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Unformatted text preview: SPINE Volume 30, Number 16, pp E459E470 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:E459E470 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....
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This note was uploaded on 01/03/2012 for the course C 532 taught by Professor Long during the Fall '11 term at Palmer Chiropractic.
- Fall '11