Reconsultation, self-reported health status and costs following treatment at a musculoskeletal Clinical Assessment and Treatment Service (CATS): a 12-month prospective cohort study

Research output: Contribution to journalArticle


  • Edward Roddy
  • Kelvin Jordan
  • Ying Chen
  • Peter Dawes
  • Samantha Hider
  • Jon Packham
  • Kay Stevenson
  • Irene Zwierska
  • Elaine Hay

Colleges, School and Institutes

External organisations

  • Keele University
  • Staffordshire Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK


Objectives To determine (1) reconsultation frequency, (2) change in self-reported health status, (3) baseline factors associated with reconsultation and change in health status and (4) associated healthcare costs and quality-adjusted life-years (QALYs), following assessment at a musculoskeletal Clinical and Assessment Treatment Service (CATS).

Design Prospective cohort study.

Setting Single musculoskeletal CATS at the primary–secondary care interface.

Participants 2166 CATS attenders followed-up by postal questionnaires at 6 and 12 months and review of medical records.

Outcome measures Primary outcome was consultation in primary care with the same musculoskeletal problem within 12 months. Secondary outcome measures were consultation at the CATS with the same musculoskeletal problem within 12 months, physical function and pain (Short Form-36), anxiety and depression (Hospital Anxiety and Depression Scale), time off work, healthcare costs and QALYs.

Results Over 12 months, 507 (38%) reconsulted for the same problem in primary care and 345 (26%) at the CATS. Primary care reconsultation in the first 3 months was associated with baseline pain interference (relative risk ratio 5.33; 95% CI 3.23 to 8.80) and spinal pain (1.75; 1.09 to 2.82), and after 3–6 months with baseline assessment by a hospital specialist (2.06; 1.13 to 3.75). Small mean improvements were seen in physical function (1.88; 95% CI 1.44 to 2.32) and body pain (3.86; 3.38 to 4.34) at 6 months. Poor physical function at 6 months was associated with obesity, chronic pain and poor baseline physical function. Mean (SD) 6-month cost and QALYs per patient were £422.40 (660.11) and 0.257 (0.144), respectively.

Conclusions While most patients are appropriate for a ‘one-stop shop’ model, those with troublesome, disabling pain and spinal pain commonly reconsult and have ongoing problems. Services should be configured to identify and address such clinical complexity.


Original languageEnglish
Article numbere011735
JournalBMJ open
Issue number10
Publication statusPublished - 1 Oct 2016


  • Primary-secondary care interface , Musculoskeletal, Outcome , Pain , Healthcare costs