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Research article
Cecilie Budtz
Regional Hospital West Jutland
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0834-6594
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This work is licensed under a CC BY 4.0 License. Read Full License
Background: Musculoskeletal conditions are the single largest contributor to years lived with disability worldwide. Most musculoskeletal conditions can be managed and treated in primary care, but for a small proportion of these patients the symptoms are caused by serious pathology. Although the general practitioner usually performs initial screening for serious pathology, evaluation and treatment by physiotherapists are often part of the treatment pathway. It is however unclear, how many patients in primary care physiotherapy have symptoms caused by a serious pathology. Historically the prevalence of serious pathology in primary care has been investigated in small populations with spine specific conditions, thus a more general prevalence in the group of patients with musculoskeletal conditions is yet to be estimated. Therefore, the aim of this study was to estimate the prevalence of neoplasm, cauda equina syndrome, spinal fracture, infection and inflammatory pathology among patients referred for musculoskeletal physiotherapy evaluation and treatment.
Methods: The study was a prospective nationwide register-based cohort study. We identified all referrals for primary care musculoskeletal physiotherapy in the Danish National Health Insurance Service Register between 1 January 2014 and 31 December 2017. Records of hospital contacts were extracted from the Danish National Patient Register within 180 days from first physiotherapy contact, identifying all diagnoses of serious pathology. Period prevalence proportions with 95%CI of the serious pathology categories were estimated.
Results: A total of 1,568,704 courses of treatment were included in the analysis. The overall prevalence of serious pathology was 2.30%.The prevalence of neoplasm was 2.11%, of which 1.13% was malignant neoplasms. The prevalence of cauda equina syndrome was 0.01%, fractures 0.13%, infections 0.01% and inflammatory pathology of the spine 0.06%. Higher prevalence's were observed among patients with a previous history of serious pathology, aged above 50 and more comorbidity.
Conclusions: Although serious pathology among musculoskeletal physiotherapy patients is rare, the present study found an overall prevalence of serious pathology which exceeded the guideline endorsed prevalence estimates of serious pathology of 1%.
Keywords
Serious pathology, prevalence, primary care, physiotherapy, musculoskeletal conditions
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A new preprint design is coming!
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research article
Cecilie Budtz
Regional Hospital West Jutland
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0834-6594
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
View the published article at Physiotherapy.
Version 1
Posted 21 Jan, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Physiotherapy.
Background: Musculoskeletal conditions are the single largest contributor to years lived with disability worldwide. Most musculoskeletal conditions can be managed and treated in primary care, but for a small proportion of these patients the symptoms are caused by serious pathology. Although the general practitioner usually performs initial screening for serious pathology, evaluation and treatment by physiotherapists are often part of the treatment pathway. It is however unclear, how many patients in primary care physiotherapy have symptoms caused by a serious pathology. Historically the prevalence of serious pathology in primary care has been investigated in small populations with spine specific conditions, thus a more general prevalence in the group of patients with musculoskeletal conditions is yet to be estimated. Therefore, the aim of this study was to estimate the prevalence of neoplasm, cauda equina syndrome, spinal fracture, infection and inflammatory pathology among patients referred for musculoskeletal physiotherapy evaluation and treatment.
Methods: The study was a prospective nationwide register-based cohort study. We identified all referrals for primary care musculoskeletal physiotherapy in the Danish National Health Insurance Service Register between 1 January 2014 and 31 December 2017. Records of hospital contacts were extracted from the Danish National Patient Register within 180 days from first physiotherapy contact, identifying all diagnoses of serious pathology. Period prevalence proportions with 95%CI of the serious pathology categories were estimated.
Results: A total of 1,568,704 courses of treatment were included in the analysis. The overall prevalence of serious pathology was 2.30%.The prevalence of neoplasm was 2.11%, of which 1.13% was malignant neoplasms. The prevalence of cauda equina syndrome was 0.01%, fractures 0.13%, infections 0.01% and inflammatory pathology of the spine 0.06%. Higher prevalence's were observed among patients with a previous history of serious pathology, aged above 50 and more comorbidity.
Conclusions: Although serious pathology among musculoskeletal physiotherapy patients is rare, the present study found an overall prevalence of serious pathology which exceeded the guideline endorsed prevalence estimates of serious pathology of 1%.
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