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Rheumatology Advance Access originally published online on June 24, 2006
Rheumatology 2007 46(1):169-176; doi:10.1093/rheumatology/kel164
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Prognostic indicators for non-recovery of non-traumatic complaints at arm, neck and shoulder in general practice—6 months follow-up

A. Feleus1,2, S. M. A. Bierma-Zeinstra1, H. S. Miedema2, A. P. Verhagen1, A. P. Nauta3, A. Burdorf4, J. A. N. Verhaar5 and B. W. Koes1

1Department of General Practice, Erasmus MC, Rotterdam, 2Netherlands Expert Center for Workrelated Musculoskeletal Disorders, Erasmus MC, Rotterdam, 3The Netherlands Society of Occupational Medicine, Centre of Excellence, Utrecht, 4Department of Public Health, Erasmus MC, Rotterdam and 5Department of Orthopaedics, Erasmus MC, Rotterdam, The Netherlands.

Correspondence to: S. M. A. Bierma-Zeinstra, Department of General Practice, Room Ff 320, Erasmus Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. E-mail: s.bierma-zeinstra{at}erasmusmc.nl


  Abstract

Objectives. To identify predictors of non-recovery in non-traumatic complaints at the arm, neck and shoulder in general practice 6 months after the first consultation.

Methods. A prospective cohort study was set in 21 Dutch general practices. Consulters with a first or new episode of non-traumatic arm, neck or shoulder complaints and age 18 through 64 yrs entered the cohort. Complaint, patient, physical, psychosocial and work characteristics were investigated as possible predictors of non-recovery at 6 months using multiple logistic regression analyses (backward Wald).

Results. At 6 months, 46% of the total population (n = 612) and 42% of the working subpopulation (n = 473) still reported complaints. Complaint characteristics (long duration of the complaint before consultation, recurrent complaint, musculoskeletal comorbidity and complaint mainly located at wrist or hand) were most predictive of non-recovery followed by psychosocial characteristics (more somatization and experiencing less social support). Having a specific diagnosis was associated with recovery. In the working subpopulation, the same variables were predictors of non-recovery. Additionally, low supervisory support was associated with non-recovery. The models correctly classified 72–75% of the patients (explained variance 0.27–0.28).

Conclusions. Besides questions on complaint characteristics, information on somatization and support can help a general practitioner to recognize patients at risk of persistent complaints.

KEY WORDS: Arm, Neck, Shoulder, Prognosis, Primary care


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