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FOTO Rehab Outcomes Blog

Impact of Co-morbidities in Treating Individuals Who Have Low Back Pain

We know in rehabilitation that co-morbidities may affect treatment outcomes. Co-morbidities are factors that a clinician cannot control. FOTO risk adjusts for co-morbidities that affect outcomes. This abstract caught my eye because it focuses on the impact co-morbidities have in treating individuals who have low back pain.

It would be nice to read a full text article. If I am understanding the abstract correctly, the individuals who have multiple co-morbidities and low back pain basically experienced overutilization of services. These individuals may have entered the system in the emergency room and received a substantial work up. For some reason, the care provided did not follow clinical guidelines and seemed to have  patterns of care that included high cost procedures like imaging . The treatments seemed to include high risk items like injections and opioids.  I wonder why these individuals received unnecessary procedures and treatments.

Below you will find a quick view of the abstract. 


Impact of co-morbidities on resource use and adherence to guidelines among commercially insured adults with new visits for back pain.




To assess if co-morbidity is associated with higher use of back-related care and adherence to back pain guidelines.


We conducted a retrospective cohort study using administrative claims data from 2007-2011. We included individuals ≥18 years with an index visit for back pain. Co-morbidities were measured 12 months prior to index. Co-morbidity burden was measured using Quan's Co-morbidity Index. Co-morbidities categories were measured using chronic condition indicators from the Agency for Healthcare Research and Quality. Total lumbar spine-related resource use for three years was ascertained using procedure codes. A clustering algorithm identified higher long-term utilizer. We identified initial use from day 0-42 for several categories of spine-related care. We used logistic regression to test the association between co-morbidities and resource use.


Greater co-morbidity burden was associated with higher long-term spine-related resource use. Those with ≥2 on Quan's Co-morbidity Index had 29% higher odds of being a high back-specific resource user compared to those with no co-morbidities [Odds Ratio (OR): 1.29, 95% Confidence Interval (CI): 1.23-1.35]. Greater co-morbidity burden was associated with more frequent initial use of imaging, emergency visits, injections, and opioid fills; and less frequent initial use of medical and physical therapy visits. Co-morbid musculoskeletal conditions had the strongest association with being a high utilizer of long-term back-specific resources (OR: 1.53, 95% CI: 1.50-1.57).


Co-morbidity burden and the presence of specific chronic conditions, such as musculoskeletal conditions, were associated with high long-term use of back-related care and care inconsistent with guidelines.

2017 May 16. doi: 10.1111/jep.12763. [Epub ahead of print]