Health professionals' referral practice and related healthcare utilization for people with low back pain in Singapore: A retrospective study.
Fong-Ling Loy, Su-Yin Yang, Jamila Chemat and 1 others
PMID 31156313WHAT IT FOUND
59.92% of patients with chronic low back pain in this Singapore tertiary pain clinic were referred for physiotherapy.
Those referred reported more pain interference and poorer physical quality of life, but pain scores alone did not explain much of how many visits they used.
Key findings
0159.92% of patients with primary low back pain in this tertiary pain clinic cohort were referred for physiotherapy, and those referred reported higher pain interference and poorer physical quality of life.
02Patients referred from tertiary care had higher pain intensity, pain interference, disability, and poorer physical and mental quality of life, and they used more medical and physiotherapy services than patients referred from primary care.
03Referral source explained 6% of the differences in medical visits and 3% of the differences in physiotherapy visits. After age, gender, education and referral source were considered, pain intensity explained an additional 2% of physiotherapy visits.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a retrospective single-site study in one Singapore tertiary pain clinic, so it describes one service's referral patterns and cannot show why referrals happened. All patients had chronic low back pain of more than 3 months and were able to complete measures in English or Mandarin, so it does not describe acute low back pain or patients who could not complete the measures. The study did not include common psychosocial factors or comorbidities such as fear avoidance, hyper vigilance, depression and anxiety, and data on psychologist referrals were inconsistent and excluded. It did not examine non-hospital therapy services, visits to primary care physicians or other specialists, so total healthcare use may be incomplete. Healthcare utilization was tracked for only 1 year after the first consultation. The analysis relied on self-reported measures, which are only part of clinical decision-making and may not fully explain referral or visit patterns.
The easy way to misread this
Do not read these referral and visit patterns as evidence that physiotherapy improves low back pain. The study was observational, and after age, gender, education and referral source were considered, pain intensity added only 2% of the variance in physiotherapy utilization.