Predictors of Outcome in Neck and Shoulder Symptoms: A Cohort Study in General Practice

Study Design. An observational prospective cohort study in general practice. Objectives. To describe the clinical course and to identify 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 clinical course and predictors of outcome in neck and shoulder 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, sociodemographic and psychological factors, social support, physical activity, general health, and comorbidity were investigated 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 patients reported recovery at 3 months and 32% reported recovery at 12-month follow-up. Duration of the symptoms before consulting the GP and a history of neck or shoulder symptoms increased the probability of an unfavorable outcome. Furthermore, less vitality and more worrying were consistently associated with poorer outcome after 3 and 12 months. The area under the receiver-operator characteristic curve for the model predicting recovery 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.

[1]  M McCaldin,et al.  General Practice , 2005, Journal of the Royal Army Medical Corps.

[2]  J. Bensing,et al.  Monitoring health inequalities through general practice: the Second Dutch National Survey of General Practice. , 2005, European journal of public health.

[3]  P. Onghena,et al.  Fear of Movement/(Re)injury in Chronic Low Back Pain: Education or Exposure In Vivo as Mediator to Fear Reduction? , 2005, The Clinical journal of pain.

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

[5]  L. Bouter,et al.  Prognostic factors for neck pain in general practice , 2004, Pain.

[6]  G. Crombez,et al.  Confirmatory Factor Analysis of the Tampa Scale for Kinesiophobia: Invariant Two-Factor Model Across Low Back Pain Patients and Fibromyalgia Patients , 2004, The Clinical journal of pain.

[7]  J. Jacobs,et al.  Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis. , 2003, Behaviour research and therapy.

[8]  D E Grobbee,et al.  External validation is necessary in prediction research: a clinical example. , 2003, Journal of clinical epidemiology.

[9]  C. Terwee,et al.  Determinants of the clinical course of musculoskeletal complaints in general practice: design of a cohort study , 2003, BMC musculoskeletal disorders.

[10]  J. Vlaeyen,et al.  Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. , 2002, American journal of epidemiology.

[11]  E. Skargren,et al.  Prognostic factors for perceived pain and function at one-year follow-up in primary care patients with neck pain , 2002, Disability and rehabilitation.

[12]  J. Fritz,et al.  The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status , 2001, Pain.

[13]  S. Linton.  Occupational Psychological Factors Increase the Risk for Back Pain: A Systematic Review , 2001, Journal of Occupational Rehabilitation.

[14]  S. Linton,et al.  A cognitive-behavioral group intervention as prevention for persistent neck and back pain in a non-patient population: a randomized controlled trial , 2001, Pain.

[15]  S. Linton,et al.  Can Chronic Disability Be Prevented?: A Randomized Trial of a Cognitive-Behavior Intervention and Two Forms of Information for Patients With Spinal Pain , 2000, Spine.

[16]  M. Hough,et al.  The impact of passive coping on rheumatoid arthritis pain. , 2000, Rheumatology.

[17]  J. Vlaeyen,et al.  Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art , 2000, Pain.

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

[19]  C. Manniche,et al.  The Copenhagen Neck Functional Disability Scale: a study of reliability and validity. , 1998, Journal of manipulative and physiological therapeutics.

[20]  S. Keinänen-Kiukaanniemi,et al.  Patients with neck and shoulder complaints and multisite musculoskeletal symptoms--a prospective study. , 1997, The Journal of rheumatology.

[21]  R. Deyo,et al.  Predicting Poor Outcomes for Back Pain Seen in Primary Care Using Patients' Own Criteria , 1996, Spine.

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

[23]  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.

[24]  P. Onghena,et al.  Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance , 1995, Pain.

[25]  P. Williams,et al.  Physical activity and public health. , 1995, JAMA.

[26]  A. Burton,et al.  Psychosocial Predictors of Outcome in Acute and Subchronic Low Back Trouble , 1995, Spine.

[27]  K. Patrick,et al.  Physical Activity and Public Health: A Recommendation From the Centers for Disease Control and Prevention and the American College of Sports Medicine , 1995 .

[28]  L. Klenerman,et al.  The Prediction of Chronicity in Patients With an Acute Attack of Low Back Pain in a General Practice Setting , 1995, Spine.

[29]  J. Katz,et al.  A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. , 1993, The Journal of bone and joint surgery. American volume.

[30]  G. Waddell,et al.  A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability , 1993, Pain.

[31]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[32]  S. Mior,et al.  The Neck Disability Index: a study of reliability and validity. , 1991, Journal of manipulative and physiological therapeutics.

[33]  Douglas G. Altman,et al.  Practical statistics for medical research , 1990 .

[34]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.

[35]  F. Kraaimaat,et al.  Pain-coping strategies in chronic pain patients: Psychometric characteristics of the pain-coping inventory (PCI) , 2003, International journal of behavioral medicine.

[36]  Peter P. Groenewegen,et al.  De tweede Nationale Studie naar ziekten en verrichtingen in de huisartsenpraktijk: aanleiding en methoden , 2001 .

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

[38]  G. Crombez,et al.  The tampa scale for kinesiophobia: psychometric characteristics and norms , 2000 .

[39]  T. Koepsell,et al.  Predicting long-term functional limitations among back pain patients in primary care settings. , 1997, Journal of clinical epidemiology.

[40]  Andrea W. M. Evers,et al.  Pijncoping-strategieën bij chronische pijnpatiënten: De ontwikkeling van de Pijn-Coping-Inventarisatielijst (PCI) , 1997 .

[41]  Markus Voelter,et al.  State of the Art , 1997, Pediatric Research.

[42]  American College of Sports Medicine position stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. , 1990, Medicine and science in sports and exercise.

[43]  P. Stratford.  Extensor carpi radialis tendonitis : A validation of selected outcome measures , 1987 .