Symptom burden and follow-up of patients with neck and back complaints in specialized outpatient care: a national register study

Abstract

Back and neck pain are common in the population, especially among immigrants. In Norway’s specialist care system, treating these patients typically involves a multidisciplinary approach based on the biopsychosocial model. However, language and cultural differences may create barriers to participation. Immigrants are often underrepresented in clinical studies, but a register‑based approach can enhance their participation in research. This study aimed to compare both the symptom burden, and treatment, among Norwegians, non‑Norwegians, and patients requiring translator service for back and neck pain within the Norwegian specialist care system. The Norwegian neck and back registry is a National Quality Register, established in 2012 and fully digitized in late 2020. The baseline data includes demographics and patient recorded outcome measures including Oswestry Disability Index, Fear‑Avoidance Beliefs, pain rating on a numeric rating scale, Hopkins Symptom Checklist and EuroQol five‑dimensional questionnaire on health related quality of life. During the two‑year study period, a total of 14,124 patients were invited, and 10,060 (71%) participated. Norwegian patients reported less pain, better function assessed by Oswestry Disability Index, lower fear avoidance beliefs, less emotional distress, and higher health related quality of life compared to non‑Norwegians. We found that patients with female gender, who were younger, more educated and exhibited fear‑ avoidance behavior were significantly more likely to receive multidisciplinary treatment. We found no difference in the proportion of Norwegian and non‑Norwegian patients receiving multidisciplinary treatment [odds ratio (OR) 1.02 (95% confidence interval (CI) 0.90–1.16)]. However, patients needing a translator were less likely to receive multidisciplinary treatment compared to those who didn’t require translation [OR 0.41 (95% CI (0.25–0.66)]. We found that non‑Norwegian patients experience a higher symptom burden compared to Norwegian. We found that both non‑Norwegians and patient in need of translator were to a greater extent recommended treatment in primary health care. The proportion of non‑Norwegians patients receiving multidisciplinary treatment was similar to Norwegians, but those needing a translator were less likely to receive such treatment.