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Background: To describe the frequency of primary care seeking for neck or back‐related conditions among people with chronic neck and low back pain and to develop prediction models of primary care seeking and frequent visits. Methods: We included participants of the Trøndelag Health Study (HUNT4, 2017–19) in Norway who self‐reported chronic neck and/or low back pain in the preceding year, and extracted data of primary care visits from the Norwegian primary healthcare registry. We investigated a total of 23 potential predictors and used multivariable logistic regression models to predict primary care seeking for neck or back‐related conditions and frequent visits by healthcare provider (i.e., the highest quartile of number of visits). Results: Among the 15,352 HUNT4 participants with chronic neck and/or low back pain, 6231 participants (40.6%) sought primary care for neck or back‐related conditions (median = 5 visits, IQR 2–15) within 2 years after the study. Participants who consulted physical therapists sought care the most frequently (median = 10 visits, IQR 3–26). Discrimination of the best‐fit prediction model of primary care seeking and frequent visits by healthcare provider, assessed by C‐statistic, ranged from 0.66–0.76. Participants who made frequent primary care visits in the preceding year were highly likely to continue frequent care seeking in the following 2 years. Conclusions: Around 40% of people seek primary care for chronic neck and low back pain, and frequent care seeking may continue for years. Future studies should investigate strategies to reduce recurrent primary care visits, especially seeking physical therapist care, and promote self‐management of chronic pain. Significance: People with chronic neck and low back pain who seek physical therapist care had the highest frequency of care seeking, underscoring the significant burden on healthcare systems. The high frequency of visits and associated healthcare expenditures highlight the critical need for effective and valuable primary care for chronic pain management. To mitigate recurrent visits and reduce costs, it is essential to provide patients with evidence‐based treatments and self‐management interventions. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the longitudinal impact of introducing a national, direct access physiotherapy model of care on the rates of primary and secondary care consultations for musculoskeletal (MSK) conditions. Design Interrupted time series analysis using segmented linear regression. Setting Norway primary care Participants A cohort of 82 072 participants was derived from 3 population-based health surveys conducted across separate geographical regions in Norway. All participants surveyed were eligible for inclusion as a national representative sample of the Norwegian population. Registered MSK consultations were linked to the Norwegian Control and Payment of Health Reimbursement database and the Norwegian Patient Register using the International Classification of Primary Care diagnostic medical codes L-chapter for MSK conditions and spine related International Classification of Diseases, 10th Revision, codes. Intervention Direct access to physiotherapy model of care introduced nationally in Norway in 2018. This model allowed Norwegians to consult directly with qualified physiotherapists for MSK conditions (eg, back pain, knee osteoarthritis) without the need for a medical referral in order to claim a social security reimbursement. Main outcomes measured Rates of primary care consultations per 10 000 population (general practitioner (GP) and physiotherapist consultations) and secondary care (specialist consultations and surgical procedures) measured from 2014 to 2021. Results The introduction of the direct access physiotherapy model was associated with an immediate stepped reduction of 391 general practice consultations per 10 000 population, (95% CI: −564 to −216), without an associated change in physiotherapy consultations. Subgroup analyses suggested there was an associated reduction in physiotherapy consultations for those in the lowest education group of 150 consultations per quarter (95% CI:−203 to −97), 70 consultations per quarter in the intermediate education group (95% CI:−115 to −27) and a stepped reduction of 2 spinal surgical procedures per 10 000 population, for those aged between 40 and 60 years (95% CI: −3 to −1) following the introduction of the direct access physiotherapy model. Conclusion The national introduction of a direct access to physiotherapy model of care was associated with a reduction in the workload of GPs for the management of MSK conditions. The use of physiotherapists in direct contact roles is a potential strategic model to reduce the burden on the GP workforce in primary care worldwide. [ABSTRACT FROM AUTHOR]

Objectives: To critically appraise and summarise measurement properties of functional performance tests in individuals following anterior cruciate ligament (ACL) or meniscal injury.Design: Systematic review.Data Sources: Systematic searches were performed in Medline (Ovid), Embase (Ovid), CINAHL (EBSCO) and SPORTSDiscus (EBSCO) on 7 July 2021.Eligibility Criteria For Selecting Studies: Studies evaluating at least one measurement property of a functional performance test including individuals following an ACL tear or meniscal injury with a mean injury age of ≤30 years. The COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist was used to assess methodological quality. A modified Grading of Recommendations Assessment, Development and Evaluation assessed evidence quality.Results: Thirty studies evaluating 26 functional performance tests following ACL injury were included. No studies were found in individuals with an isolated meniscal injury. Included studies evaluated reliability (n=5), measurement error (n=3), construct validity (n=26), structural validity (n=1) and responsiveness (n=1). The Single Leg Hop and Crossover Hop tests showed sufficient intrarater reliability (high and moderate quality evidence, respectively), construct validity (low-quality and moderate-quality evidence, respectively) and responsiveness (low-quality evidence).Conclusion: Frequently used functional performance tests for individuals with ACL or meniscal injury lack evidence supporting their measurement properties. The Single Leg Hop and Crossover Hop are currently the most promising tests following ACL injury. High-quality studies are required to facilitate stronger recommendations of performance-based outcomes following ACL or meniscal injury. [ABSTRACT FROM AUTHOR]

Objective: To update a systematic review on the association between knee extensor muscle weakness and the risk of incident knee osteoarthritis in women and men.Design: Systematic review and meta-analysis.Data Sources: Systematic searches in PubMed, EMBASE, SPORTDiscus, CINAHL, AMED and CENTRAL in May 2021.Eligible Criteria For Selecting Studies: Longitudinal studies with at least 2 years follow-up including baseline measure of knee extensor muscle strength, and follow-up measure of symptomatic or radiographic knee osteoarthritis. Studies including participants with known knee osteoarthritis at baseline were excluded. Risk of bias assessment was conducted using six criteria for study validity and bias. Grading of Recommendations Assessments, Development and Evaluation assessed overall quality of evidence. Meta-analysis estimated the OR for the association between knee extensor muscle weakness and incident knee osteoarthritis.Results: We included 11 studies with 46 819 participants. Low quality evidence indicated that knee extensor muscle weakness increased the odds of symptomatic knee osteoarthritis in women (OR 1.85, 95% CI 1.29 to 2.64) and in adult men (OR 1.43, 95% CI 1.14 to 1.78), and for radiographic knee osteoarthritis in women: OR 1.43 (95% CI 1.19 to 1.71) and in men: OR 1.39 (95% CI 1.07 to 1.82). No associations were identified for knee injured populations except for radiographic osteoarthritis in men.Discussion: There is low quality evidence that knee extensor muscle weakness is associated with incident symptomatic and radiographic knee osteoarthritis in women and men. Optimising knee extensor muscle strength may help to prevent knee osteoarthritis.Prospero Registration Number: CRD42020214976. [ABSTRACT FROM AUTHOR]