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Rheumatology Advance Access published online on June 24, 2006
Rheumatology, 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
Received January 20, 2006
Accepted April 7, 2006

Original Papers

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

A. Feleus 1, S. M. A. Bierma-Zeinstra 2 *, H. S. Miedema 3, A. P. Verhagen 2, A. P. Nauta 4, A. Burdorf 5, J. A. N. Verhaar 6, and B. W. Koes 2

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

* To whom correspondence should be addressed.
S. M. A. Bierma-Zeinstra, 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.

Keywords: Arm; Neck; Shoulder; Prognosis; Primary care.
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