Our criteria make a substantial contribution toward defining explicit quality criteria for measurement properties of health status questionnaires. Our criteria can be used in systematic reviews of health status questionnaires, to detect shortcomings and gaps in knowledge of measurement properties, and to design validation studies. The future challenge will be to refine and complete the criteria and to reach broad consensus, especially on quality criteria for good measurement properties.

Objective: To identify all available shoulder disability questionnaires designed to measure physical functioning and to evaluate evidence for the clinimetric quality of these instruments. Methods: Systematic literature searches were performed to identify self administered shoulder disability questionnaires. A checklist was developed to evaluate and compare the clinimetric quality of the instruments. Results: Two reviewers identified and evaluated 16 questionnaires by our checklist. Most studies were found for the Disability of the Arm, Shoulder, and Hand scale (DASH), the Shoulder Pain and Disability Index (SPADI), and the American Shoulder and Elbow Surgeons Standardised Shoulder Assessment Form (ASES). None of the questionnaires demonstrated satisfactory results for all properties. Most questionnaires claim to measure several domains (for example, pain, physical, emotional, and social functioning), yet dimensionality was studied in only three instruments. The internal consistency was calculated for seven questionnaires and only one received an adequate rating. Twelve questionnaires received positive ratings for construct validity, although depending on the population studied, four of these questionnaires received poor ratings too. Seven questionnaires were shown to have adequate test-retest reliability (ICC .0.70), but five questionnaires were tested inadequately. In most clinimetric studies only small sample sizes (n,43) were used. Nearly all publications lacked information on the interpretation of scores. Conclusion: The DASH, SPADI, and ASES have been studied most extensively, and yet even published validation studies of these instruments have limitations in study design, sample sizes, or evidence for dimensionality. Overall, the DASH received the best ratings for its clinimetric properties. F unction of the shoulder has conventionally been assessed with objective measures such as range of motion and strength. However, objective measures can be impractical in some settings, because they are time consuming and require face to face contact. Besides, although shoulder disorders are often associated with restricted range of motion and muscle weakness, these measures have no direct clinical meaning to patients, who just want to be free of pain and perform their daily activities. Nowadays, the efficacy of treatment is more often evaluated using outcomes that are directly relevant to patients. Both in clinical practice and research, using subjective measures that assess the ability to function in daily life ensures that the treatment and evaluations focus on the patient rather than on the disease. In the past decade a large number of shoulder disability questionnaires have been developed, which are designed to assess physical functioning (that is, the performance of daily activities).2-17 The choice of which questionnaire to use may be based on the study group, the purpose of the questionnaire, its clinimetric quality as shown by validity, reproducibility, responsiveness, and on practical considerations (for examp...

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Objective: To study the incidence and prevalence of neck and upper extremity musculoskeletal complaints in Dutch general practice. Methods: Data were obtained from the second Dutch national survey of general practice. In all, 195 general practitioners (GPs) from 104 practices across the Netherlands recorded all contacts with patients during 12 consecutive months. Incidence densities and consultation rates were calculated. Results: The total number of contacts during the registration period of one year was 1 524 470. The most commonly reported complaint was neck symptoms (incidence 23.1 per 1000 person-years), followed by shoulder symptoms (incidence 19.0 per 1000 person-years). Sixty six GP consultations per 1000 personyears were attributable to a new complaint or new episode of complaint of the neck or upper extremity (incidence density). In all, the GPs were consulted 147 times per 1000 registered persons for complaints of the neck or upper extremity. For most complaints the incidence densities and consultation rates were higher for women than for men. Conclusions: Neck and upper extremity symptoms are common in Dutch general practice. The GP is consulted approximately seven times each week for a complaint relating to the neck or upper extremity; of these, three are new complaints or new episodes. Attention should be paid to training GPs to deal with neck and upper limb complaints, and to research on the prognosis and treatment of these common complaints in primary care. N eck or upper extremity complaints are a common reason for consulting a general practitioner (GP). It has been estimated that the 12 month period prevalence of neck pain is 31.4%, of shoulder pain 30.3%, of elbow pain 11.2%, and of wrist or hand pain 17.5% in the general population of the Netherlands.1 Roughly 30-40% of people reporting musculoskeletal pain during the past year indicated that they had contacted their GP for these complaints. 1Despite the high prevalence of complaints of the neck and upper extremity in the general population, detailed information on the number of GP consultations attributable to these complaints is scarce. In Finland, musculoskeletal pain was found to be the reason for approximately 18% of the visits to health centre doctors 2 and 9.3% in Iceland. 3 In England and Wales, 15% of all registered patients consulted their GP for a disorder of the musculoskeletal system. 4 These figures refer to musculoskeletal complaints in general and do not tell us about the number of consultations attributable to different types of complaint. There is a need for information on the number of consultations attributable to neck and upper extremity complaints, for the following reasons.First, the incidence of neck and upper extremity complaints in general practice informs us about the burden of these complaints in the general population-in other words, the number of people with neck and upper extremity complaints that are serious, painful, or annoying enough to seek medical care. In the Netherlands, nearly every citizen is registere...

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

BackgroundIntensive lifestyle interventions in well-controlled settings are effective in lowering the risk of chronic diseases such as type 2 diabetes (T2DM) and cardiovascular diseases (CVD), but there are still no effective lifestyle interventions for everyday practice. In the Hoorn Prevention Study we aimed to assess the effectiveness of a primary care based lifestyle intervention to reduce the estimated risk of developing T2DM and for CVD mortality, and to motivate changes in lifestyle behaviors.MethodsThe Hoorn Prevention Study is a parallel group randomized controlled trial, implemented in the region of West-Friesland, the Netherlands. 622 adults with ≥10% estimated risk of T2DM and/or CVD mortality were randomly assigned and monitored over a period of 12 months. The intervention group (n=314) received a theory-based lifestyle intervention based on an innovative combination of motivational interviewing and problem solving treatment, provided by trained practice nurses in 12 general practices. The control group (n=308) received existing health brochures. Primary outcomes was the estimated diabetes risk according to the formula of the Atherosclerosis Risk In Communities (ARIC) Study, and the estimated risk for CVD mortality according to the Systematic COronary Risk Evaluation (SCORE) formula. Secondary outcomes included lifestyle behavior (diet, physical activity and smoking). The research assistants, the principal investigator and the general practitioners were blinded to group assignment. Linear and logistic regression analysis was applied to examine the between-group differences in each outcome measure, adjusted for baseline values.Results536 (86.2%) of the 622 participants (age 43.5 years) completed the 6-month follow-up, and 502 (81.2%) completed the 12-month follow-up. The mean baseline T2DM risk was 18.9% (SD 8.2) and the mean CVD mortality risk was 3.8% (SD 3.0). The intervention group participated in a median of 2 sessions. Intention-to-treat analyses showed no significant differences in outcomes between the two groups at 6 or 12-months follow-up.ConclusionsThe lifestyle intervention was not more effective than health brochures in reducing risk scores for T2DM and CVD or improving lifestyle behavior in an at-risk population.Trial registrationCurrent Controlled Trials: ISRCTN59358434

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The results suggest that the hip joints are at least no longer involved in balance control. This may imply that conservative therapy should focus on the prevention of restriction of the hip joints.