The impact of painful musculoskeletal conditions on outcomes of dementia

Date of Approval
Application Number
Technical Summary

In people with long-term conditions such as dementia, comorbid musculoskeletal pain is common but often neglected. Musculoskeletal comorbidity could adversely impact outcomes if pain, and associated restricted functioning and sleep interference, prevent or delay delivery of appropriate treatment or reduce its effectiveness. As part of a series of four different clinical cohorts, we wish to investigate whether there is an impact of musculoskeletal comorbidities on outcomes in patients with dementia. Using CPRD Aurum, HES and ONS mortality records, we will analyse data of patients newly diagnosed with dementia and compare patients with a prior painful musculoskeletal condition requiring health care to patients without on the risk of (and time to) hospitalisation, duration of hospitalisation, risk of readmission within or beyond 30 days after discharge, pharmacological interventions for dementia, time to disease progression (including established markers of progression, mortality, first entry onto a palliative care register), resource use and costs. Painful musculoskeletal conditions will be identified from primary care records in the 24-months prior to incident diagnosis of dementia. Negative binomial regression will be used to determine differences in hospital length of stay and number of new markers of progression in the 12 months after dementia diagnosis. Flexible parametric survival models will be used for time to event outcomes (e.g. first hospitalisation, mortality, palliative care). We will assess if impact varies by time of most recent musculoskeletal consultation or pain severity (proxy measures of musculoskeletal referral, analgesia prescription). We will also determine if inequalities exist in these relationships by socioeconomic characteristics (age, ethnicity, deprivation, geographical region), and if relationships differ by type of painful musculoskeletal condition. Our findings will allow assessment of the potential for existing evidence-based management of musculoskeletal pain and associated disability to be targeted at patients to improve outcomes following a diagnosis of dementia.

Health Outcomes to be Measured

i) Time to first admission to hospital (any cause) following incident diagnosis of dementia
ii) Length of stay in hospital based on admission and discharge dates recorded in HES
iii) Readmission to hospital within 30 days of discharge for the same primary reason as initial hospitalisation
iv) Readmission to hospital within 30 days of discharge for any reason
v) (time to) Mortality based on recorded information in linked ONS data
vi) Progression of disease defined as number of new indicators of dementia progression recorded in primary care in the first 12 months after diagnosis as defined in our previous study, addition of additional anti-dementia drugs, and palliative care register entry
vii) Management of index condition based on prescriptions recorded in primary care in the three months following the incident diagnosis. This will include (a) referral to a memory clinic or equivalent, (b) drugs used to slow progression of dementia (such as donepezil, memantine), and (c) drugs used in the behavioural and psychological symptoms of dementia (including antipsychotic agents, benzodiazepines, carbamazepine).
viii) Cumulative health care use and costs over 5 years after index date. Primary care data will include number, type and length of consultations with each health care professional, prescriptions, tests and investigations. Secondary care utilisation includes referral, type of admission, length of stay, diagnosis, and procedures undertaken


Kelvin Jordan - Chief Investigator - Keele University
Kayleigh Mason - Corresponding Applicant - Keele University
Alyson Huntley - Collaborator - University of Bristol
Christian Mallen - Collaborator - Keele University
Felix Achana - Collaborator - University of Oxford
James Bailey - Collaborator - Keele University
John Edwards - Collaborator - Keele University
Mamas Mamas - Collaborator - Keele University
Martin Frisher - Collaborator - Keele University
May Ee Png - Collaborator - University of Oxford
Michelle Marshall - Collaborator - Keele University
Neil Heron - Collaborator - Keele University
Simon White - Collaborator - Keele University
stephen tatton - Collaborator - Keele University


HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation