The Effect of a Multidisciplinary Spine Clinic on Time to Care in Patients with Chronic Back and/or Leg Pain: A Propensity Score-Matched Analysis

Abstract

Chronic back and leg pain are leading causes of disability worldwide. The purpose of this study was to compare the care in a unidisciplinary (USC) versus multidisciplinary (MSC) spine clinic, where patients are evaluated by different specialists during the same office visit. Adult patients presenting with a chief complaint of back and/or leg pain between June 2018 and July 2019 were assessed for eligibility. The main outcome measures included the first treatment recommendations, the time to treatment order, and the time to treatment occurrence. A 1:1 propensity score-matched analysis was performed on 874 patients (437 in each group). For all patients, the most common recommendation was physical therapy (41.4%), followed by injection (14.6%), and surgery (9.7%). Patients seen in the MSC were more likely to be recommended injection (p < 0.001) and less likely to be recommended surgery as first treatment (p = 0.001). They also had significantly shorter times to the injection order (log-rank test, p = 0.004) and the injection occurrence (log-rank test, p < 0.001). In this study, more efficient care for patients with back and/or leg pain was delivered in the MSC setting, which was evidenced by the shorter times to the injection order and occurrence. The impact of the MSC approach on patient satisfaction and health-related quality-of-life outcome measures warrants further investigation.

Can We Make Spine Surgery Safer and Better?

“…Multiple studies have shown the benefits of multidisciplinary case conferences, tumor boards, and shared-decision making in the management of these conditions [ 9 , 10 ]. Naidu et al recently showed that a multidisciplinary spine clinic significantly reduced the utilization of surgery as a first treatment option and provided quicker times to injections for patients afflicted with chronic back and/or leg pain [ 11 ]. A systematic review of ten studies examining multidisciplinary approaches in spinal deformity found that these strategies significantly reduced operative time and complication occurrence [ 9 ].…”