COMORBIDITY CHARACTERISTICS OF ADULT PATIENTS WITH REPORTED NECK AND LOW BACK COMPLAINTS - AN OUTPATIENT CLINICAL POPULATION-BASED COHORT STUDY

Abstract

In clinical practice, a comprehensive history and examination often includes questionnaires covering all systems. Physical examination is augmented by functional assessment using subjective (neck and lumbar disability indexes, NDI and LBDI respectively) and objective measures (computerized dynamic posturography, CDP). In this retrospective chart review of patients with complaints of postural instability and neck or low back pain, the presence and number of comorbidities and their classification were analyzed by age, gender, and severity of the disability. In general subjects showed higher disability in the NDI than in the LBDI (with more significant impact of the proximal vs. distal pain, joint and receptor dysfunction); they had a wide range of CDP results (the more difficult the test, the higher the number of subjects that were not able to complete it and the lower the number that had healthy balance); and on average 3.84 comorbid conditions were present, with 21 subjects presenting with 5 or more, 3 with 10 or more, and one reporting 15 comorbidities. No statistically significant differences were found for age, BMI and LBDI; sex and NDI affected metabolic comorbidities; certain tests of the CDP affected the Musculoskeletal and Other type of comorbidities. It was difficult to detect strong correlation trends that could be easily explained. Complex subjects cases complicate the possibility of doing practice based clinical research, but more importantly they create a challenge for the clinician in deciding the best course of action for treating the patient. New algorithmic assessments and integrated approaches are needed.