Dagenais Pierre, Courteau Mireille, Courteau Josiane, Martel Gilles, Vanasse Alain
Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada.
Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada.
Pain. 2025 Apr 1;166(4):835-846. doi: 10.1097/j.pain.0000000000003409. Epub 2024 Sep 27.
This study explored diverse care trajectories (CTs) for low back pain (LBP) and other musculoskeletal disorders (MSDs), over a 5-year period following a first episode of LBP. Based on Quebec's administrative health data from 2007 to 2011, this longitudinal cohort study involved 12,608 adults seeking health care for LBP. Using a new multidimensional state sequence analysis, we identified 6 distinct types of CTs. The most prevalent types 1, 2, and 3 (comprising 79.2%, 18.0%, and 21.7% of the cohort, respectively) exhibit rapid recovery and similar patterns of healthcare use over 5 years but differing in initial diagnoses: nonspecific LBP in type 1, trauma-related LBP in type 2 (mostly younger men and highest initial emergency consultation), and specific LBP in type 3. Types 4 to 6, representing smaller groups, show high healthcare utilization with comparable mixed LBP diagnoses at entry but distinctive subsequent care use patterns. Patients in types 4 and 6 (mainly older age groups and women) sought care for other MSDs from general practitioners or specialists, while middle-aged patients in type 5 experienced persistent nonspecific LBP with frequent general practitioner consultations over 5 years. The CTs typology revealed several key areas for improvement in nonpharmacological interventions, including the need to address possible inappropriate medical imaging and invasive interventions for older women with MSDs and the lack of ambulatory care access for younger patients with trauma-related LBP. Finally, results clearly highlighted poor access to rehabilitation physicians and rehabilitation services for all patients suffering from LBP and MSDs.
本研究探讨了腰痛（LBP）首次发作后的5年期间，腰痛及其他肌肉骨骼疾病（MSD）的不同护理轨迹（CT）。基于魁北克2007年至2011年的行政卫生数据，这项纵向队列研究纳入了12608名因腰痛寻求医疗保健的成年人。我们使用一种新的多维状态序列分析方法，确定了6种不同类型的护理轨迹。最常见的1型、2型和3型（分别占队列的79.2%、18.0%和21.7%）显示出快速康复，且在5年期间的医疗保健使用模式相似，但初始诊断不同：1型为非特异性腰痛，2型为创伤相关腰痛（主要是年轻男性，初始急诊会诊率最高），3型为特异性腰痛。4型至6型代表较小的群体，入院时混合性腰痛诊断相当，但后续护理使用模式独特，医疗保健利用率较高。4型和6型患者（主要是老年群体和女性）向全科医生或专科医生寻求其他肌肉骨骼疾病的护理，而5型中年患者在5年期间持续患有非特异性腰痛，频繁咨询全科医生。护理轨迹类型学揭示了非药物干预几个关键的改进领域，包括需要解决对患有肌肉骨骼疾病的老年女性可能不适当的医学影像检查和侵入性干预，以及对患有创伤相关腰痛的年轻患者缺乏门诊护理服务的问题。最后，结果清楚地凸显了所有腰痛和肌肉骨骼疾病患者获得康复医生和康复服务的机会不佳。
