Patients with shoulder syndromes in general and physiotherapy practice: an observational study

BMC Musculoskeletal Disorders

Cindy Veenhof²  Dinny de Bakker¹  Christel van Dijk²  Ilse Swinkels²  Margit Kooijman² 

[1] Scientific Centre for Transformation in Care and Welfare (TRANZO), Tilburg University, PO Box 90153, Tilburg, LE, 5000, the Netherlands;Department of Allied Health Care, NIVEL, Netherlands Institute of Health Services Research, PO Box 1568, Utrecht, BN, 3500, the Netherlands

关键词: Primary health care;    Physical therapy specialty;    Shoulder impingement syndrome;   

Others  :  1132990
DOI  :  10.1186/1471-2474-14-128

 received in 2012-04-23, accepted in 2013-04-03,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Kooijman et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Kooijman MK, Swinkels ICS, Leemrijse CJ, de Bakker DH, Veenhof C: National Information Service of Allied Health Care. : ; 2011.
• [2]Verheij RA, van Dijk CE, Stirbu-Wagner I, Dorsman SA, Visscher S, Abrahamse H: Netherlands Information Netwerk of General Practices. : ; 2011.
• [3]Windt DAWM, Koes BW, Boeke AJP, Devillé W, Jong BA, Bouter LM: Shoulder disorders in general practice: prognostic indicators of outcome. Br J Gen Pract 1996, 46(410):519-523.
• [4]Croft P, Pope D, Silman A: The clinical course of shoulder pain: prospective cohort study in primary care. Br Med J 1996, 313:601-602.
• [5]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 1999, 38:160-163.
• [6]Bot SDM, Van der Waal JM, Terwee CB, Van Der Windt DAWM, Scholten RJPM, Bouter LM: Predictors of outcome in neck and shoulder symptoms. Spine 2005, 30(16):E459-E470.
• [7]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(1):17. BioMed Central Full Text
• [8]Kennedy CA, Manno M, Hogg-Johnsson S, Haines T, Hurley L, McKenzie D: Prognosis of soft tissue disorders of the shoulder: predicting both change in disability and level of disability after treatment. Phys Ther 2006, 86(7):1013-1032.
• [9]Winters JC, Van Der Windt DAWM, Spinnewijn WEM, de Jongh AD, van der Heijden GJMG, Buis PAJ: Dutch College of General Practitioners' standard shoulder complaints. Huisarts en Wetenschap 2008, 51(11):555-565.
• [10]Hung C-J, Jan M-H, Lin Y-F, Wang T-Q, Lin J-J: Scapular kinematics and impairment features for classifying patients with subacromial impingement syndrome. Man Ther 2010, 15(6):547-551.
• [11]Dorresteijn O, Stevens M, Winters JC, van der Meer K, Diercks RL: Conservative or surgical treatment for subacromial impingement syndrome? A systematic review. J Shoulder Elbow Surg 2009, 18(4):652-660.
• [12]Green S: Buchbinder R. Hetrick SE: Physiotherapy interventions for shoulder pain. Cochrane Database of Systematic Reviews; 2003. (2)
• [13]Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT: Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sport Med 2008, 42(2):80-92.
• [14]Kelly SM, Wrightson PA, Meads CA: Clinical outcomes of exercise in the management of subacromial impingement syndrome: a systematic review. Clin Rehabil 2010, 24(2):99-109.
• [15]Kromer TO, Tautenhahn UG, de Bie RA, Staal JB, Bastiaenen CHG: Effects of physiotherapy in patients with shoulder impingement syndrome: a systematic review of the literature. J Rehabil Med 2009, 41(11):870-880.
• [16]Jansen MJ, Brooijmans F, Geraets JJXR, Lenssen T, Ottenheijm R, Penning L: Evidence based statement subcromial complaints. Nederlands Tijdschrift voor Fysiotherapie 2011., 121(1)
• [17]Leemrijse CJ, Swinkels ICS, Veenhof C: Direct access to physical therapy in the Netherlands: results from the first year in community based physical therapy. Phys Ther 2008, 88(8):936-946.
• [18]Lamberts H, Wood M: International Classification of Primary Care. Oxford: Oxford University Press; 1987.
• [19]Kuijpers T, Van Der Windt DAWM, Boeke AJP, Twisk JWR, Vergouwe Y, Bouter LM: Clinical prediction rules for the prognosis of shoulder pain in general practice. Pain 2006, 120(3):276-285.
• [20]Windt DAWM: Koes BW, de Jong BA, Bouter LM: Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis 1995, 54(12):959-964.
• [21]Kuijpers T, Van Der Windt DA, Van Der Heijden GJ, Bouter L: Systematic review of prognostic cohort studies on shoulder disorders. Pain 2004, 109(3):420-431.
• [22]Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM: Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sport Med 2012, 46(14):964-978.
• [23]Nygren A, Von Koch M: Neck and shoulder pain: an increasing problem. Scand J Rehabil Med 1995, 32:107-112.
• [24]Kuijpers T, van Tulder MW, Van Der Heijden GJ, Bouter LM, Van Der Windt DAWM: 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