patients with LBP within a tertiary specialist clinic setting. A secondary objective was to explore potential associations between primary independent variables of pain and life interferences with health service utilization. Methods: Participants were patients with low back pain, who completed a set of self-reported low back pain measures. These included measures for pain intensity, pain interference, disability and quality of life. The participants’ back pain-related referral and health service utilization in the subsequent 12 months were recorded. Results: A total of 282 patients completed the full measures. Of these, 59.9% were referred for physiotherapy, 26.3% for diagnostic imaging and 9.2% for interventional procedures. Compared to patients who were referred from tertiary care, those from primary care had lower pain intensity ([Formula: see text]), pain interference ([Formula: see text]), disability ([Formula: see text]), but better physical and mental quality of life ([Formula: see text], [Formula: see text]). High pain interference was a common factor among patients who were referred on to other services after first consultation. Levels of medical utilization and physiotherapy utilization were both associated with pain intensity ([Formula: see text], [Formula: see text] vs [Formula: see text], [Formula: see text]), pain interference ([Formula: see text], [Formula: see text] vs [Formula: see text], 0.01) and disability ([Formula: see text], [Formula: see text] vs [Formula: see text], [Formula: see text]). Regression analysis showed that the source of referral contributed to 6% of the variance in medical utilization and 3% of the variance in physiotherapy utilization. After controlling the demographic variables and referral sources, none of the independent variables added any significant variance to medical utilization. Only pain intensity contributed an additional 2% variance to physiotherapy utilization. Conclusion: Referral patterns and practices appear similar to those reported in other studies. Higher levels of pain intensity, interference, disability and quality of life appear to influence the referral to different health services and subsequent treatment utilization.

Use of healthcare services and therapeutic measures associated with new episodes of acute low back pain-related disability among elderly people: a cross-sectional study on the Back Complaints in the Elders - Brazil cohort

“…Among the indicators of use of healthcare services, physical therapy consultations offer the potential to explain the incapacity. However, in the present investigation, as corroborated through the investigations of Loy et al 54 and Freburger et al, 55 there was no association between consultations with a physiotherapist and occurrences of low back pain-related disability. It is possible that this result was influenced by the low number of participants who had physical therapy consultation during the preceding six weeks (only 3%), which would demonstrate flaws in the medical referral system within public services and health plan services in Brazil and problems regarding timely access.…”

Factors influencing imaging clinical decision‐making in low back pain management. A scoping review

“…Ten ( n = 1) studies reported clinical features that influence imaging CDM (Barnett et al., 2020; Ely et al., 2018; Ferreira et al., 2019; Graves et al., 2012; Kohns et al., 2018; Loy et al., 2019; Peurois et al., 2022; Piccoliori et al., 2013; Schlemmer et al., 2015; Urrutia et al., 2020) (Table 2).…”

“…Ten (n = 1) studies reported clinical features that influence imaging CDM (Barnett et al, 2020;Ely et al, 2018;Ferreira et al, 2019;Graves et al, 2012;Kohns et al, 2018;Loy et al, 2019;Peurois et al, 2022;Piccoliori et al, 2013;Schlemmer et al, 2015;Urrutia et al, 2020) (Table 2). Clinical features were divided into seven subcategories: red flags (n = 4; 40%), pain (n = 6; 60%), neurological deficit (n = 3; 30%), cognitive and disability metrics (n = 3; 30%), presentation (n = 1; 10%) and injury severity (n = 1; 10%) (Table 2).…”

“…Red flags Red flags (not) present (Ferreira et al, 2019;Kohns et al, 2018;Schlemmer et al, 2015;Urrutia et al, 2020) Pain Characteristics: Severity (Barnett et al, 2020;Ely et al, 2018;Graves et al, 2012), radicular or sciatic pain (Ely et al, 2018;Kohns et al, 2018;Peurois et al, 2022;Piccoliori et al, 2013) location (Ely et al, 2018), progression (Ely et al, 2018), duration (Ely et al, 2018) Neurological deficit Neurological deficit (Ely et al, 2018;Graves et al, 2012;Urrutia et al, 2020), radiculopathy diagnosis (Graves et al, 2012) Cognitive/disability metrics Disability (Graves et al, 2012;Loy et al, 2019), quality-of-life/mental health (Ely et al, 2018;Graves et al, 2012;Loy et al, 2019), maladaptive beliefs (Ely et al, 2018;Graves et al, 2012) Presentation Arrival via ambulance (Ferreira et al, 2019), triage urgency (Ferreira et al, 2019) Injury severity Documented severity rating (Graves et al, 2012) Patient characteristics Age Age (Barnett et al, 2020;Bouck et al, 2019;Ferreira et al, 2019;Friedman et al, 2010;Gidwani et al, 2016;Graves et al, 2012;Hong et al, 2017;Kohns et al, 2018;McCaughey et al, 2016;Schlemmer et al, 2015;…”

Factors associated with utilization of physical therapy services during pregnancy and after childbirth

“…While factors associated with medical healthcare and physical therapy utilization may be similar (e.g. source of referral, pain and disability) [ 23 ], it remains unknown whether disparities exist in terms of factors associated with physical therapy utilization versus overall medical utilization in pregnant and postpartum women due to the lack of direct access to physical therapy in some countries or locations (i.e. Taiwan) [ 24 ] and socio-cultural differences among countries [ 21 ].…”