Predictors of Functional Outcome in Musculoskeletal Healthcare: An Umbrella Review

Burgess, Roanna; Mansell, Gemma; Bishop, Annette; Lewis, Martyn; Hill, Jonathan

Abstract

BACKGROUND
Multiple cohort and systematic review studies exist, reporting independent predictive factors associated with outcome in musculoskeletal populations. These studies have found evidence for a number of 'generic' factors that have been shown to predict outcome across musculoskeletal patient cohorts. This review provides a higher level review of the evidence with a focus on generic patient factors associated with functional musculoskeletal outcome with a view to informing predictive modelling.

OBJECTIVES
a) Identify patient factors found to have evidence to support their association with functional outcome, and b) review these findings across body areas/conditions to identify generic predictive factors.

Databases and Data Treatment: Electronic databases of MEDLINE, AMED, EMBASE, CINAHL and Cochrane were searched for eligible studies. Two reviewers independently extracted data and assessed quality using an established checklist for umbrella reviews.

RESULTS
Twenty one systematic reviews met inclusion criteria, all were of moderate/high quality. Six independent predictors were found to have strong evidence of association with worse musculoskeletal functional outcome across anatomical body sites (worse baseline function, higher symptom/pain severity, worse mental wellbeing, more comorbidities, older age and higher body mass index). Longer duration of symptoms, worse pain coping, presence of workers compensation, lower vitality and lower education were also found to have moderate evidence of association with worse functional outcome across body sites.

CONCLUSIONS
This study identifies a number of factors associated with musculoskeletal functional outcome. The generic predictive factors identified should be considered for inclusion into musculoskeletal prognostic models, including models used for case-mix-adjustment of patient reported outcome measure data.

Citation

Burgess, R., Mansell, G., Bishop, A., Lewis, M., & Hill, J. (2019). Predictors of Functional Outcome in Musculoskeletal Healthcare: An Umbrella Review. European Journal of Pain, 24(1), 51-70. https://doi.org/10.1002/ejp.1483

• Journal Article Type: Article
• Acceptance Date: Sep 11, 2019
• Publication Date: Sep 11, 2019
• Journal: European Journal of Pain
• Print ISSN: 1090-3801
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 24
• Issue: 1
• Pages: 51-70
• DOI: https://doi.org/10.1002/ejp.1483
• Keywords: predictors, functional outcome, musculoskeletal
• Publisher URL: https://doi.org/10.1002/ejp.1483