Neck and back pain: Differences between patients treated in primary and specialist health care.
Mari Kristine Tyrdal, Marit B Veierød, Cecilie Røe and 3 others
PMID 35657413WHAT IT FOUND
Patients referred to specialist care had heavier physical workloads and lower education than those treated in primary physiotherapy.
Specialist patients reported more pain and worse quality of life, but psychological distress scores were similar after adjustment. Referral patterns align with pain duration and socioeconomic factors rather than mental health severity.
Key findings
01Specialist healthcare patients were significantly more likely to have heavy physical workloads, lower education levels, and receive social benefits compared to primary care patients.
02After adjusting for confounders, there was no significant difference in psychological distress between patients treated in primary care and those in specialist care.
03Patients with pain duration of 3–12 months were more likely to be treated in specialist care, while those with pain lasting over 12 months were less likely to be referred there.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study did not include patients treated only by general practitioners, missing a significant portion of the primary care population. Data on the referral process, including refused referrals and reasons for referral, were not available. Disability scores were missing for 32% of patients, and those with missing data reported higher pain and distress, potentially biasing the results. The cross-sectional design cannot determine causality or track individual patient trajectories over time. Specialist care data covered only approximately 63% of all patients treated in these departments in 2018, limiting generalizability.
Declared interests
The authors declared no competing interests. The study used existing national register data (FYSIOPRIM and NNRR) without specific external funding mentioned in the provided text.
The easy way to misread this
Do not assume that specialist referral is triggered by high psychological distress. Although more specialist patients scored above the distress cut-off in raw numbers, the difference disappeared after adjusting for other factors, suggesting that socioeconomic and physical workload issues are stronger drivers of referral than mental health status alone.