The prevalence of serious pathology in musculoskeletal physiotherapy patients - a nationwide register-based cohort study.

Introduction: 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.

Objective: To estimate the prevalence of neoplasm, cauda equina syndrome, spinal fracture, infection and inflammatory pathology among patients referred for musculoskeletal physiotherapy.

Methods: 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.

Results: 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.

Conclusions: 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.