Students' Lifestyle Behaviour and Later Health Care Utilization Due to Musculoskeletal Pain
Condition: Musculoskeletal Pain
MeSH terms: Musculoskeletal Pain
Study type: Observational [Patient Registry]

Summary: 
      This study aims to assess whether there is an association between students' lifestyle
      behaviour, in terms of physical activity level, sleep duration, smoking status, alcohol
      consumption and use of cannabis and other illegal drugs, and later health care utilisation
      due to musculoskeletal pain. The study will combine data from a national survey in Norway
      (SHOT2018), in which all full-time university students in Norway were invited, with data from
      a register on health care utilisation in primary health care.
    

Detailed description: 
      This study aims to determine:

      i) whether male and female university students' lifestyle behaviours, in terms of physical
      activity level, sleep durance, alcohol consumption, smoking and illicit drug use, are
      associated with future health care utilisation for musculoskeletal pain, back pain or neck
      pain, and ii) whether the number of adverse lifestyle behaviours is associated with future
      health care utilisation for musculoskeletal pain, back pain or neck pain.

      Study design and setting:

      Cohort study, in which data from the Students' Health and Wellbeing study (SHoT) is merged
      with data from the Norwegian Register of Primary Health Care (NRPHC).

      The eligibility criteria:

      Inclusion criteria • Participants of the SHoT2018 study (18-35 years of age)

      Exclusion criteria

        -  Participants studying abroad

        -  Participants above 35 years of age

        -  Recent health care utilisation for a musculoskeletal pain diagnosis (the last 12 months
           prior to the exposure assessment)

      Primary outcome:

      - Health care utilisation for musculoskeletal pain in primary health care, registered in the
      NRPHC (follow-up period: 3 years after baseline)

      Secondary outcome:

        -  Health care utilisation for back pain, registered in NRPHC (follow-up period: 3 years
           after baseline)

        -  Health care utilisation for neck pain, registered in NRPHC (follow-up period: 3 years
           after baseline)

      Exposures:

        -  Physical activity, obtained from the SHOT-questionnaire, categorised in accordance with
           recommendations for weekly physical activity

        -  Sleep duration, obtained from the SHOT-questionnaire, categorised in accordance with
           recommendations

        -  Smoking (yes / no)

        -  Alcohol consumption (assessed with AUDIT)

        -  Cannabis (categorised in use the last year yes/no)

        -  Other illegal drug use (categorised in use the last year yes/no)

        -  Number of adverse lifestyle behaviours (0-5) (low physical activity, short sleep
           duration, smoking, risky alcohol use, illegal drug use the last year)

      Potential confounders:

      We will consider to include the following variables as potential confounders in the analyses:
      age, financial difficulties, physical health complaints, symptoms of depression and anxiety,
      musculoskeletal pain, other lifestyle behaviours, consultation frequency irrespective of
      cause, the last year prior baseline (the last will be used as an indicator of health care
      seeking behaviour)

      Statistical analyses:

      We will compute the annual incidence rates (with 95% CI) of health utilisation for
      musculoskeletal pain, back pain and neck pain.

      Crude and adjusted associations between each of the lifestyle behaviours and health care
      utilisation for musculoskeletal pain, back pain and neck pain will be assessed separately.
      Also, the association between the number of adverse lifestyle behaviours and musculoskeletal
      pain, back and neck pain will be assessed in crude and adjusted analyses. Logistic regression
      will be used to analyse the associations with binary outcomes (health care utilisation for
      musculoskeletal pain yes/no). To asses the associations with an outcome variable reflecting
      the number of health care visits for musculoskeletal pain, the exact statistical analysis
      method will be chosen after inspection of the distribution of the outcome data.

      The following sensitivity analyses will be considered:

        -  only including outcome data before 12 March 2020 to assess the associations prior to the
           Covid 19 restrictions

        -  excluding participants above 30 years of age to assess the associations in a sample of
           students withing the "emerging adult" definition (up to 30 years of age)

      All analyses will be conducted with STATA statistical software system, version 16
      (StataCorp., 2019)
    

Intervention name(s): Lifestyle behaviour (exposure in a observational study)
Intervention type(s): Other
Intervention description(s): Lifestyle behaviour, including physical activity, sleep duration, alcohol consumption, smoking, cannabis and other illegal drugs
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        University full-time students, 18-35 years of age