Health-Related Quality of Life of Patients Presenting to the Emergency Department with a Musculoskeletal Disorder

Abstract

Background Musculoskeletal disorders (MSKDs) are among the most disabling and costly non-fatal health conditions. They may lead to long-term consequences such as chronic pain, physical limitations, and poorer quality of life. They also account for a significant proportion of emergency department visits, representing between 18% and 25% of all visits, depending on country. Purpose To assess the health-related quality of life of patients presenting to the emergency department with a MSKD, to convert their answers to utility scores and to explore the association between diverse socio-demographic and clinical variables and patients’ health-related quality of life. Patients and Methods This is an analysis of cross-sectional data obtained during the baseline assessment performed as part of a 6-month pragmatic randomized controlled trial conducted in an academic emergency department. We included patients aged 18–80 years with a minor MSKD. The main outcome measures were health-related quality of life (five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and utility scores (−0.148 – worse than death, 0 – dead, 0.949 – perfect health) measured with the EQ-5D-5L. Possible associations were explored by comparing scores across subgroups based on certain socio-demographic (eg, age, gender, triage score) and clinical factors (eg, pain interference on function, pain intensity) and with reference values using descriptive statistics (mean, median), rankFD ANOVAs, and χ 2 tests. Results Sixty-nine participants completed the EQ-5D-5L. Mean and median utility scores were, respectively, 0.536 (95% CI: 0.479–0.594) and 0.531 (IQR: 0.356–0.760). Participants with higher levels of pain (<4/10: 0.741, 95% CI: 0.501–0.980; 4–7/10: 0.572, 0.500–0.644; >7/10: 0.433, 0.347–0.518) or pain interference on function (<4/10: 0.685, 95% CI: 0.605–0.764; 4–7/10: 0.463, 0.394–0.533; >7/10: 0.294, 0.126–0.463) presented significantly lower utility scores. No significant differences were found for other socio-demographic characteristics. Conclusion In patients with MSKDs who present to the emergency department, higher levels of pain or pain interference are associated with decreased health-related quality of life. These findings need to be confirmed on a larger scale.

Integration of primary contact physiotherapists in the emergency department for individuals presenting with minor musculoskeletal disorders: Protocol for an economic evaluation

“…The only source of variability considered for the purpose of these analyses will be that related to the time required for ED processes. Utility scores were obtained at the initial visit [ 48 ] and at 1 and 3 months using the EQ-5D-5L, a generic standardized questionnaire designed to measure health status in an economic and clinical evaluation [ 49 ]. The EQ-5D-5L has been found to be reliable, valid, and sensitive to change [ 50 , 51 ].…”

Integration of primary contact physiotherapists in the emergency department for individuals presenting with minor musculoskeletal disorders: Protocol for an economic evaluation

“…Costs associated with each of the resources used will be drawn from data from the Régie de l'assurance-maladie du Québec (RAMQ) (fees of the emergency physician and other physicians consulted, drugs, imaging tests) and from a search of the grey literature (costs of the fees of the primary contact physiotherapist and other health professionals consulted, and of technical aids). [46] Mean utility scores were obtained at the initial visit [47] and at 1 and 3 months using the EQ-5D-5L, a generic standardized questionnaire designed to measure health status in an economic and clinical evaluation. [48] The EQ-5D-5L has been found to be reliable, valid, and sensitive to change.…”