Objective: To identify which users of a self-management app for musculoskeletal pain are more likely to utilize secondary healthcare (i.e., specialist services within the musculoskeletal domain following primary care referrals).

Study design: Cohort study with one-year follow-up.

Methods: Data on secondary healthcare utilization was collected from the Danish National Patient Register. Potential risk factors were collected from the Danish Population Statistics Register and the TrainAwayPain application (TAP app) which is designed to support musculoskeletal pain self-management. Univariate negative binomial regression models were applied to identify differences in the frequency of secondary healthcare contacts due to musculoskeletal pain in the 12 months following app download. Results were reported as incidence rate ratios (IRRs).

Results: We observed higher utilization of secondary healthcare among females (IRR 1.32 (95 %CI 1.19-1.46)), older (IRR 1.03 (95 %CI 1.02-1.03)), those with short-cycle higher education (IRR 1.91 (95 %CI 1.61-2.26)), residents of the Region of Southern Denmark (IRR 1.82 (95 %CI 1.48-2.24)), those experiencing hip pain (IRR 1.63 (95 %CI 1.33-2.00)), and those with long-term pain (IRR 2.31 (95 %CI 2.06-2.62)). By contrast, lower rates of secondary healthcare utilization were noted among app users with higher musculoskeletal health status (IRR 0.95, (95 %CI 0.95-0.96)). These comparisons are relative to app users who are male, younger, live in the North Denmark Region, have neck pain, and experience pain <1 month.

Conclusion: Those who most likely seek secondary healthcare may be female, older, not from the Northern part of Denmark, experiencing peripheral joint pain rather than spinal pain, have longer symptom duration, and more severe symptoms.

Keywords: Musculoskeletal pain; Secondary healthcare; Self-management; Telemedicine.

Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.

目标： 确定哪些使用肌肉骨骼疼痛自我管理应用程序的用户更有可能利用二级医疗服务（即，初次诊疗后的肌肉骨骼专科服务）。

研究设计： 一年随访队列研究。

方法： 从丹麦国家患者登记处收集了关于二次医疗保健利用的数据。潜在的风险因素来自丹麦人口统计学注册和TrainAwayPain应用程序（TAP应用），该应用旨在支持肌肉骨骼疼痛的自我管理。使用单变量负二项回归模型来识别在下载应用程序后12个月内因肌肉骨骼疼痛而进行的二级医疗服务频率差异，结果以发病率比值（IRRs）报告。

结果： 我们观察到女性、老年人群、短期周期高等教育人群以及来自南丹麦地区的居民使用二次医疗保健服务较多（IRR分别为1.32 (95 %CI 1.19-1.46)、1.03 (95 %CI 1.02-1.03)、1.91 (95 %CI 1.61-2.26)和1.82 (95 %CI 1.48-2.24)）。同样，髋关节疼痛（IRR 1.63 (95 %CI 1.33-2.00)）和长期疼痛（IRR 2.31 (95 %CI 2.06-2.62)）的患者使用二次医疗服务也更多。相比之下，具有较高肌肉骨骼健康状况的应用程序用户则较少使用二级医疗保健服务（IRR 0.95 (95 %CI 0.95-0.96)）。这些对比均以男性、年轻人、北丹麦地区居民以及颈部疼痛且经历1个月以内疼痛的用户为参照。

结论： 最有可能寻求二级医疗服务的人群可能是女性，年龄较大，不是来自丹麦北部地区的居民，患有外周关节痛而非脊柱痛，并且症状持续时间较长和更为严重。

关键词： 肌肉骨骼疼痛；二次医疗保健；自我管理；远程医疗。