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O'Leary S, Raymer M, Window P, Swete Kelly P, Lee D, Garsden L, Tweedy R, Phillips B, O'Sullivan W, Wake A, Smith A, Pahor S, Pearce L, McLean R, Thompson D, Williams E, Nolan D, Anning J, Seels I, Wickins D, Marks D, Diplock B, Parravicini V, Parnwell L, Vicenzino B, Comans T, Cottrell M, Khan A, McPhail S. A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service. BMC Musculoskelet Disord 2020; 21:807. [PMID: 33272228 PMCID: PMC7713165 DOI: 10.1186/s12891-020-03839-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service. METHODS Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure. RESULTS Overall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17-6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01-1.77) per 10/100 point score increase, p = 0.046). CONCLUSIONS A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.
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Affiliation(s)
- Shaun O'Leary
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia. .,Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Maree Raymer
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Peter Window
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Patrick Swete Kelly
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Darryl Lee
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Linda Garsden
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Rebecca Tweedy
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Ben Phillips
- Physiotherapy Department, Townsville Hospital, Townsville, Australia
| | - Will O'Sullivan
- Physiotherapy Department, Townsville Hospital, Townsville, Australia
| | - Anneke Wake
- Physiotherapy Department, Townsville Hospital, Townsville, Australia
| | - Alison Smith
- Physiotherapy Department, Cairns Hospital, Cairns, Australia
| | - Sheryl Pahor
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Luen Pearce
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Rod McLean
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - David Thompson
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Erica Williams
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Damien Nolan
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Jody Anning
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Ian Seels
- Physiotherapy Department, Nambour Hospital, Nambour, Australia
| | - Daniel Wickins
- Physiotherapy Department, Redcliffe Hospital, Redcliffe, Australia
| | - Darryn Marks
- Physiotherapy Department, Gold Coast Hospital, Gold Coast, Australia.,Physiotherapy, Faculty of Health Sciences & Medicine, Bond Institute of Health and Sport, Bond University, Robina, Australia
| | | | | | - Linda Parnwell
- Physiotherapy Department, Logan Hospital, Logan, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Tracy Comans
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Michelle Cottrell
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Asaduzzaman Khan
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Steven McPhail
- Clinical Informatics Directorate, Metro South Hospital and Health Service, Brisbane, Australia.,Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia
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O'Leary S, Raymer M, Window P, Swete Kelly P, Elwell B, McLoughlin I, O'Sullivan W, Phillips B, Wake A, Ralph A, O'Gorman H, Jang E, Groves K, Hislop A, Lee D, Garsden L, Conroy M, Wickins D, Vicenzino B, Comans T, Cottrell M, Khan A, McPhail S. Patient characteristics associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis: a multisite prospective longitudinal study in an advanced practice physiotherapist-led tertiary service. BMJ Open 2020; 10:e037070. [PMID: 33028549 PMCID: PMC7539614 DOI: 10.1136/bmjopen-2020-037070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To explore patient characteristics recorded at the initial consultation associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis (KOA) in tertiary care. DESIGN Prospective multisite longitudinal study. SETTING Advanced practice physiotherapist-led multidisciplinary orthopaedic service within eight tertiary hospitals. PARTICIPANTS 238 patients with KOA. PRIMARY AND SECONDARY OUTCOME MEASURES Standardised measures were recorded in all patients prior to them receiving non-surgical multidisciplinary management in a tertiary hospital service across multiple sites. These measures were examined for their relationship with a poor response to management 6 months after the initial consultation using a 15-point Global Rating of Change measure (poor response (scores -7 to +1)/positive response (scores+2 to+7)). Generalised linear models with binomial family and logit link were used to examine which patient characteristics yielded the strongest relationship with a poor response to management as estimated by the OR (95% CI). RESULTS Overall, 114 out of 238 (47.9%) participants recorded a poor response. The odds of a poor response decreased with higher patient expectations of benefit (OR 0.74 (0.63 to 0.87) per 1/10 point score increase) and higher self-reported knee function (OR 0.67 (0.51 to 0.89) per 10/100 point score increase) (p<0.01). The odds of a poor response increased with a greater degree of varus frontal knee alignment (OR 1.35 (1.03 to 1.78) per 5° increase in varus angle) and a severe (compared with mild) radiological rating of medial compartment degenerative change (OR 3.11 (1.04 to 9.3)) (p<0.05). CONCLUSIONS These characteristics may need to be considered in patients presenting for non-surgical multidisciplinary management of KOA in tertiary care. Measurement of these patient characteristics may potentially better inform patient-centred management and flag the need for judicious monitoring of outcome for some patients to avoid unproductive care.
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Affiliation(s)
- Shaun O'Leary
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Maree Raymer
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Peter Window
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Patrick Swete Kelly
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Bula Elwell
- Physiotherapy Department, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Ian McLoughlin
- Physiotherapy Department, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Will O'Sullivan
- Physiotherapy Department, Townsville Hospital, Townsville, Queensland, Australia
| | - Ben Phillips
- Physiotherapy Department, Townsville Hospital, Townsville, Queensland, Australia
| | - Anneke Wake
- Physiotherapy Department, Townsville Hospital, Townsville, Queensland, Australia
| | - Andrew Ralph
- Physiotherapy Department, Mackay Hospital, Mackay, Queensland, Australia
| | - Helen O'Gorman
- Physiotherapy Department, Mater Hospital, Brisbane, Queensland, Australia
| | - Ellen Jang
- Physiotherapy Department, Mater Hospital, Brisbane, Queensland, Australia
| | - Karen Groves
- Physiotherapy Department, Mater Hospital, Brisbane, Queensland, Australia
| | - Andrew Hislop
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Darryl Lee
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Linda Garsden
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Michael Conroy
- Physiotherapy Department, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Daniel Wickins
- Physiotherapy Department, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Tracy Comans
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Michelle Cottrell
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Asaduzzaman Khan
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Steven McPhail
- Clinical Informatics Directorate, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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