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Open Access Research article

Heterogeneity in health status and the influence of patient characteristics across patients seeking musculoskeletal orthopaedic care – a cross-sectional study

Anthony V Perruccio123, Rajiv Gandhi14, Y Raja Rampersaud14* and on behalf of The Arthritis Program, University Health Network

Author Affiliations

1 Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, 1st Floor, East Wing, Room 441, Toronto, ON, Canada

2 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

3 Toronto Musculoskeletal Centre, University of Toronto, Toronto, ON, Canada

4 Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

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BMC Musculoskeletal Disorders 2013, 14:83  doi:10.1186/1471-2474-14-83

Published: 7 March 2013



Health status is an important predictor of patient outcomes. Consequently, identifying patient predictors of health status is essential. In musculoskeletal orthopaedic care, the majority of work examining the association between patient characteristics and health status has been undertaken among hip/knee cohorts. We investigate these associations comparing findings across four musculoskeletal cohorts (hip/knee; foot/ankle; neck/back; elbow/shoulder).


Patients seeking elective musculoskeletal orthopaedic care were recruited prior to consultation. Questionnaires captured health domain status (bodily pain, physical functioning, and mental and general health) and covariates: demographics; socioeconomic characteristics; and comorbidity. Scores were compared across cohorts. Two path regression analyses were undertaken. First, domain scores were simultaneously examined as dependent variables in the overall sample. Subsequently, the model was assessed stratified by cohort.


1,948 patients: 454 neck/back, 767 hip/knee, 378 shoulder/elbow, 349 foot/ankle. From stratified analyses, significant variability in covariate effects was observed. Worse bodily pain scores were associated with increasing age and female sex among hip/knee, low income among foot/ankle, and overweight/obese for foot/ankle and hip/knee. Worse mental health scores were associated with low income across cohorts except elbow/shoulder, low education within neck/back, and compared to Whites, Blacks had significantly worse scores among foot/ankle, better scores among hip/knee. Worse general health scores were observed for Asians among hip/knee, Blacks among foot/ankle, and South-Asians among elbow/shoulder and neck/back.


The substantial heterogeneity across musculoskeletal cohorts suggests that patient- and cohort-specific approaches to patient counsel and care may be more effective for achieving optimal health and outcomes.

Health status; Patient characteristics; Orthopaedics; Patient education