# Treatment trajectories among patients with musculoskeletal disorders in Norway – a register-based cohort study over 2 years

## TL;DR

The study examines how patients with musculoskeletal disorders in Norway use healthcare services over two years and finds that most are low users.

## Contribution

The novel use of group-based multi-trajectory modeling to classify treatment patterns in MSD patients using nationwide register data.

## Key findings

- 75% of MSD patients were classified as low healthcare users over two years.
- High healthcare use was primarily due to frequent physiotherapy visits.
- Education and country of origin were associated with treatment trajectory classes.

## Abstract

Explore treatment trajectories over a two-year follow-up among patients with musculoskeletal disorders (MSDs) in Norway and investigate the associations with education and country of origin.

Register-based cohort study.

Data were obtained from three national registers, the Norwegian Control and Payment of Health Reimbursements Database (KUHR), the Norwegian Patient Registry (NPR) and Statistics Norway (SSB).

Patients diagnosed with MSDs in 2015 in primary healthcare according to the International Classification of Primary Care, second edition (ICPC-2).

Treatment trajectory classes of healthcare use over a 2-years follow-up were generated using group-based multi-trajectory modelling, for all patients registered with MSDs and three common diagnoses: spine pain, osteoarthritis and fibromyalgia.

From the analysis, four treatment trajectory classes of healthcare use were identified for MSD patients overall; low (75%), stable (10%), descending (9%) and high use (5%). The pattern was almost similar for the three diagnostic groups. High use was primarily caused by consistent high use of physiotherapy. For MSD patients overall, low education increased the probability of being in the low and stable use classes, while high education increased the probability of being in the descending use class. Patients with Norway as country of origin, were less likely to be in the class with low use and more likely to be in the class with descending use.

Using nationwide register data and group-based multi-trajectory modelling show that about 75% of all patients with MSD, consulting primary healthcare in Norway, were classified as low users of healthcare services and 5% were classified as high users. Overall, both education and country of origin were associated with the treatment trajectory classes. However, high use was not associated with neither education nor country of origin.