title: Point-of-care prognosis for common musculoskeletal pain in older adults.
abstract: OBJECTIVE
  Many site-specific, multivariable risk models for predicting the outcome of musculoskeletal pain problems have been published. The overlapping content in these models suggests a common set of generic indicators suitable for use in primary care.
  
  
  OBJECTIVE
  To investigate whether a brief set of generic prognostic indicators can predict the outcome of musculoskeletal pain in older patients presenting to general practitioners.
  
  
  METHODS
  A prospective observational cohort study conducted from September 1, 2006, through March 31, 2007, of consecutive patients 50 years or older presenting with noninflammatory musculoskeletal pain to 1 of the 5 participating general practices in the United Kingdom.
  
  
  METHODS
  During consultation, the treating physician assessed and recorded 5 brief generic items (duration of present pain episode, current pain intensity, pain interference with daily activities, presence of multiple-site pain, and ultrashort depression screen) and recorded their overall prognostic judgment. The primary outcome was patient-rated improvement, which was measured 6 months after consultation and cross-validated with repeated measures up to 3 years.
  
  
  RESULTS
  A total of 194 (48.1%) of 403 participants were classified as having an unfavorable outcome at 6 months. Inclusion of 3 generic prognostic indicators (duration of present pain episode, pain interference with daily activities, and presence of multiple-site pain) in the prognostic model improved on reliance on physicians' prognostic judgment alone (C statistic = 0.72 vs 0.62; net reclassification index = 0.136; proportion correctly classified = 69%). The improvement in prognostic accuracy was attributable to correcting physicians' tendency toward overoptimistic expectations of outcome.
  
  
  CONCLUSIONS
  Three easy-to-obtain pieces of information followed by systematic recording of the general practitioners' prognostic judgment provide a simple generic assessment of prognosis at point of care in older persons presenting with musculoskeletal problems to primary care practices in the United Kingdom. Such an assessment offers a common foundation for investigating the usefulness of prognostic stratification for guiding management in the consultation across a range of common painful conditions.
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Staffordshire ST5 5BG, England. c.d.mallen@keele.ac.uk
authors.forename: Christian D
authors.initials: CD
authors.lastname: Mallen
authors.forename: Elaine
authors.initials: E
authors.lastname: Thomas
authors.forename: John
authors.initials: J
authors.lastname: Belcher
authors.forename: Trishna
authors.initials: T
authors.lastname: Rathod
authors.forename: Peter
authors.initials: P
authors.lastname: Croft
authors.forename: George
authors.initials: G
authors.lastname: Peat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D019095:Point-of-Care Systems; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D006113:United Kingdom