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

BMC Musculoskeletal Disorders

Ilkka Kiviranta²  Mauno Vanhala¹  Hannu Kautiainen¹  Sanna Koskela⁴  Juha Paloneva³ 

[1] Unit of Family Practice, Central Finland Central Hospital, Keskussairaalantie 19, Jyväskylä 40620, Finland;Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland;Department of Surgery, Unit of Family Practice, Central Finland Central Hospital, Keskussairaalantie 19, Jyväskylä 40620, Finland;Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland

关键词: VAS;    ASES;    Outcome;    Prospective cohort study;    General practice;    Primary health care;    Rheumatology;    Shoulder;   

Others  :  1129079
DOI  :  10.1186/1471-2474-14-348

 received in 2013-01-16, accepted in 2013-12-04,  发布年份 2013

【 摘 要 】

Background

Shoulder 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.

Methods

All 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.

Results

A 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).

Conclusions

Shoulder 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.

【 授权许可】

   
2013 Paloneva et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Makela M, Heliovaara M, Sainio P, Knekt P, Impivaara O, Aromaa A: Shoulder joint impairment among Finns aged 30 years or over: prevalence, risk factors and co-morbidity. Rheumatology (Oxford) 1999, 38:656-662.
• [2]Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, Simmons A, Williams G: Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis 1998, 57:649-655.
• [3]van der Windt DA, Koes BW, Boeke AJ, Deville W, De Jong BA, Bouter LM: Shoulder disorders in general practice: prognostic indicators of outcome. Br J Gen Pract 1996, 46:519-523.
• [4]Linsell L, Dawson J, Zondervan K, Rose P, Randall T, Fitzpatrick R, Carr A: Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral. Rheumatology (Oxford) 2006, 45:215-221.
• [5]Greving K, Dorrestijn O, Winters JC, Groenhof F, van der Meer K, Stevens M, Diercks RL: Incidence, prevalence, and consultation rates of shoulder complaints in general practice. Scand J Rheumatol 2012, 41:150-155.
• [6]Mitchell C, Adebajo A, Hay E, Carr A: Shoulder pain: diagnosis and management in primary care. BMJ 2005, 331:1124-1128.
• [7]Dorrestijn O, Greving K, van der Veen WJ, van der Meer K, Diercks RL, Winters JC, Stevens M: Patients with shoulder complaints in general practice: consumption of medical care. Rheumatology (Oxford) 2011, 50:389-395.
• [8]Masters S, O’Doherty L, Mitchell GK, Yelland M: Acute shoulder pain in primary care - an observational study. Aust Fam Physician 2007, 36:473-476.
• [9]Kuijpers T, van der Windt DA, van der Heijden GJ, Bouter LM: Systematic review of prognostic cohort studies on shoulder disorders. Pain 2004, 109:420-431.
• [10]Virta L, Joranger P, Brox JI, Eriksson R: Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden. BMC Musculoskelet Disord 2012, 13:17. BioMed Central Full Text
• [11]van der Windt DA, Koes BW, de Jong BA, Bouter LM: Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis 1995, 54:959-964.
• [12]Croft P, Pope D, Silman A: The clinical course of shoulder pain: prospective cohort study in primary care: primary care rheumatology society shoulder study group. BMJ 1996, 313:601-602.
• [13]Winters JC, Sobel JS, Groenier KH, Arendzen JH, Meyboom-de Jong B: The long-term course of shoulder complaints: a prospective study in general practice. Rheumatology (Oxford) 1999, 38:160-163.
• [14]Reilingh ML, Kuijpers T, Tanja-Harfterkamp AM, van der Windt DA: Course and prognosis of shoulder symptoms in general practice. Rheumatology (Oxford) 2008, 47:724-730.
• [15]Kocher MS, Horan MP, Briggs KK, Richardson TR, O’Holleran J, Hawkins RJ: Reliability, validity, and responsiveness of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis. J Bone Joint Surg Am 2005, 87:2006-2011.
• [16]Michener LA, McClure PW, Sennett BJ: American Shoulder and Elbow surgeons standardized Shoulder assessment form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg 2002, 11:587-594.
• [17]Fetter RB, Shin Y, Freeman JL, Averill RF, Thompson JD: Case mix definition by diagnosis-related groups. Med Care 1980, 18(2):1-53.
• [18]Kuijpers T, van Tulder MW, van der Heijden GJ, Bouter LM, van der Windt DA: Costs of shoulder pain in primary care consulters: a prospective cohort study in The Netherlands. BMC Musculoskelet Disord 2006, 7:83. BioMed Central Full Text
• [19]Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C: Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum 2004, 51(4):642-651.
• [20]Sallay PI, Reed L: The measurement of normative American Shoulder and Elbow Surgeons scores. J Shoulder Elbow Surg 2003, 12:622-627.
• [21]Tashjian RZ, Deloach J, Green A, Porucznik CA, Powell AP: Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease. J Bone Joint Surg Am 2010, 92:296-303.
• [22]Kuijpers T, van der Windt DA, van der Heijden GJ, Twisk JW, Vergouwe Y, Bouter LM: A prediction rule for shoulder pain related sick leave: a prospective cohort study. BMC Musculoskelet Disord 2006, 7:97. BioMed Central Full Text
• [23]Bamji AN, Erhardt CC, Price TR, Williams PL: The painful shoulder: can consultants agree? Br J Rheumatol 1996, 35:1172-1174.
• [24]de Winter AF, Jans MP, Scholten RJ, Deville W, van Schaardenburg D, Bouter LM: Diagnostic classification of shoulder disorders: interobserver agreement and determinants of disagreement. Ann Rheum Dis 1999, 58:272-277.