Predictive socio-cultural factors of pain intensity, disability, and quality of life in patients with nonspecific musculoskeletal pain: a prospective cohort study

ABSTRACT: Nonspecific musculoskeletal pain (NSMSP) presents a complex challenge in primary care due to its unequal distribution, multidimensional nature, and increasing prevalence. Understanding socio-cultural factors associated with or predicting the course of NSMSP is essential. This study, performed in people with NSMSP visiting Dutch primary care physiotherapy, aimed to (1) determine which socio-cultural factors are predictors on short- and long-term NSMSP outcomes, and (2) determine the associations between socio-cultural factors and pain intensity, disability, and health-related quality of life (HRQoL) at baseline, and 3, 6, and 12 months follow-up. This prospective cohort study included 1350 NSMSP patients who completed questionnaires on socio-cultural (eg, education level, migration background), demographic (eg, sex, age), pain-related (eg, analgesics), and health-related factors (eg, smoking), alongside standardized measures for outcomes pain intensity, disability, and HRQoL at baseline and follow-up. Linear mixed models were constructed to examine the predictions and associations of the socio-cultural factors on each outcome variable. Results showed that unemployment, retirement, migration background, and non-native Dutch language proficiency were associated with poorer pain intensity, disability, and HRQoL over 12 months in primary care NSMSP patients. Living together was associated with higher pain-related disability, while overall higher education levels were associated with lower pain intensity and disability over time. Cross-validation revealed large unexplained variability in all prediction models, indicating that within this highly diverse primary care sample, individual NSMSP outcomes cannot be predicted based on specific socio-cultural factors. Nevertheless, longitudinal associations indicate that NSMSP is unequally distributed, potentially leading to poorer outcomes for some NSMSP patients.