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Disability Trajectories in Patients With Complaints of Arm, Neck, and Shoulder (CANS) in Primary Care: Prospective Cohort Study

Harald S. Miedema, Anita Feleus, Sita M.A. Bierma-Zeinstra, Trynke Hoekstra, Alex Burdorf, Bart W. Koes
DOI: 10.2522/ptj.20150226 Published 1 July 2016
Harald S. Miedema
H.S. Miedema, MD, MSc, Research Center Innovations in Care, Rotterdam University of Applied Sciences, Room RS 02.123, PO Box 25035, 3001 HA Rotterdam, the Netherlands, and Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
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Anita Feleus
A. Feleus, PT, PhD, MSc, Research Center Innovations in Care, Rotterdam University of Applied Sciences.
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Sita M.A. Bierma-Zeinstra
S.M.A. Bierma-Zeinstra, PT, PhD, MSc, Department of General Practice, Erasmus University Medical Center.
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Trynke Hoekstra
T. Hoekstra, PhD, MSc, EMGO Institute for Health and Care Research, Free University Medical Center, Amsterdam, the Netherlands.
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Alex Burdorf
A. Burdorf, PhD, MSc, Department of Public Health, Erasmus University Medical Center.
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Bart W. Koes
B.W. Koes, PhD, MSc, Department of General Practice, Erasmus University Medical Center.
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Figures

Figure 1.
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Figure 1.

Three disability trajectories in patients with complaints of the arm, neck, and shoulder (CANS) in primary care. DASH=Disabilities of the Arm, Shoulder and Hand questionnaire.

Figure 2.
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Figure 2.

Observed variability within each trajectory in a 15% random sample. DASH=Disabilities of the Arm, Shoulder and Hand questionnaire.

Tables

Table 2.
Table 2.

Level of Disability Due to CANS at Baseline and Follow-upa

  • ↵a CANS=complaints of arm, neck, and shoulder; DASH=Disabilities of the Arm, Shoulder and Hand questionnaire.

Table 4.
Table 4.

Multivariate Multinomial Regression Analysis for Characteristics of Disability Trajectoriesa

  • ↵a OR=odds ratio; CI=confidence interval; SF-12=12-Item Short-Form Health Survey; 4DSQ=Four-Dimensional Symptom Questionnaire; TSK=Tampa Scale for Kinesiophobia; CSQ-catastrophizing=Coping Strategy Questionnaire catastrophizing scale; SSQ=Social Support Questionnaire. Explained variance (Nagelkerke R2=0.544). Percentage correctly predicted overall: 76.8% (91.5% within fast recovery group, 42.2% within modest recovery group, and 55.9% within continuous high disability group). See Method section of text for measures that were utilized. Model without SF-12 Mental Component Scale because of the high correlation (.67) with distress score (4DSQ). Fast recovery group is reference group for multinomial regression analysis. Cutoff points for dichotomous variables are defined by median score of the total population. The variables of paid work, no sports participation, recurrent complaints, nonmusculoskeletal comorbidity, low health locus of control, and distress (4DSQ) were removed from the model.

Table 1.
Table 1.

Determinants of Nonresponse at the 4 Follow-up Measurementsa

  • ↵a OR=odds ratio; CI=confidence interval; SF-12 MCS=12-Item Short-Form Health Survey Mental Component Scale; SF-12 PCS=12-Item Short-Form Health Survey Physical Component Scale; DASH=Disabilities of the Arm, Shoulder and Hand questionnaire; 4DSQ=Four-Dimensional Symptom Questionnaire. See Method section of text for measures that were utilized, included in the models education, body mass index, paid work, specific diagnosis, region of most complaints, widespread complaints (3 regions), recurrent complaint, complaint duration, complaint severity previous week, nonmusculoskeletal comorbidity, low general health, physical limitations (DASH and SF-12 PCS; not tested with DASH simultaneously due to high correlation; same other variables in model), somatization and distress (4DSQ), mental limitations (SF-12 MCS; not tested with 4DSQ distress scale simultaneously due to high correlation; same other variables in model), high kinesiophobia, high catastrophizing, low social support, and low health locus of control.

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Table 3.

Characteristics of the Disability Trajectories and Results of Univariate Multinomial Regression Analysisa

  • ↵a OR=odds ratio; CI=confidence interval; NRS=numeric rating scale; SF-12 MCS=12-Item Short-Form Health Survey Mental Component Scale; SF-12 PCS=12-Item Short-Form Health Survey Physical Component Scale; DASH=Disabilities of the Arm, Shoulder and Hand questionnaire; 4DSQ=Four-Dimensional Symptom Questionnaire; TSK=Tampa Scale for Kinesiophobia; CSQ-catastrophizing=Coping Strategy Questionnaire catastrophizing subscale; SSQ=Social Support Questionnaire. See Method section of text for measures that were utilized. Fast recovery group is reference group for multinomial regression analysis. Cutoff points for dichotomous variables are defined by median score of the total population.

  • b 1 missing questionnaire.

  • c 2 missing questionnaires.

  • d In 12 cases with complaints at multiple locations without most painful location, neck-shoulder-forearm was chosen if present; otherwise, hand-wrist was chosen.

  • e 4 missing questionnaires.

  • f 5 missing questionnaires.

  • g 22 missing questionnaires.

Supplementary Data

eTables

Files in this Data Supplement:

  • eTables (PDF) (47 KB) - This PDF contains the following supplements:
    • eTable 1. Specific and Nonspecific Disorders of the Complaints of Arm, Neck, and Shoulder (CANS) Model
    • eTable 2. Specific Diagnoses Made by the General Practitioners in the Study
    • eTable 3. Latent Class Growth Mixture Model Fit Indexes
    • eTable 4. Work-Related Characteristics of the Disability Trajectories and Univariate Associations Within the Working Population
    • eTable 5. Parsimonious Model Resulting From the Multivariate Multinomial Regression Analysis for Characteristics of Disability Trajectories and Selection of Key Factors
    • eTable 6. Comparison of Study Results Regarding Prognostic Indicators for Unfavorable Outcome With the Literature/li>
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Vol 96 Issue 7 Table of Contents
Physical Therapy: 96 (7)

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  • Physical Therapy Residency and Fellowship Education: Reflections on the Past, Present, and Future
  • Prognostic Models in Adults Undergoing Physical Therapy for Rotator Cuff Disorders: Systematic Review
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  • Locomotor Performance During Rehabilitation of People With Lower Limb Amputation and Prosthetic Nonuse 12 Months After Discharge
  • Physical Therapists' Use of Functional Electrical Stimulation for Clients With Stroke: Frequency, Barriers, and Facilitators
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Disability Trajectories in Patients With Complaints of Arm, Neck, and Shoulder (CANS) in Primary Care: Prospective Cohort Study
Harald S. Miedema, Anita Feleus, Sita M.A. Bierma-Zeinstra, Trynke Hoekstra, Alex Burdorf, Bart W. Koes
Physical Therapy Jul 2016, 96 (7) 972-984; DOI: 10.2522/ptj.20150226

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Disability Trajectories in Patients With Complaints of Arm, Neck, and Shoulder (CANS) in Primary Care: Prospective Cohort Study
Harald S. Miedema, Anita Feleus, Sita M.A. Bierma-Zeinstra, Trynke Hoekstra, Alex Burdorf, Bart W. Koes
Physical Therapy Jul 2016, 96 (7) 972-984; DOI: 10.2522/ptj.20150226
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Show more Musculoskeletal

Subjects

  • Psychosocial
    • Psychosocial: Other
  • Musculoskeletal System/Orthopedic
    • Injuries and Conditions: Shoulder
    • Injuries and Conditions: Upper Extremity
    • Injuries and Conditions: Neck
  • Diagnosis/Prognosis
    • Diagnosis/Prognosis: Other

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