Abstract
Background Nontraumatic complaints of arm, neck, and shoulder (CANS) represent an important health issue, with a high prevalence in the general working age population and huge economic impact. Nevertheless, only few prospective cohort studies for the outcome of CANS are available.
Objectives The purpose of this study was to identify disability trajectories and associated prognostic factors during a 2-year follow-up of patients with a new episode of CANS in primary care.
Design This was a prospective cohort study.
Methods Data of 682 participants were collected through questionnaires at baseline and every 6 months thereafter. Disability was measured with the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Latent class growth mixture (LCGM) modeling was used to identify clinically meaningful groups of patients who were similar in their disability trajectory during follow-up. Multivariate multinomial regression analysis was used to evaluate associations between sociodemographic, complaint-related, physical, and psychosocial variables and the identified disability trajectories.
Results Three disability trajectories were identified: fast recovery (67.6%), modest recovery (23.6%), and continuous high disability (8.8%). A high level of somatization was the most important baseline predictor of continuous high disability. Furthermore, poor general health, widespread complaints, and medium level of somatization were associated with this trajectory and >3 months complaint duration, musculoskeletal comorbidity, female sex, history of trauma, low educational level, low social support, and high complaint severity were associated with both continuous high disability and modest recovery. Age, kinesiophobia, and catastrophizing showed significant associations only with modest recovery.
Limitations Loss to follow-up ranged from 10% to 22% at each follow-up measurement. Disabilities were assessed only with the DASH and not with physical tests. Misclassification by general practitioners regarding specific or nonspecific diagnostic category might have occurred. The decision for optimal LCGM model, resulting in the disability trajectories, remains arbitrary to some extent.
Conclusions Three trajectories described the course of disabilities due to CANS. Several prognostic indicators were identified that can easily be recognized in primary care. As some of these prognostic indicators may be amenable for change, their presence in the early stages of CANS may lead to more intensive or additional interventions (eg, psychological or multidisciplinary therapy). Further research focusing on the use of these prognostic indicators in treatment decisions is needed to further substantiate their predictive value.
Footnotes
Dr Miedema, Dr Feleus, Professor Bierma-Zeinstra, Professor Burdorf, and Professor Koes were responsible for the initial idea to conduct a prospective cohort study in primary care in order to study the course and outcome of patients with CANS. Together they were responsible for the study design, choice of measures, and content of questionnaires. Dr Miedema is guarantor for the part of the study described in this article. Dr Feleus conducted data collection under the supervision of Professor Bierma-Zeinstra, Dr Miedema, and Professor Koes. Dr Feleus, Professor Bierma-Zeinstra, and Professor Koes were involved in organization of the network of GPs who participated in the study. Dr Miedema, Dr Feleus, Professor Burdorf, and Professor Koes were responsible for the planning of the analyses of the 2-year follow-up data. Dr Hoekstra was consulted for specific advice regarding use of LCGM and the Mplus software. Dr Miedema and Dr Feleus constructed the design and syntaxes for the analyses using Mplus and SPSS software. Dr Miedema performed all analyses for this study and drafted the manuscript. Dr Hoekstra was consulted about the output of Mplus software and the choice of the final LCGM model. All authors were involved in discussions on the study results, commented on drafts of the manuscript, and approved the final version.
The authors thank the participating GPs and the patients for their valuable contribution to this study.
The Medical Ethical Committee of Erasmus University Medical Center approved the study.
This study was supported by internal funding from Erasmus University Medical Center, Rotterdam, and the Rotterdam University of Applied Sciences.
- Received April 20, 2015.
- Accepted November 22, 2015.
- © 2016 American Physical Therapy Association
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