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bouter et al spine 2005

bouter et al spine 2005 - SPINE Volume 30 Number 16 pp E459...

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SPINE Volume 30, Number 16, pp E459–E470 ©2005, Lippincott Williams & Wilkins, Inc. Predictors of Outcome in Neck and Shoulder Symptoms A Cohort Study in General Practice Sandra D.M. Bot, MSc,* Johanna M. van der Waal, MSc,* Caroline B. Terwee, PhD,* Danie ¨lle A.W.M. van der Windt, PhD,*† Rob J.P.M. Scholten, MD, PhD,‡ Lex M. Bouter, PhD,* and Joost Dekker, PhD* § Study Design. An observational prospective cohort study in general practice. Objectives. To describe the clinical course and to iden- tify predictors of recovery, changes in pain intensity, and changes in functional disability in patients with neck or shoulder symptoms at 3- and 12-month follow-up. Summary of Background Data. Knowledge on the clin- ical course and predictors of outcome in neck and shoul- der symptoms is limited. Such knowledge would facilitate treatment decisions and may help to inform patients about their prognosis. Methods. Four hundred and forty-three patients who consulted their general practitioner with neck or shoulder symptoms participated in the study. Baseline scores of pain and disability, symptom characteristics, sociodemo- graphic and psychological factors, social support, physi- cal activity, general health, and comorbidity were inves- tigated as possible predictors of recovery, changes in pain intensity, and changes in functional disability using multiple regression analyses. Results. The recovery rate was low; 24% of the pa- tients reported recovery at 3 months and 32% reported recovery at 12-month follow-up. Duration of the symp- toms before consulting the GP and a history of neck or shoulder symptoms increased the probability of an unfa- vorable outcome. Furthermore, less vitality and more worrying were consistently associated with poorer out- come after 3 and 12 months. The area under the receiver- operator characteristic curve for the model predicting re- covery was 0.8 at 3 months and 0.75 at 12 months. The explained variance of the models on pain and functional disability ranged from 43 to 54%. Conclusions. The results found in this study indicate that besides clinical characteristics, psychological factors also predict the outcome of neck and shoulder symptoms. Key words: prognosis, neck, shoulder, recovery, pain, disability, general practice. Spine 2005;30:E459–E470 Musculoskeletal symptoms of the neck and shoulder are frequently presented in general practice. The annual con- sulting incidence in Dutch general practice for neck symptoms has been estimated at 23.1 per 1000 person years and for shoulder symptoms at 19.0 per 1000 per- son years. 1 In the Netherlands, GPs are consulted 101 times annually per 1000 registered persons for neck or shoulder symptoms. 1 Little is known about the clinical course of neck and shoulder symptoms after presentation in general practice. Yet, knowledge on the course may facilitate treatment decisions and may help to inform patients about their prognosis. Knowledge of predictors of outcome should lead to the early identification of those at risk for the development of chronic symptoms.
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