Total number and severity of comorbidities do not differ based on anatomical region of musculoskeletal pain

J Orthop Sports Phys Ther. 2011 Jul;41(7):477-85. doi: 10.2519/jospt.2011.3686.


Study design: Secondary analysis, cross-sectional study.

Objectives: To (1) compare differences in individual comorbidity rates among patients with cervical, lumbar, and extremity pain complaints and (2) compare rates based on total number and severity in these same patient groups.

Background: Comorbidities can impact recovery, prognosis, and potentially hinder participation in rehabilitation. Few studies have compared comorbidity rates among patients with different anatomical region of pain, to determine whether specific screening is warranted in physical therapy settings.

Methods: Included in the analyses were 2375 patients who reported complete demographic, clinical, and comorbidity information using Patient Inquiry software. Comorbidity data were collected from the Functional Comorbidity Index (18 items) and 6 additional comorbidities, to assess the presence of medical disease across multiple body systems. Comorbidities were further classified as "nonsevere" or "severe," based on inclusion in the Charlson Comorbidity Index. Chi-square analyses investigated differences in the rates of total number and severe comorbidities. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated on rates with statistically significant differences (P<.001), using the lumbar spine as the reference group.

Results: Of the 24 comorbid conditions included in this analysis, 3 nonsevere medical conditions (degenerative disc disease, obesity, and headache) had different rates among anatomical region. A lower rate for degenerative disc disease was associated with the extremity conditions (χ2 = 66.3; OR = 0.40; 95% CI: 0.32, 0.50). Higher rate of headache (χ2 = 115.3; OR = 3.01; 95% CI: 2.45, 3.70) and lower rate of obesity (χ2 = 16.2; OR = 0.64; 95% CI: 0.51, 0.80) were associated with cervical conditions. There were no differences among the 3 anatomical regions for total number or severe comorbidities.

Conclusion: Focused screening for degenerative disc disease, obesity, and headache may be warranted. However, the same strategy was not supported for total number or severe comorbidities, at least when considering comparative rates from this cohort. Physical therapists should consider the potential influence of total number and severe comorbidities equally for all anatomical regions of musculoskeletal pain.

Level of evidence: Differential diagnosis/symptom prevalence, level 3b.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Headache / epidemiology
  • Humans
  • Intervertebral Disc Degeneration / epidemiology
  • Male
  • Middle Aged
  • Musculoskeletal Diseases / epidemiology*
  • Obesity / epidemiology
  • Pain / epidemiology*
  • Prevalence
  • Severity of Illness Index