General health factors may be a barrier to effective non-surgical multidisciplinary rehabilitation of common orthopaedic conditions in tertiary care settings

Abstract

Background: To explore patient characteristics predictive of a poor response to multidisciplinary non-surgical rehabilitation of three common orthopaedic conditions within a tertiary care service. Methods: A retrospective audit of medical records of patients who had undergone multidisciplinary non-surgical management of their knee osteoarthritis (KOA, n = 190), shoulder impingement syndrome (SIS, n = 199), or low back pain (LBP, n = 242) within a multisite tertiary care service was undertaken. Standardised clinical measures recorded by the service at the initial consultation were examined using a base binary logistic regression model to determine their relationship with a poor response to management (ie. not achieving a minimal clinically important improvement in the condition disability measure pre-post management). Results: Factors predictive of a poor response following non-surgical management included;; higher levels of anxiety (OR 1.11, P < 0.02) and lower functional score (OR 0.76, P < 0.04) for KOA, higher number of comorbidities (OR 1.16, P < 0.03) for SIS, and coexisting cervical or thorax pain (OR 2.1, P = 0.04) and lower pain self-efficacy (OR 0.98, P = 0.02) for LBP. Conclusions: General health issues may present a barrier to achieving favourable outcomes in response to multidisciplinary non-surgical rehabilitation for the management of common orthopaedic conditions in a tertiary care setting. Clinicians may need to consider these broader patient issues when designing management strategies for patients with these conditions.