Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
BMC Musculoskelet Disord. 2009 Dec 7;10:153. doi: 10.1186/1471-2474-10-153.
A large proportion of people living with hip or knee pain do not consult health care professionals. Pain severity is often believed to be the main reason for help seeking in this population; however the evidence for this is contradictory. This study explores the importance of several potential risk factors on help seeking across different practitioner groups, among adults living with chronic hip or knee pain in a large community sample.
Health care utilization, defined as having seen a family doctor (GP) during the past 12 months; or an allied health professional (AHP) or alternative therapist during the past 3 months, was assessed in a community based sample aged 35 or over and reporting pain in hip or knee. Adjusted odds ratios were determined for social deprivation, rurality, pain severity, mobility, anxiety/depression, co-morbidities, and body mass index.
Of 1119 persons reporting hip or knee pain, 52% had pain in both sites. Twenty-five percent of them had seen a doctor only, 3% an AHP only, and 4% an alternative therapist only. Thirteen percent had seen more than one category of health care professionals, and 55% had not seen any health care professional. In the multivariate model, factors associated with consulting a GP were mobility problems (OR 2.62 (1.64-4.17)), urban living (OR 2.40 (1.14-5.04) and pain severity (1.28 (1.13-1.44)). There was also some evidence that obesity was associated with increased consultation (OR 1.72 (1.00-2.93)). Factors were similar for consultation with a combination of several health care professionals. In contrast, seeing an alternative therapist was negatively associated with pain severity, anxiety and mobility problems (adjusting for age and sex).
Disability appears to be a more important determinant of help-seeking than pain severity or anxiety and depression, for adults with chronic pain in hip or knee. The determinants of seeking help from alternative practitioners are different from determinants of consulting GPs, AHPs or a combination of different health care providers.
很大一部分髋或膝关节疼痛患者并未咨询医疗保健专业人员。疼痛严重程度通常被认为是该人群寻求帮助的主要原因；然而，这方面的证据存在矛盾。本研究旨在探讨在一个大型社区样本中，不同从业者群体中，几种潜在风险因素对患有慢性髋或膝关节疼痛的成年人寻求帮助的重要性。
在一个年龄在 35 岁及以上并报告髋或膝关节疼痛的社区基础样本中，评估了过去 12 个月内看过家庭医生（GP）或过去 3 个月内看过联合健康专业人员（AHP）或替代治疗师的卫生保健利用情况。使用调整后的优势比来确定社会剥夺程度、农村程度、疼痛严重程度、活动能力、焦虑/抑郁、合并症和体重指数。
在报告髋或膝关节疼痛的 1119 人中，52%的人同时在两个部位疼痛。其中 25%的人仅看过医生，3%的人仅看过 AHP，4%的人仅看过替代治疗师。13%的人看过不止一类的医疗保健专业人员，而 55%的人没有看过任何医疗保健专业人员。在多变量模型中，与咨询 GP 相关的因素是活动能力问题（OR 2.62（1.64-4.17））、城市居住（OR 2.40（1.14-5.04）和疼痛严重程度（1.28（1.13-1.44））。还有一些证据表明，肥胖与增加咨询有关（OR 1.72（1.00-2.93））。与咨询多种医疗保健专业人员相结合的因素相似。相比之下，看替代治疗师与疼痛严重程度、焦虑和活动能力问题呈负相关（调整年龄和性别后）。
对于患有髋或膝关节慢性疼痛的成年人来说，残疾似乎比疼痛严重程度或焦虑和抑郁更能决定寻求帮助。寻求替代从业者帮助的决定因素与咨询全科医生、AHP 或不同医疗保健提供者组合的决定因素不同。
