Physiotherapy and chiropractic healthcare utilization in adults with spinal pain: four-year trajectories of 47,777 Danish individuals

Aim: People with spinal pain use healthcare with considerable variability. We examined how socioeconomic, demographic, and clinical factors relate to physiotherapy and chiropractic care utilization patterns among patients with chronic spinal pain. Subject and methods: We conducted a cohort study using a clinical database from a regional Danish outpatient spine center linked to national registry data, including 47,777 adult patients who consulted the spine center from 2016 to 2021. Latent class growth analysis was used to model quarterly healthcare consultations over 4 years centered around the spine center assessment and stratified by profession. Associations between class membership and socioeconomic, demographic, and clinical factors were analyzed in separate steps using multivariable multinomial logistic regression. Results: A six-class solution was selected for both professions: No visits; Isolated period of visits; Decreasing visits; Increasing visits; Moderate visit frequency; and High visit frequency. Over 90% of patients belonged to No or Isolated visits classes, while the remaining ~ 10% accounted for ~ 50% of all utilization. Physiotherapy was used more frequently and over longer periods than chiropractic. Utilization was more strongly associated with demographic and socioeconomic factors than clinical factors. Danish origin, female sex, higher education, and income were linked to greater use. Physiotherapy use was associated with older age, comorbidity, social welfare, and prior surgery; chiropractic use was associated with employment and private health insurance. Conclusion: Most individuals had limited physiotherapy and chiropractic utilization. Socioeconomic and demographic factors were stronger drivers of utilization patterns than clinical factors, with notable differences between the two professions.