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Referrals for musculoskeletal disorders: patterns, predictors, and outcomes
D H Solomon1, D W Bates, J L Schaffer
1Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. dhsolomon@partners.org
The Journal of Rheumatology
|September 12, 2001
Summary
Musculoskeletal referrals for knee and shoulder pain are common. Referral did not improve pain or function and may be linked to worse outcomes for shoulder pain patients.
Area of Science:
- Orthopedics
- Rheumatology
- Primary Care Medicine
Background:
- Musculoskeletal conditions like knee and shoulder pain frequently lead patients to primary care.
- Understanding referral patterns and their impact on clinical outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To investigate factors influencing musculoskeletal referrals for knee and shoulder pain.
- To determine if referral to specialists affects patient pain and function outcomes.
Main Methods:
- Patients with knee or shoulder pain presenting to primary care were followed for up to 12 months.
- Data collected included baseline pain/function, complaint duration, diagnosis, insurance, and demographics.
- Clinical outcomes were measured as changes in pain and function.
Main Results:
- 41% of patients with knee or shoulder pain were referred to specialists.
- Knee pain referrals were associated with internal derangement diagnosis (p=0.02); no factors predicted shoulder referrals.
- Referral was not linked to improved outcomes and was associated with worse outcomes for shoulder pain (p=0.02).
Conclusions:
- Referral for knee and shoulder pain is frequent, with internal derangement being a key factor for knee referrals.
- Referral does not appear to improve pain or function and may be associated with poorer outcomes in shoulder pain patients.
- Unmeasured factors likely influence referral decisions and outcomes.