Unique characteristics of patients who choose an intensive lifestyle medicine program to address chronic musculoskeletal pain

Abby Cheng, Katherine V. Carbonell, Heidi Prather, Barry Hong, Dana L. Downs, John P. Metzler, Devyani Hunt

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Factors that motivate musculoskeletal patients to pursue an intensive, lifestyle medicine–based approach to care are poorly understood. Objective: To determine whether, compared to patients seeking musculoskeletal care through traditional pathways, patients who choose an intensive lifestyle medicine program for musculoskeletal pain endorse greater physical dysfunction, worse psychological health, and/or more biopsychosocial comorbidities. Design: Cross-sectional analysis of existing medical records from 2018 to 2021. Setting: Orthopedic department of one academic medical center. Patients: Fifty consecutive patients who enrolled in an intensive lifestyle medicine program to address a musculoskeletal condition. Comparison groups were the following: (1) 100 patients who presented for standard nonoperative musculoskeletal care, and (2) 100 patients who presented for operative evaluation by an orthopedic surgeon and qualified for joint arthroplasty. Intervention: Not applicable. Main Outcome Measures: Primary outcomes were age-adjusted, between-group differences in Patient-Reported Outcomes Measurement Information System (PROMIS) physical and psychological health measures. Secondary outcomes were between-group differences in sociodemographic and medical history characteristics. Results: Patients who enrolled in the intensive lifestyle medicine program were more racially diverse (non-White race: lifestyle cohort 34% vs. comparison cohorts 16%-18%, p ≤.029) and had a higher prevalence of obesity and diabetes than both comparison groups (mean body mass index: lifestyle cohort 37.6 kg/m2 vs. comparison cohorts 29.3-32.0, p <.001; diabetes prevalence: lifestyle cohort 32% vs. comparison cohorts 12%-16%, p ≤.024). Compared to standard nonoperative patients, there were no clear between-group differences in PROMIS physical or psychological health scores. Compared to standard operative evaluation patients, patients in the lifestyle program reported worse anxiety but less pain interference (PROMIS Anxiety: B = 3.8 points [95% confidence interval, 0.1 to 7.4], p =.041; Pain interference: B = −3.6 [−6.0 to −1.2], p =.004). Conclusions: Compared to musculoskeletal patients who sought care through traditional pathways, patients who chose an intensive lifestyle medicine pathway had a higher prevalence of metabolic comorbidities, but there was substantial overlap in patients' physical, psychological, and sociodemographic characteristics.

Original languageEnglish
JournalPM and R
DOIs
StateAccepted/In press - 2022

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