Patients with shoulder complaints in general practice: consumption of medical care

Dorrestijn, Oscar; Greving, K.; Veen, Willem Jan van der; Meer, Klaas van der; Diercks, Ron L.; Winters, Jan C.; Stevens, Martin

doi:10.1093/rheumatology/keq333

Cited by 29 publications

(27 citation statements)

References 15 publications

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“…16,41 Many measurement instruments have been developed to evaluate the problems that patients with shoulder complaints experience in their everyday functioning. 1,44 Shoulder-specific disability questionnaires, like the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) 1,27,34,44,56 and the Shoulder Pain and Disability Index (SPADI), 1,3,14,31,43,44 consist of a standard set of questions concerning activities that patients with shoulder pain, in general, experience difficulty with.…”

mentioning

confidence: 99%

Evaluative Measurement Properties of the Patient-Specific Functional Scale for Primary Shoulder Complaints in Physical Therapy Practice

Koehorst¹,

Trijffel²,

Lindeboom

2014

Journal of Orthopaedic & Sports Physical Therapy

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Study Design Clinical measurement, longitudinal. Objectives To assess the test-retest reliability, construct validity, and responsiveness of the Patient-Specific Functional Scale (PSFS) in patients with a primary shoulder complaint. Background Health measurement outcomes have become increasingly important for evaluating treatment. Patient-specific questionnaires are useful tools for determining treatment goals and evaluating treatment in individual patients. These questionnaires have not yet been validated in patients with nonspecific shoulder pain. Methods Patients completed the PSFS, the numeric pain rating scale, and the Shoulder Pain and Disability Index at baseline, and after 1 week and 4 to 6 weeks. Test-retest reliability was determined using intraclass correlation coefficients. To assess convergent validity, change scores of the PSFS were correlated with the numeric pain rating scale and Shoulder Pain and Disability Index change scores. Responsiveness was assessed by calculating the area under the curve, the minimal clinically important change, and minimal detectable change, using the global rating of change as an external criterion. Results Fifty patients (37 men; mean age, 47.7 years) participated in the study. Reliability was high (intraclass correlation coefficient = 0.87; 95% confidence interval [CI]: 0.72, 0.94). The correlations between the change scores of the PSFS and those of the Shoulder Pain and Disability Index and numeric pain rating scale were 0.45 (95% CI: 0.17, 0.80) and 0.55 (95% CI: 0.29, 0.73), respectively. The area under the curve for the PSFS was 0.67 (95% CI: 0.51, 0.83). The minimal detectable change and minimal clinically important change were 0.97 and 1.29 points, respectively. Conclusion These results suggest that the PSFS is a reliable, valid, and responsive instrument that can be used as an evaluative instrument in patients with a primary shoulder complaint. J Orthop Sports Phys Ther 2014;44(8):595–603. Epub 16 July 2014. doi:10.2519/jospt.2014.5133

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confidence: 99%

Evaluative Measurement Properties of the Patient-Specific Functional Scale for Primary Shoulder Complaints in Physical Therapy Practice

Koehorst¹,

Trijffel²,

Lindeboom

2014

Journal of Orthopaedic & Sports Physical Therapy

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“…The rate of referrals to an orthopaedic surgeon or specialist in rehabilitation medicine in our material was higher (20%) than reported in the literature on new episodes of shoulder problems (5-14%). Surgery was also required more often (8% versus 0.38-2% in the literature) [3,7,10,19]. …”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that general practitioners seldom make a specific diagnosis for shoulder disorder, and that even a general diagnostic category has been shown to change over time in a significant proportion of individuals [7,13,23,24]. Diagnosis based on clinical examination performed even by an especially trained physician is frequently unreliable [13,23].…”

Section: Discussionmentioning

confidence: 99%

“…The course of shoulder disorders in general practice has generally been thought to be rather benign [7,8]. Half of the individuals with a new episode of a shoulder disorder recover completely within 6 months and almost half consult only once [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…The current literature is limited to the prognosis of new episodes of shoulder disorders in primary health care [5,7,8,11-14]. Due to the chronic nature of shoulder disorders, both resource use and clinical outcome are potentially underestimated if only new episodes are observed.…”

Section: Introductionmentioning

confidence: 99%

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Consumption of medical resources and outcome of shoulder disorders in primary health care consulters

Paloneva

Koskela

Kautiainen

et al. 2013

BMC Musculoskelet Disord

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BackgroundShoulder disorders are common problems in primary health care. The course of disease of patients consulting for a new episode of a shoulder problem has been thought to be benign. In this prospective cohort study, we assessed the one-year consumption of medical resources and clinical outcome of shoulder disorders inclusive of all disease episodes.MethodsAll individuals consulting primary health care for shoulder disorder in a catchment area of more than 120 000 people were included. A composite questionnaire including the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) was used to measure use of resources as well as shoulder pain and function. A follow-up assessment was performed after one year.ResultsA total of 128 individuals responded to the questionnaire. Only 24% of the patients had recovered after one year. Mean shoulder pain (Visual analogue scale, VAS, max 100 mm) decreased from 38.9 mm to 28.6 mm (95% CI -16.3 to -4.2 mm). The ASES score (max 100) improved significantly from 59.9 to 70.2 (95% CI 5.3 to 15.3). Mean one-year consumption of medical resources after the index consultation was 1.5 consultations, 0.5 radiological examinations, and 3.3 visits to physiotherapist. Mean resource-weighted direct costs were €543/patient/year (95% CI €351 to 735).ConclusionsShoulder disorders are often chronic and require a significant amount of resources from the health care system. The clinical outcome of the management of shoulder disorders in our study population including also individuals who have consulted previously for a shoulder problem is notably poorer than the one reported by previous studies on new episodes. However, despite the relatively modest outcome, subjective disability is low.

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Peripheral sensitization is demonstrated in subacromial pain syndrome, with central sensitization found only in females

King

Shapiro

Karduna

2022

Journal Orthopaedic Research

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The objective of this study was to explore whether hypersensitivity in patients with subacromial pain syndrome (SPS) manifests purely as localized peripheral sensitization or central sensitization, is influenced by the presence of subacromial pain, and presents similarly in male and female patients. Pressure pain threshold was assessed in both a patient cohort with unilateral SPS and an uninjured matched control group. Control subjects were assessed twice, with a 15 minute rest period between testing, while patients were assessed at baseline and after an almost instantaneous reduction in pain arising from an anesthetic injection in patients. Patients received a subacromial injection consisting of both anesthetics (3 cc of 2% lidocaine and 6 cc 0.5% Marcaine with Epinephrine) and a corticosteroid agent (1 cc DepoMedrol). Patients demonstrated hypersensitivity across the involved shoulder only, providing evidence for peripheral sensitization. There were trends for hypersensitivity across remote joints, however when separated by sex, only female patients demonstrated both peripheral and central sensitization. Immediate pain reduction had no influence on hypersensitivity in the short‐term. Clinical Significance: Neuropathic components are likely present in some patients with subacromial pain syndrome, and female patients may be particularly at risk for presenting with neuropathic pain. These findings are applicable towards understanding the heterogeneous etiology underlying subacromial pain syndrome and informing clinical management.

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Patients with shoulder complaints in general practice: consumption of medical care

Abstract: Nearly half of patients with a new shoulder complaint consult their GP only once. Medical consumption in general practice is highest for male shoulder patients and the 45- to 64-year age group. Shoulder problems are mainly an issue for primary care.

Cited by 29 publications

References 15 publications

Evaluative Measurement Properties of the Patient-Specific Functional Scale for Primary Shoulder Complaints in Physical Therapy Practice

Evaluative Measurement Properties of the Patient-Specific Functional Scale for Primary Shoulder Complaints in Physical Therapy Practice

Consumption of medical resources and outcome of shoulder disorders in primary health care consulters

Peripheral sensitization is demonstrated in subacromial pain syndrome, with central sensitization found only in females

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