Do patients assigned to multidisciplinary examination differ from patients assigned to monodisciplinary examination at the University Hospital of Northern Norway? - The Norwegian neck and back registry 2018

Abstract

Background: Back pain is a very common disability. 60-80% of the population in Norway will experience LBP during their life. 30-50% of all people report neck pain during a year. Most back pain has no pathoanatomical diagnosis and is considered a multifactorial condition where biopsychosocial factors influence pain. “Yellow flags” are used in guidelines referring to psychosocial risk-factors for chronic pain. The guideline recommends referral to a multidisciplinary rehabilitation program like a “specialized clinic in physical medicine and rehabilitation” if pain persist after 6-8 weeks. The guidelines also define a multidisciplinary team of at least two health professionals. No studies have previously investigated the patients assigned to multidisciplinary versus monodisciplinary examinations at a specialized clinic in Norway. Aims: Investigate if the patients assigned to multidisciplinary examination differ from patients assigned to monodisciplinary examination regarding patient characteristics, yellow flags, pain indicators, function level and treatment recommendations. Material and methods: Data from the Norwegian Neck and Back Registry (NNRR) were used. All patients who were examined at the University Hospital of Northern Norway (UNN) in 2018 and completed the first patient questionnaire of the NNRR were included. Final sample of 655 patients. Differences in patient characteristics were described. Binary logistic regression was used to calculate multivariable adjusted odds ratios (OR) with 95% confidence intervals (95% CI) of associations between exposure variables and being assigned to mono- or multidisciplinary examinations. Results: Patients assigned to multidisciplinary examinations were on average 5.6 years younger. Among the yellow flags describing mental health problems there were increased odds for the multidisciplinary group to report both depression (OR=2.04, 95% CI=1.09-3.80), anxiety (2.06, 95% CI=1.03-4.12) and a HSCL-10 score >1.85 indicating mental health problems (OR=1.64, 95% CI=0.96-2.77) compared to patients assigned to monodisciplinary examinations. There were also increased odds (OR=2.53, 95% CI=1.25-5.10) that the patient believed his/her pain was caused by mental problems. Among yellow flags describing comorbidities there were increased odds of stomach discomfort (OR=2.16, 95% CI=1.10-4.24), upper back pain (OR=1.74 95% CI=1.04-2.90) and shoulder pain (OR=1.85 95% CI=1.12-3.06) in the multidisciplinary group compared to the monodisciplinary group. There were increased odds (OR=2.36, 95% CI=1.20-4.64) of the patients in the multidisciplinary group using prescription pain medication more than once every week compared to the patients in the monodisciplinary group. Patients in the multidisciplinary group had lower odds (OR=0.43, 95% CI=0.24-0.76) of being recommended no treatment compared to the patients in the monodisciplinary group, while at the same time having increased odds (OR=3.1, 95% CI=1.85-5.20) of being recommended treatment for follow-up by a physician in primary care. Conclusion: This study shows that patients assigned for multidisciplinary examinations at UNN are younger than patients assigned for monodisciplinary examinations. There are also indications that patients assigned to multidisciplinary examinations suffers from more mental health problems, as well as being more likely to use pain medication requiring a prescription. The patients assigned to multidisciplinary examinations were also receiving overall more treatment recommendations from the health professionals and were especially more likely to be recommended to follow-up by a physician in primary care. There were no differences between the groups concerning pain, function and work-related variables.