Date of Award

January 2026

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jonathan N. Grauer

Abstract

Background/Scientific Premise: Non-specific lower back pain (LBP) is a major source of disability. Patients with cerebral palsy (CP) have musculoskeletal issues that may predispose them to such back pain, but potential disparities in their rate of LBP diagnosis and treatment utilization remain unclear.

Methods: Using the 2010-2023Q1 PearlDiver M10 database, which included a sample of 10 million random patients within an administrative dataset, the current study identified patients without and with CP and stratified by LBP diagnosis. After matching 2:1 by age, sex, and Elixhauser Comorbidity Index, LBP prevalence, new physical therapy (PT) utilization within 6 months of diagnosis, and lumbar injection utilization were assessed. Temporal trends in LBP diagnosis and treatment utilization were also evaluated across the study period.

Results: From the study population, LBP was less commonly diagnosed for those with CP (5,784/35,667 [16.2%]) than without CP (2,405,096/ 9,964,333 [24.1%]) (p<0.001). After matching, 5,752 CP patients with LBP were compared with 11,488 non-CP patients with LBP. CP patients had higher prior PT utilization (39.3% vs. 25.2%, p<0.001) but no difference in new PT utilization (p=0.215). CP patients had lower utilization of lumbar injection (9.0% vs. 13.2%, p<0.001). Temporal analysis demonstrated LBP diagnoses trended similar for CP and non-CP patients, with LBP diagnoses increasing during the early to mid-study period before declining in later years. Proportional PT utilization, of those diagnosed with LBP each year, remained relatively stable overall, though increased in recent years in the non-CP cohort compared with the CP cohort. Injection utilization increased earlier in the study period before stabilizing.

Conclusions: CP patients were less likely to be diagnosed with LBP and, when diagnosed, less likely to receive injections. It is unclear whether this reflects lower LBP incidence or a bias in evaluation and diagnosis. However, matched patients with CP and LBP were less likely to receive lumbar injections. Further research is needed to explore barriers to diagnosis and pain management access in CP patients.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 07/14/2027

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