The epidemiology of multisite pain and hip pain conditions in the adult South Australian population

Abstract

Musculoskeletal (MSK) pain conditions are among the most common and disabling chronic conditions in Australia. Through illness, pain and disability, they place a significant burden on people, society and the health care system. In previous decades, there has been an increased policy focus on MSK conditions targeting prevention, early detection and improved treatment. This thesis provides an updated self-reported prevalence of MSK conditions in South Australia (SA). This thesis utilised data from two stages [Stage3 (2008-10) and North West 2015 (NW15)] of the North West Adelaide Health Study (NWAHS). The eligible cohort comprised 4056 participants (18 years and over) and the sample region (regional population ~0.6 million) is representative of approximately half of the population in Adelaide (population ~1.1 million) or one third of the population in SA (population of ~1.5 million). Data were collected using a computer-assisted telephone interview, clinical assessment, and a self-reported questionnaire. The prevalence of MSK conditions and associated risk factors in one or multiple pain sites, the prevalence and predictors of hip pain, and health care utilisation in relation to hip pain were examined using descriptive statistics, univariable and multivariable logistic regression, multi-level repeated measures models, pairwise correlations and Pearson’s Chi-square where appropriate. Overall, the prevalence of MSK conditions is high in the SA population, with most people reporting pain from multiple pain sites 49.9% (95%CI:46.9-53.0) versus 23.1% (95%CI:20.6- 25.8) reporting single site pain and 27.0% (95%CI:25.3-28.7) not experiencing MSK joint pain. Factors including older age, female sex, higher BMI, fair or poor general health and educational attainment were predictive of pain in two or more pain sites over time. The point prevalence of hip pain was high with 24.7% (95%CI:22.6-27.0) and 25.8% (95%CI:23.6-26.9) affected at Stage 3 and NW15, respectively. Of those reporting hip pain, 11.1% (95%CI:9.4-12.8) had incident hip pain, 14.3% (95%CI:12.4-16.2) recurrent hip pain, and 10.4% (95%CI:8.7-12.1) resolved hip pain. Demographic factors like older age and female sex have been identified as risk factors for incident and recurrent hip pain. Persistent hip pain was also associated with fair or poor health, financial stress, and activity limitations (walking). Although the prevalence of hip pain in the past 12 months was high (78.5%), participants did not seek any medical advice for treatment or management. If participants consulted a health professional about their hip pain in the past 12 months, they most frequently consulted a GP (52.4%) for treatment, followed by physiotherapist (32.3%), chiropractor (30.0%), orthopaedic surgeon (11.3%) and rheumatologist (5.5%). Given the high prevalence of MSK pain conditions, and the large proportion of people not seeking or having access to pain management and care, the efficacy of policy measures currently in place is discussed. Early detection and treatment are crucial to prevent MSK pain, however, to improve the Australian health care system, change is needed on three levels: micro, at the level of the first clinical encounter and access to care; meso, at the level of healthcare service delivery; and macro, at the level of political framework and governance. Findings from this thesis will contribute to the epidemiological literature, provide valuable data for researchers aiming to understand the occurrence of MSK pain in multiple pain sites and its distribution over the body, and may have implications for current health policy.