title: Total number and severity of comorbidities do not differ based on anatomical region of musculoskeletal pain.
abstract: METHODS
  Secondary analysis, cross-sectional study.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Differential diagnosis/symptom prevalence, level 3b.
authors.affiliation: Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610-0154, USA. rcoronado@phhp.ufl.edu
authors.forename: Rogelio A
authors.initials: RA
authors.lastname: Coronado
authors.forename: Meryl J
authors.initials: MJ
authors.lastname: Alappattu
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Hart
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006261:Headache / Q000453:epidemiology; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology*; D009765:Obesity / Q000453:epidemiology; D010146:Pain / Q000453:epidemiology*; D015995:Prevalence; D012720:Severity of Illness Index