A prediction rule for shoulder pain related sick leave: a prospective cohort study

BackgroundShoulder pain is common in primary care, and has an unfavourable outcome in many patients. Information about predictors of shoulder pain related sick leave in workers is scarce and inconsistent. The objective was to develop a clinical prediction rule for calculating the risk of shoulder pain related sick leave for individual workers, during the 6 months following first consultation in general practice.MethodsA prospective cohort study with 6 months follow-up was conducted among 350 workers with a new episode of shoulder pain. Potential predictors included the results of a physical examination, sociodemographic variables, disease characteristics (duration of symptoms, sick leave in the 2 months prior to consultation, pain intensity, disability, comorbidity), physical activity, physical work load, psychological factors, and the psychosocial work environment. The main outcome measure was sick leave during 6 months following first consultation in general practice.ResultsResponse rate to the follow-up questionnaire at 6 months was 85%. During the 6 months after first consultation 30% (89/298) of the workers reported sick leave. 16% (47) reported 10 days sick leave or more. Sick leave during this period was predicted in a multivariable model by a longer duration of sick leave prior to consultation, more shoulder pain, a perceived cause of strain or overuse during regular activities, and co-existing psychological complaints. The discriminative ability of the prediction model was satisfactory with an area under the curve of 0.70 (95% CI 0.64–0.76).ConclusionAlthough 30% of all workers with shoulder pain reported sick leave during follow-up, the duration of sick leave was limited to a few days in most workers. We developed a prediction rule and a score chart that can be used by general practitioners and occupational health care providers to calculate the absolute risk of sick leave in individual workers with shoulder pain, which may help to identify workers who need additional attention. The performance and applicability of our model needs to be tested in other working populations with shoulder pain to enable valid and reliable use of the score chart in everyday practice.

[1]  L. Bouter,et al.  Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: randomised trial , 1998, BMJ.

[2]  P. Westerhuis.  Manipulative Therapy in Addition to Usual Medical Care for Patients with Shoulder Dysfunction and Pain - A Randomized, Controlled Trial , 2005 .

[3]  L M Bouter,et al.  Shoulder disorders in general practice: prognostic indicators of outcome. , 1996, The British journal of general practice : the journal of the Royal College of General Practitioners.

[4]  A. J. van der Beek,et al.  Work-related disease in general practice: a systematic review. , 2005, Family practice.

[5]  Alex Burdorf,et al.  Reduced productivity after sickness absence due to musculoskeletal disorders and its relation to health outcomes. , 2005, Scandinavian journal of work, environment & health.

[6]  P. Bongers,et al.  Linear and nonlinear relations between psychosocial job characteristics, subjective outcomes, and sickness absence: baseline results from SMASH. Study on Musculoskeletal Disorders, Absenteeism, Stress, and Health. , 2000, Journal of occupational health psychology.

[7]  Susan A. Murphy,et al.  Monographs on statistics and applied probability , 1990 .

[8]  A. Silman,et al.  Occupational risk factors for shoulder pain: a systematic review , 2000, Occupational and environmental medicine.

[9]  F. Harrell,et al.  Prognostic/Clinical Prediction Models: Multivariable Prognostic Models: Issues in Developing Models, Evaluating Assumptions and Adequacy, and Measuring and Reducing Errors , 2005 .

[10]  G. Bergman.  Manipulative therapy for shoulder complaints in general practice , 2005 .

[11]  C. Terwee,et al.  Incidence and prevalence of complaints of the neck and upper extremity in general practice , 2004, Annals of the rheumatic diseases.

[12]  C. Terwee,et al.  Predictors of Outcome in Neck and Shoulder Symptoms: A Cohort Study in General Practice , 2005, Spine.

[13]  L M Bouter,et al.  Shoulder disability questionnaire design and responsiveness of a functional status measure. , 2000, Journal of clinical epidemiology.

[14]  A Burdorf,et al.  Prevalence and incidence of shoulder pain in the general population; a systematic review , 2004, Scandinavian journal of rheumatology.

[15]  A. Silman,et al.  The clinical course of shoulder pain: prospective cohort study in primary care , 1996, BMJ.

[16]  David W. Hosmer,et al.  Applied Logistic Regression , 1991 .

[17]  W. Schaufeli,et al.  The four-dimensional symptom questionnaire (4DSQ): measuring distress and other mental health problems in a working population , 2004 .

[18]  I.L.D. Houtman,et al.  Linear and nonlinear relations between psychosocial job characteristics, subjective outcomes, and sickness absence : baseline results from SMASH , 2000 .

[19]  J. Arendzen,et al.  The long-term course of shoulder complaints: a prospective study in general practice. , 1999, Rheumatology.

[20]  G. J. van der Heijden.  Shoulder disorders: a state-of-the-art review. , 1999, Bailliere's best practice & research. Clinical rheumatology.

[21]  S. T. Buckland,et al.  An Introduction to the Bootstrap. , 1994 .

[22]  van der Heijden GJ.  Shoulder disorders: a state-of-the-art review , 1999, Bailliere's clinical rheumatology.

[23]  G. V. D. Heijden.  Shoulder disorders: a state-of-the-art review , 1999, Bailliere's clinical rheumatology.

[24]  Robert Karasek,et al.  Job decision latitude and mental strain: Implications for job redesign , 1979 .

[25]  Jesse A. Berlin,et al.  Assessing the Generalizability of Prognostic Information , 1999 .

[26]  H. D. de Vet,et al.  A patient-specific approach for measuring functional status in low back pain. , 1999, Journal of manipulative and physiological therapeutics.

[27]  A. Burdorf,et al.  Impact of musculoskeletal co-morbidity of neck and upper extremities on healthcare utilisation and sickness absence for low back pain , 2004, Occupational and Environmental Medicine.

[28]  H C de Vet,et al.  Measuring the Functional Status of Patients With Low Back Pain: Assessment of the Quality of Four Disease-Specific Questionnaires , 1995, Spine.

[29]  A J van der Beek,et al.  Pushing and pulling in association with low back and shoulder complaints , 2002, Occupational and environmental medicine.

[30]  L. Bouter,et al.  Systematic review of prognostic cohort studies on shoulder disorders , 2004, Pain.

[31]  E Viikari-Juntura,et al.  A prospective study of work related factors and physical exercise as predictors of shoulder pain , 2001, Occupational and environmental medicine.

[32]  J. Vlaeyen,et al.  Fear of movement/(re)injury and muscular reactivity in chronic low back pain patients: an experimental investigation , 1999, PAIN.

[33]  Cs Neer,et al.  2nd. Impingement lesions. , 1983 .