Regional Hospital West Jutland, Department of Occupational Medicine - University Research Clinic, Gl. Landevej 61, 7400 Herning, Denmark.
Central Denmark Region, Skottenborg 26, 8800 Viborg, Denmark.
Physiotherapy. 2021 Sep;112:96-102. doi: 10.1016/j.physio.2021.03.004. Epub 2021 Mar 14.
Musculoskeletal conditions are the single largest contributor to years lived with disability worldwide. Most musculoskeletal conditions can be managed 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 serious pathology.
To estimate the prevalence of neoplasm, cauda equina syndrome, spinal fracture, infection and inflammatory pathology among patients referred for musculoskeletal physiotherapy.
The study was a nationwide register-based cohort study. The authors identified all referrals for primary care musculoskeletal physiotherapy in the Danish National Health Insurance Service Register from 2014 to 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. Prevalence estimates of the serious pathology categories were reported.
A total of 1568704 courses of treatment were included in the analysis. The overall prevalence of serious pathology was 2.30%. The prevalence of neoplasm was 2.11%, cauda equina syndrome 0.01%, fractures 0.13%, infections 0.01% and inflammatory pathology 0.06%. Higher prevalence's were observed among patients with a previous history of serious pathology, aged above 50 and with comorbidites.
Although serious pathology among patients referred by the General Practitioner to musculoskeletal physiotherapy is rare, the present study found an overall prevalence of serious pathology which exceeded the guideline endorsed prevalence estimates.
肌肉骨骼疾病是全球导致残疾年数最多的单一原因。大多数肌肉骨骼疾病可以在初级保健中得到治疗，但对于一小部分患者来说，这些症状是由严重的病理引起的。尽管全科医生通常对严重病理进行初步筛查，但理疗师的评估和治疗通常是治疗途径的一部分。然而，目前尚不清楚初级保健理疗中有多少患者的症状是由严重的病理引起的。
估计因肌肉骨骼疾病接受物理治疗的患者中肿瘤、马尾综合征、脊柱骨折、感染和炎症性病理的患病率。
该研究是一项全国范围内基于登记的队列研究。作者从 2014 年至 2017 年，从丹麦国家健康保险服务登记处确定了所有因肌肉骨骼疾病接受初级保健物理治疗的转诊患者。从首次物理治疗接触后的 180 天内，从丹麦国家患者登记处提取了医院接触记录，确定了所有严重病理的诊断。报告了严重病理类别的患病率估计值。
共纳入 1568704 个疗程的治疗。严重病理的总体患病率为 2.30%。肿瘤的患病率为 2.11%，马尾综合征为 0.01%，骨折为 0.13%，感染为 0.01%，炎症性病理为 0.06%。在有严重病史、年龄大于 50 岁和合并症的患者中，患病率更高。
尽管全科医生转诊至肌肉骨骼物理治疗的患者中严重病理较为罕见，但本研究发现，严重病理的总体患病率超过了指南认可的患病率估计值。
