Impact of Changes in Patient Reported Outcomes on Healthcare Use After a Self-Management Supportive Intervention for Individuals with Low Back Pain

Søren Grøn,1 Alice Kongsted,1,2 Kim Rose Olsen,3 Bart Koes,3,4 Melker S Johansson1,3 1Departments of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark; 2Chiropractic Knowledge Hub, Odense M, Denmark; 3Department of Public Health, University of Southern Denmark, Odense M, Denmark; 4Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The NetherlandsCorrespondence: Søren Grøn, Center for Muscle and Joint Health, Departments of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark, Email [email protected]; [email protected]: To investigate the potential impact of changes in patient reported outcome measures (PROMs) on subsequent healthcare use following a self-management supportive program for low back pain.Patients and methods: Clinical data from a cohort of 2803 participants enrolled in a self-management supportive intervention for LBP (2018 to 2022) was linked with Danish national registry data. PROMs (predictors) were collected at baseline and at 3-months follow-up (end of intervention), including pain intensity, disability, illness perceptions, self-efficacy, and health-related quality of life. Healthcare use (outcome) was measured as the total use in the year before and after the intervention for i) visits to physiotherapists or chiropractors and ii) analgesics use. Associations between standardized changes in PROMs and changes in healthcare use were analyzed using zero-inflated negative binomial regression models and reported as incidence rate ratios (IRRs) with 95% confidence intervals (CIs). Subgroup analyses were conducted for low, medium, and high baseline use of each outcome.Results: Across PROMs, improvements from baseline to 3-months follow-up were associated with reductions in subsequent healthcare use. For example, one standard deviation improvement in back pain, disability, and self-efficacy were associated with 6– 8% reductions in visits (adjusted IRRs [95% CI], back pain: 0.92 [0.88, 0.97]; disability: 0.94 [0.90, 0.99]; self-efficacy: 0.92 [0.87, 0.96]). For analgesic use, improvements in back pain and self-efficacy were related to a 4% reduction (adjusted IRR [95% CI], back pain: 0.96 [0.92, 1.01], self-efficacy 0.96 [0.91, 1.00]). Stronger associations were observed in subgroups with medium visit use and medium or low analgesic use at baseline.Conclusion: On a group-level, improvements across PROMs were associated with reductions in subsequent healthcare use following participation in a self-management supportive intervention. The strength of the associations varied across subgroups and additional factors not measured by the PROMs are likely to also influence changes in healthcare use.Keywords: low back pain, healthcare utilization, self-management