Comparison of baseline PROMIS-10 scores of mental and physical health of patients with low back pain evaluated by physiatrists and orthopedic spine surgeons.

BACKGROUND

Enabling spine patients to access appropriate spine providers based on their course of care can enhance care outcomes. Physiatrists are trained to provide care throughout the continuum of low-back pain (LBP) symptoms and structural conditions that do not require urgent/emergent spine structural intervention.

OBJECTIVE

To assess if patients triaged to a physiatrist for LBP based on where they are in their continuum of spine care will report better baseline physical and mental health than patients presenting to a spine surgeon.

DESIGN

Retrospective study comparing physical and mental health (Patient-Reported Outcomes Measurement Information System [PROMIS]-10) in patients with LBP who are triaged for initial evaluations with physiatrists or spine surgeons.

SETTING

Tertiary orthopedic hospital.

PATIENTS: Adult patients presenting with chief concerns of nonemergent/nonurgent LBP to physiatry or spine surgery from April 1, 2019 to July 1, 2021.

INTERVENTIONS: N/A.

MAIN OUTCOME MEASURES: Initial-visit PROMIS-10 mental and physical health scores.

RESULTS

A total of 2646 new patients presented to physiatrists (n = 1911 [72.2%]) and spine surgeons (n = 735 [27.8%]). Patients evaluated by physiatrists had higher mental health (physiatry 50.1 ± 8.5, spine surgery 46.7 ± 9.0; p < .001) and physical health scores (physiatry 43.7 ± 7.5, spine surgery 39.8 ± 7.2; p < .001) than those presenting to spine surgeons. Furthermore, patients evaluated by physiatrists were more likely to have mental and physical health scores >55 and less likely to have scores <45 (p ≤ .001). Patients with LBP + lower extremity (LE) pain had significantly lower mental and physical health scores than those with LBP alone (mental health 48.5 ± 8.6 [LBP + LE-pain], 49.9 ± 8.9 [LBP-alone]; physical health 41.5 ± 7.3 [LBP + LE-pain], 44.0 ± 7.7 [LBP-alone]; p < .001).

CONCLUSIONS

Patients directed to spine surgeons via triage had worse PROMIS-10 mental and physical health, suggesting this subgroup of patients may especially need additional resources to address these issues in the course of their care. Physiatrists provided nearly two-thirds of nonurgent LBP evaluations in this tertiary orthopedic center, serving an important role in the initial evaluation and treatment of nonurgent LBP. The impact on patient outcomes, patient satisfaction, and associated health care costs requires further investigation.