Using big data to prevent back pain and other musculoskeletal conditions

At the Centre for Big Data Research in Health (CBDRH), we address musculoskeletal conditions including osteoarthritis and back pain. These affect around 30 per cent of Australians and are a leading cause of ill health and disability. 

Our research in musculoskeletal conditions uses multiple sources of big data, including hospital, Medicare and pharmaceutical records to tackle questions including:

  • How common are infections following joint replacement procedures? 

  • Do outcomes of hip replacement vary according to the surgical approach used?

  • How do pathways of care and outcomes for joint replacement surgery vary between urban and rural patients?

  • What are the trends in surgery for back pain, and how do these vary according to source of funding?

Project: Low back pain

Degenerative spinal disorders and associated chronic back and leg pain is common amongst the general population and its workers. Patients seek surgical care when non-surgical management fails. 

Despite the controversies around evidence-based benefits of spinal surgery for degenerative conditions, the uptake of surgery has increased substantially across the world in the past decades. This could be partly explained by an aging population, the overuse of diagnostic imaging, a lack of consensus on surgery indication, the perceived benefits of advanced medical technology and inadequate research evidence on the effectiveness of surgery. 

Australian data indicates that the use of surgery was disproportionately higher for those with private health insurance, suggesting an influence of financial incentives and issues with equity access to surgical intervention. Similarly, a rise in the rates of surgery and associated costs was also reported among Workers’ Compensation-insured population, with less than 40 per cent returning to work at full capacity.  

Data from public hospitals show variations by the type of surgery performed. These findings were drawn from segmented data sources, hence limiting our ability to comprehensively examine the surgery uptake trajectory and patient outcomes across populations (i.e., public, private and Workers Compensation). 

This program of work will analyse admitted patient data in NSW across 19 years (2001–2020) together with linked records of mortality, MBS and PBS claims data to investigate trends in spinal procedures; health outcomes including readmissions, reoperation and mortality; post-operative use of pain management medications and; community-based health services. 

The findings will shed light to informed decisions around clinical care and public debates that help reform policies and clinical guidelines. 

Project: Enhancing joint replacement outcomes through registry linkage with national health administrative and clinical registry data in Australia

There are almost 110,000 hip, knee and shoulder replacements undertaken each year. The incidence of these procedures has increased rapidly in recent years and that increase is expected to continue.

This study involves the analysis of a new and unique national dataset with the purpose of further enhancing the outcome of hip, knee and shoulder replacement surgery. It builds on the recognised success of the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR).

Although the AOANJRR has been very successful at improving the outcome of joint replacement surgery in this country it is currently only able to report on two outcomes: revision and mortality. There is a much wider range of complications that can occur, contributing to significant ongoing morbidity and cost.

This new data set of more than one million patients combines the entire AOANJRR data set (1999–2015) through case level linkage to MBS, PBS and state hospital databases. This data linkage enhances the capacity of the AOANJRR to report on an expanded range of outcomes.

The analysis of these data will be able to identify national, regional and hospital incidence trends and variations for a wide range of previously unreported complications. In addition, it is planned to identify the effects of patient, surgical, implant, surgeon, hospital, pharmacological and disease related factors on a range of specific local and systemic complications.

Understanding the relative importance and interaction of these factors and how the effects can be modified in patient populations is critically important to identifying and implementing best practice. In addition, this study will define and describe the use of rehabilitation, as well as the frequency of rehospitalisation and emergency room encounters post-surgery to more completely assess the extent of health resource utilisation associated with joint replacement surgery.