Determinants of the clinical course of musculoskeletal complaints in general practice: design of a cohort study

Abstract

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.

The course and prognosis of hip complaints in general practice

“…Using these data, the course of hip complaints presented in general practice can be described and relevant prognostic indicators of outcome can be identified. The design of the study has been described in further detail elsewhere (19). The study protocol was approved by the Medical Ethics Committee of the VU University Medical Center.…”

Clinical Prediction Models for Patients With Nontraumatic Knee Pain in Primary Care: A Systematic Review and Internal Validation Study

“…49 In this systematic review, these would be the models developed by Belo et al 6 for recovery and the model developed by van der Waal et al 41 for function. For external validation, we were able to use 3 different data sets that included patients with knee pain: the General Practitioners Research Network Erasmus University Rotterdam (HONEUR) cohort, 13 the BAS cohort, 40 and the Cohort Hip and Cohort Knee (CHECK) cohort 47 ; however, all 3 data sets missed 1 or more essential predictors. Also, there were no suitable proxies available in these data sets; therefore, we were not able to externally validate the existing prognostic models.…”

“…In developing the new models (in the BAS cohort), 40 we found that the explained variance of the function model was 0.36 and the recovery model was 0.33. The function model demonstrated good performance as a prognostic model, after internal validation, while the recovery model failed to reach our a priori threshold for good model performance.…”

“…The patients were recruited consecutively by 52 general practitioners from 29 practices as part of the Dutch National Survey of General Practice, carried out by the Netherlands Institute for Health Services Research in the Netherlands. 40 We internally validated these new models by bootstrap analysis (250 bootstrap draws), a datasimulation method used to correct for overoptimism in regression coefficients and performance measures, because a prediction model will always perform better in the data set used to develop the model than in new future patients. 37 For the function model (continuous outcome), we calculated the explained variance (R 2 ), a value that can also be seen as a kind of discriminative index.…”

Generalizability of a prediction rule for sick leave due to shoulder pain

“…The musculoskeletal disorder study (MDS) is a large observational cohort study that was conducted in 61 general practices (97 general practitioners) (20)(21). The physicians recruited patients who consulted them due to a new episode of musculoskeletal pain.…”