title: Patients with shoulder syndromes in general and physiotherapy practice: an observational study.
abstract: BACKGROUND
  Shoulder complaints are commonly seen in general practice and physiotherapy practice. The only complaints for which general practitioners (GPs) refer more patients to the physiotherapist are back and neck pain. However, a substantial group have persistent symptoms. The first goal of this study is to document current health care use and the treatment process for patients with shoulder syndromes in both general practice and physiotherapy practice. The second goal is to detect whether there are differences between patients with shoulder syndromes who are treated by their GP, those who are treated by both GP and physiotherapist and those who access physiotherapy directly.
  
  
  METHODS
  Observational study using data from the Netherlands Information Network of General Practice and the National Information Service for Allied Health Care. These registration networks collect healthcare-related information on patient contacts including diagnoses, prescriptions, referrals, treatment and evaluation on an ongoing basis.
  
  
  RESULTS
  Many patients develop symptoms gradually and 35% of patients with shoulder syndromes waited more than three months before visiting a physiotherapist. In 64% of all patients, treatment goals are fully reached at the end of physiotherapy treatment. In general practice, around one third of the patients return after the referral for physiotherapy. Patients with shoulder syndromes who are referred for physiotherapy have more consultations with their GP and are prescribed less medication than patients without a referral. Often, this referral is made at the first consultation. In physiotherapy practice, referred patients differ from self-referrals. Self-referrals are younger, they more often have recurrent complaints and their complaints are more often related to sports and leisure activities.
  
  
  CONCLUSIONS
  There is a fairly large group of patients with persistent symptoms. Early referral by a GP is not advised under current guidelines. However, in many patients, symptoms develop gradually and a wait-and-see policy means more valuable time may pass before physiotherapy intervention takes place. Meanwhile a long duration of complaints is a predictor for poor outcome. Therefore, future research into early referral is required. As physiotherapists, we should develop a way of educating patients to avoid lengthy waiting periods before seeking help. To prevent high costs, physiotherapists could consider a classification of pain and limitations and wait-and-see policy as used by GPs. With early detection, a once-off consultation might be sufficient.
authors.affiliation: Department of Allied Health Care, NIVEL, Netherlands Institute of Health Services Research, PO Box 1568, Utrecht, BN 3500, The Netherlands. m.kooijman@nivel.nl
authors.forename: Margit
authors.initials: M
authors.lastname: Kooijman
authors.forename: Ilse
authors.initials: I
authors.lastname: Swinkels
authors.forename: Christel
authors.initials: C
authors.lastname: van Dijk
authors.forename: Dinny
authors.initials: D
authors.lastname: de Bakker
authors.forename: Cindy
authors.initials: C
authors.lastname: Veenhof
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D058006:General Practice / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010353:Patient Education as Topic / Q000379:methods* / Q000592:standards; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities / Q000592:standards; D020069:Shoulder Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors
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