The results found in this study indicate that besides clinical characteristics, psychological factors also predict the outcome of neck and shoulder symptoms.

Objective. Patients frequently present with knee complaints in general practice. Information about the course and prognosis of knee complaints is needed to inform patients and facilitate decisions on referral and treatment. The objective of the study was to assess the course of knee complaints and to identify predictors of outcome in patients visiting their general practitioner with a new episode of knee complaints. Methods. Data were collected by means of self-administered questionnaires. After 3 and 12 months of followup, the following outcomes were assessed: perceived recovery, change in pain, and change in physical functioning. As potential predictors of outcome, several sociodemographic variables, characteristics of the symptom, baseline scores of the outcome measures, and intra-and extra-individual variables were analyzed using multiple regression analyses. Results. We included 251 patients with a new episode of knee complaints presented in general practice. Only 25% reported recovery after 3 months, increasing to 44% after 12 months. A history of knee complaints, a longer duration of the current episode of knee complaints, other coexisting musculoskeletal complaints, and a higher level of distress were associated with a worse prognosis. In the linear regression models, 41-53% of the variance in pain reduction and improvement in functioning could be explained by the predictors. The area under the receiver operating characteristic curves, estimating the predictive accuracy of the Cox regression models concerning perceived recovery, was 0.77 after 3 months and 0.72 after 12 months. Conclusion. Many patients did not recover after 12 months. Distress was found to be strongly associated with less pain reduction and less improvement in functioning.

Both incidences of and consultation rates for lower extremity complaints are substantial in general practice. This implies a considerable impact on the workload of the GP.

Objectives: The purpose of this review is to summarize the available evidence on the impact of nontraumatic hip or knee disorders on health-related quality of life (HRQL), as measured with the Short Form 36 Health Survey (SF-36) or Short Form 12 Health Survey (SF-12), by comparing this with data from reference populations. Methods: Studies were identified by an electronic search of the MEDLINE, PsychInfo and Cinahl databases. Studies with the following features were included: study population included patients with non-traumatic hip or knee disorders, the SF-36 or SF-12 was used as an outcome measure and mean scores on these HRQL measures were presented. Using mean HRQL scores from the selected studies and scores from reference populations, z-scores were computed. Pooled estimates were computed for subgroups of studies with similar patients in similar settings. Results: A total of 40 studies met the inclusion criteria. Patients with non-traumatic hip and knee disorders scored up to 2.5 standard deviations (SDs) below reference population values, especially on the physical aspects of HRQL. Social and mental aspects were up to 1 SD below reference population values, especially in patients in clinical settings. Conclusions: The impact of non-traumatic hip or knee disorders on HRQL is substantial, especially on the physical aspects of HRQL.

Background: Information about quality of life of patients with chronic hip or knee complaints in general practice is scarce. This study describes the health-related and overall quality of life (HRQL) of these complaints. Methods: Data were obtained from a cohort study in general practice. HRQL at three months follow-up was analysed. HRQL was measured as: symptoms, physical, psychological and social functioning, and general health perceptions, using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the MOS 36-item short-form-health survey (SF-36). Overall quality of life was measured using a 5-point rating scale. Results: The results show that patients with chronic hip or knee complaints have a substantial lower HRQL compared to patients who had recovered from baseline hip or knee complaints. The largest effect was found on symptoms and physical functioning: up to 2.9 standard deviations below patients who had recovered from baseline hip or knee complaints. Scores of patients with both chronic hip and knee complaints were significantly worse than scores of patients with only knee complaints on most subscales. Conclusion: In patients with chronic hip or knee complaints the worst scores were seen on scales that measure symptoms and physical functioning, but still a substantially lower score was obtained for overall quality of life. Quality of life was poorer for patients with both chronic hip and knee complaints compared to those with chronic hip or knee complaints only.

BackgroundMusculoskeletal complaints are frequent and have large consequences for public health. Information about the prognosis after presentation in general practice is far from complete. Knowledge about determinants of the clinical course of musculoskeletal complaints is essential for management decisions and to inform patients about their prognosis. The purpose of this study is to provide information about the prognosis of musculoskeletal complaints other than low back pain by studying the course of these complaints in general practice and to identify determinants of this course.MethodsPatients of 18 years and older, who present in general practice with a new episode of a musculoskeletal complaint of the neck, shoulder, elbow, wrist, hand, arm, hip, knee, ankle or foot, are recruited by their general practitioner (GP). Participants will receive complaint-specific questionnaires by mail at baseline and after 3, 6, 12 and 18 months. The following putative determinants of the course of the complaints will be investigated: sociodemographic characteristics, characteristics of the complaint, psychosocial job characteristics, physical workload, physical activity during leisure time, pain coping, mood, kinesiophobia, social support, optimism. The primary outcomes are perceived recovery, pain, functional status, sick leave and overall quality of life.

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