title: Predictors of outcome in neck and shoulder symptoms: a cohort study in general practice.
abstract: METHODS
  An observational prospective cohort study in general practice.
  
  
  OBJECTIVE
  To describe the clinical course and to identify predictors of recovery, changes in pain intensity, and changes in functional disability in patients with neck or shoulder symptoms at 3- and 12-month follow-up.
  
  
  BACKGROUND
  Knowledge on the clinical course and predictors of outcome in neck and shoulder symptoms is limited. Such knowledge would facilitate treatment decisions and may help to inform patients about their prognosis.
  
  
  METHODS
  Four hundred and forty-three patients who consulted their general practitioner with neck or shoulder symptoms participated in the study. Baseline scores of pain and disability, symptom characteristics, sociodemographic and psychological factors, social support, physical activity, general health, and comorbidity were investigated as possible predictors of recovery, changes in pain intensity, and changes in functional disability using multiple regression analyses.
  
  
  RESULTS
  The recovery rate was low; 24% of the patients reported recovery at 3 months and 32% reported recovery at 12-month follow-up. Duration of the symptoms before consulting the GP and a history of neck or shoulder symptoms increased the probability of an unfavorable outcome. Furthermore, less vitality and more worrying were consistently associated with poorer outcome after 3 and 12 months. The area under the receiver-operator characteristic curve for the model predicting recovery was 0.8 at 3 months and 0.75 at 12 months. The explained variance of the models on pain and functional disability ranged from 43 to 54%.
  
  
  CONCLUSIONS
  The results found in this study indicate that besides clinical characteristics, psychological factors also predict the outcome of neck and shoulder symptoms.
authors.affiliation: Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Sandra D M
authors.initials: SD
authors.lastname: Bot
authors.forename: Johanna M
authors.initials: JM
authors.lastname: van der Waal
authors.forename: Caroline B
authors.initials: CB
authors.lastname: Terwee
authors.forename: Daniëlle A W M
authors.initials: DA
authors.lastname: van der Windt
authors.forename: Rob J P M
authors.initials: RJ
authors.lastname: Scholten
authors.forename: Lex M
authors.initials: LM
authors.lastname: Bouter
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology*; D015331:Cohort Studies; D004185:Disability Evaluation; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications*; D019547:Neck Pain / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D020127:Recovery of Function; D012678:Sensation Disorders / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D020069:Shoulder Pain / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D013997:Time Factors