Participation rate was high (91%), 176 patients (55% females, mean age 54.5 years) agreed to complete the questionnaires. 126 (71.6%) reported at least one musculoskeletal problem during the previous 12-month period (responses to the NMQ questions) with low back pain being the most frequent (n = 76, 43.2%), followed by knee (n = 55, 31.3%), shoulder (n = 53, n = 31.1%) and neck problems (n = 46, 26.1%). Less than half of those who reported MSD (n = 55, 31.3%) attributed to them restrictions in daily activities and 42% reported pain during the previous 7-day period (point prevalence). Women and the elder tended to report more symptoms for every pain site (p < 0.05).
The impact on quality of life
Musculoskeletal symptoms were generally associated with worsened HRQL. Subjects reporting neck pain over the previous 7-day period, had significantly lower scores in SF-36, particularly for physical functioning (SF-36 score, 42.9 versus 81.0, p < 0.0001), role limitation due to emotional problems (45.2 v 77.9, p < 0.0001), bodily pain (52.9 v 24.4, p < 0.001), general health (56.4 v 48.7, p = 0.023), vitality (47.5 v 62.5, p = 0.002) and role limitation due to physical problems (32.1 v 86.7, p < 0.001). Scores relating to other musculoskeletal symptoms are presented in Figure (t-test analysis). Wrist pain did not show a significant effect on any dimension of SF-36. The social functioning, vitality and general health domains demonstrated the least association with MSDs and the mental health domain was affected only by knee pain. Impaired HRQL was particularly evident for the physical functioning, role limitations due to physical health problems and bodily pain domains in patients reporting any musculoskeletal problem comparing with those (n = 50) reporting no musculoskeletal problems at all. In general, HRQL for subjects with coexisting MSD were worse than those with only one disorder. Reporting of more than four musculoskeletal symptoms significantly deteriorated all SF-36 dimensions, except for vitality, social functioning and mental health.
Figure 1 SF-36 mean scores of patients with and without MSD during the last 7-day period. Statistical significant values are printed in bold/italics. SD values are presented in the parentheses below. PH: physical functioning (MSD YES: Mean = 30.7, Min = 25.4, (more ...)
Among subjects reporting musculoskeletal symptoms, age was found to influence physical functioning, role limitations due to physical problems and bodily pain. Obesity and lower education were both related to lower scores in physical functioning. Women reported worst HRQL than men as they scored lower in most SF-36 dimensions, except for vitality, social functioning and mental health. Occupation did not show any significant correlations in the study population. The presence of clinical co-morbidities did not influence the SF-36 scores.
The multiple regression analysis revealed that elderly patients with pain in the hip or the upper back reported more bodily pain. Physical functioning was worse in elderly patients with low back or elbow pain. Role limitations due to physical health problems were worse in overweight patients with hip pain. By summarizing the dimensions of SF-36 into two categories of 'physical dimension' and 'mental dimension', neck pain (Beta = -7.9, 95% C.I. -14.07- -1.93, p = 0.01) and upper back pain (Beta = -5.6, 95% C.I. -10.47- -0.68, p = 0.02) appeared as the most disabling symptoms, respectively (Table ).
Associations between HRQL factors and MSD
The impact on mental health
According to the analysis of GHQ-28 scores, MSD patients were more likely than non-MSD patients to present symptoms of mental distress for every pain reported for the time period of the last week. In multivariate analysis, mental distress, as measured through GHQ-28, added a negative effect in HRQL dimensions of SF-36, except for general health (Table ). Moreover, patients with mental distress (those who scored positive in GHQ-28) were more likely to be men (Beta = -1.25, 95% C.I. 0.12-0.65, p = 0.003) who suffer from neck (Beta = 1.92, 95% C.I. 1.21-38.40, p = 0.03) or shoulder pain (Beta = 1.18, 95% C.I. 1.40-7.47, p = 0.006), according to the multiple regression analysis.
The impact on seeking care patterns
Only 32% of those who reported MSD had consulted PCC services during the same period to seek advice on their symptoms. The consultations were referring to GPs, nurses and physiotherapists. Even when participants reported restrictions in their daily activities due to any MSD, they did not consult (crude odds ratio). Mental distress as measured with GHQ-28 (OR = 3.94, 95% C.I. 1.80-8.65, p = 0.001), and marginally bodily pain (OR = 1.02, 95% C.I. 1.01 - 1.04, p = 0.02) as measured by SF-36, were the main factors affecting a patient with musculoskeletal symptom to consult the PCC (Table ). Logistic regression analysis revealed significant correlations of the consultations of MSD patients only with physical functioning as measured with SF-36 and depression as measured with GHQ-28.
Factors affecting the consultations to the PCC