Management Decisions in Nontraumatic Complaints of Arm, Neck, and Shoulder in General Practice
Abstract Objective We wanted to evaluate associations between diagnosis and characteristics of the patient, complaint, and general practitioner (GP), as well as 6 common management decisions, in patients with nontraumatic arm, neck, and shoulder complaints at the time of the first consultation with...
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| Veröffentlicht in: | Annals of family medicine 2009-09, Vol.7 (5), p.446-454 |
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| creator | Feleus, Anita, PhD Bierma-Zeinstra, Sita M.A., PhD Bernsen, Roos M.D., PhD Miedema, Harald S., MD Verhaar, Jan A.N., PhD Koes, Bart W., PhD |
| description | Abstract Objective We wanted to evaluate associations between diagnosis and characteristics of the patient, complaint, and general practitioner (GP), as well as 6 common management decisions, in patients with nontraumatic arm, neck, and shoulder complaints at the time of the first consultation with their physician. Methods We undertook an observational cohort study set in 21 Dutch general practices, including 682 patients with nontraumatic complaints of arm, neck, and shoulder. The outcome measure was application (yes/no) of a specific management option: watchful waiting, additional diagnostic tests, prescription of medication, corticosteroid injection, referral for physiotherapy, and referral for medical specialist care. Results Separate multilevel analyses showed that overall, the diagnostic category, having long duration of complaints, and reporting many functional limitations were most frequently associated with the choice of a management option. For watchful waiting, only complaint variables played a role (long duration of complaints, high complaint severity, many functional limitations, recurrent complaint). All these variables were negatively associated with watchful waiting. When opting for 1 of the 5 other management options, several physician characteristics played a role as well. Less clinical experience was associated with additional diagnostic tests and referral to a medical specialist. GPs working in a solo practice more frequently referred to a medical specialist. GPs working in a rural area more frequently referred for physiotherapy. Female GPs prescribed medication less frequently. Physicians with special interest in musculoskeletal complaints gave corticosteroid injections more frequently. Conclusions Diagnostic category, long duration of complaints, and high functional limitations were key variables in management decisions with these complaints. In addition, several physician characteristics played a role as well. |
| doi_str_mv | 10.1370/afm.993 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2746505</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S154417090960130X</els_id><sourcerecordid>67650518</sourcerecordid><originalsourceid>FETCH-LOGICAL-c451t-77df556b8fea75314a13513095b99a334a0dcc036affc4090f793291f00bba473</originalsourceid><addsrcrecordid>eNpVkUFPFTEUhRujEUTjPzBd6YaH7XQ6pRsT8hQ0QTRBE1c2dzq3UOi0j3aGhH9PJ7yArtqk556eez5C3nJ2wIViH8GNB1qLZ2SXy7ZdccXV88c70zvkVSlXjDW8Ec1LssO1kk2rxC75-x0iXOCIcaKf0friUyzUR3qW4pRhHmHylq7TuAng41RocvQoj_v0DO31PoU40PPLNIcB8zJ1ghEzBPozg62D-Jq8cBAKvtmee-T38Zdf66-r0x8n39ZHpyvbSj6tlBqclF1_6BCUFLwFLiQXTMteaxCiBTZYy0QHztmWaeaUFo3mjrG-h7rIHvn04LuZ-xEHi0v4YDbZj5DvTAJv_n-J_tJcpFvTqLaTTFaD91uDnG5mLJMZfbEYAkRMczGdWmT8sAo_PAhtTqVkdI-fcGYWFqayMJVFVb77N9OTblv-U2iszdx6zMYGH72FcI13WK7SnGMtzXBTGsPM-YJzocl0x2o5f8Q9aY2aBQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>67650518</pqid></control><display><type>article</type><title>Management Decisions in Nontraumatic Complaints of Arm, Neck, and Shoulder in General Practice</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Feleus, Anita, PhD ; Bierma-Zeinstra, Sita M.A., PhD ; Bernsen, Roos M.D., PhD ; Miedema, Harald S., MD ; Verhaar, Jan A.N., PhD ; Koes, Bart W., PhD</creator><creatorcontrib>Feleus, Anita, PhD ; Bierma-Zeinstra, Sita M.A., PhD ; Bernsen, Roos M.D., PhD ; Miedema, Harald S., MD ; Verhaar, Jan A.N., PhD ; Koes, Bart W., PhD</creatorcontrib><description>Abstract Objective We wanted to evaluate associations between diagnosis and characteristics of the patient, complaint, and general practitioner (GP), as well as 6 common management decisions, in patients with nontraumatic arm, neck, and shoulder complaints at the time of the first consultation with their physician. Methods We undertook an observational cohort study set in 21 Dutch general practices, including 682 patients with nontraumatic complaints of arm, neck, and shoulder. The outcome measure was application (yes/no) of a specific management option: watchful waiting, additional diagnostic tests, prescription of medication, corticosteroid injection, referral for physiotherapy, and referral for medical specialist care. Results Separate multilevel analyses showed that overall, the diagnostic category, having long duration of complaints, and reporting many functional limitations were most frequently associated with the choice of a management option. For watchful waiting, only complaint variables played a role (long duration of complaints, high complaint severity, many functional limitations, recurrent complaint). All these variables were negatively associated with watchful waiting. When opting for 1 of the 5 other management options, several physician characteristics played a role as well. Less clinical experience was associated with additional diagnostic tests and referral to a medical specialist. GPs working in a solo practice more frequently referred to a medical specialist. GPs working in a rural area more frequently referred for physiotherapy. Female GPs prescribed medication less frequently. Physicians with special interest in musculoskeletal complaints gave corticosteroid injections more frequently. Conclusions Diagnostic category, long duration of complaints, and high functional limitations were key variables in management decisions with these complaints. In addition, several physician characteristics played a role as well.</description><identifier>ISSN: 1544-1709</identifier><identifier>EISSN: 1544-1717</identifier><identifier>DOI: 10.1370/afm.993</identifier><identifier>PMID: 19752473</identifier><language>eng</language><publisher>United States: American Academy of Family Physicians</publisher><subject>Adolescent ; Adult ; Arm Injuries - diagnosis ; Arm Injuries - therapy ; Clinical Competence - statistics & numerical data ; Cohort Studies ; Family Practice - statistics & numerical data ; Female ; Humans ; Internal Medicine ; Male ; Middle Aged ; Neck Pain - diagnosis ; Neck Pain - therapy ; Netherlands ; Original Research ; Population ; Practice Patterns, Physicians' - statistics & numerical data ; Professional Practice - statistics & numerical data ; Referral and Consultation - statistics & numerical data ; Sex Factors ; Shoulder Pain - diagnosis ; Shoulder Pain - therapy ; Young Adult</subject><ispartof>Annals of family medicine, 2009-09, Vol.7 (5), p.446-454</ispartof><rights>Annals of Family Medicine, Inc.</rights><rights>Copyright © Copyright 2009 Annals of Family Medicine, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-77df556b8fea75314a13513095b99a334a0dcc036affc4090f793291f00bba473</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746505/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746505/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,53770,53772</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19752473$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Feleus, Anita, PhD</creatorcontrib><creatorcontrib>Bierma-Zeinstra, Sita M.A., PhD</creatorcontrib><creatorcontrib>Bernsen, Roos M.D., PhD</creatorcontrib><creatorcontrib>Miedema, Harald S., MD</creatorcontrib><creatorcontrib>Verhaar, Jan A.N., PhD</creatorcontrib><creatorcontrib>Koes, Bart W., PhD</creatorcontrib><title>Management Decisions in Nontraumatic Complaints of Arm, Neck, and Shoulder in General Practice</title><title>Annals of family medicine</title><addtitle>Ann Fam Med</addtitle><description>Abstract Objective We wanted to evaluate associations between diagnosis and characteristics of the patient, complaint, and general practitioner (GP), as well as 6 common management decisions, in patients with nontraumatic arm, neck, and shoulder complaints at the time of the first consultation with their physician. Methods We undertook an observational cohort study set in 21 Dutch general practices, including 682 patients with nontraumatic complaints of arm, neck, and shoulder. The outcome measure was application (yes/no) of a specific management option: watchful waiting, additional diagnostic tests, prescription of medication, corticosteroid injection, referral for physiotherapy, and referral for medical specialist care. Results Separate multilevel analyses showed that overall, the diagnostic category, having long duration of complaints, and reporting many functional limitations were most frequently associated with the choice of a management option. For watchful waiting, only complaint variables played a role (long duration of complaints, high complaint severity, many functional limitations, recurrent complaint). All these variables were negatively associated with watchful waiting. When opting for 1 of the 5 other management options, several physician characteristics played a role as well. Less clinical experience was associated with additional diagnostic tests and referral to a medical specialist. GPs working in a solo practice more frequently referred to a medical specialist. GPs working in a rural area more frequently referred for physiotherapy. Female GPs prescribed medication less frequently. Physicians with special interest in musculoskeletal complaints gave corticosteroid injections more frequently. Conclusions Diagnostic category, long duration of complaints, and high functional limitations were key variables in management decisions with these complaints. In addition, several physician characteristics played a role as well.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Arm Injuries - diagnosis</subject><subject>Arm Injuries - therapy</subject><subject>Clinical Competence - statistics & numerical data</subject><subject>Cohort Studies</subject><subject>Family Practice - statistics & numerical data</subject><subject>Female</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neck Pain - diagnosis</subject><subject>Neck Pain - therapy</subject><subject>Netherlands</subject><subject>Original Research</subject><subject>Population</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Professional Practice - statistics & numerical data</subject><subject>Referral and Consultation - statistics & numerical data</subject><subject>Sex Factors</subject><subject>Shoulder Pain - diagnosis</subject><subject>Shoulder Pain - therapy</subject><subject>Young Adult</subject><issn>1544-1709</issn><issn>1544-1717</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkUFPFTEUhRujEUTjPzBd6YaH7XQ6pRsT8hQ0QTRBE1c2dzq3UOi0j3aGhH9PJ7yArtqk556eez5C3nJ2wIViH8GNB1qLZ2SXy7ZdccXV88c70zvkVSlXjDW8Ec1LssO1kk2rxC75-x0iXOCIcaKf0friUyzUR3qW4pRhHmHylq7TuAng41RocvQoj_v0DO31PoU40PPLNIcB8zJ1ghEzBPozg62D-Jq8cBAKvtmee-T38Zdf66-r0x8n39ZHpyvbSj6tlBqclF1_6BCUFLwFLiQXTMteaxCiBTZYy0QHztmWaeaUFo3mjrG-h7rIHvn04LuZ-xEHi0v4YDbZj5DvTAJv_n-J_tJcpFvTqLaTTFaD91uDnG5mLJMZfbEYAkRMczGdWmT8sAo_PAhtTqVkdI-fcGYWFqayMJVFVb77N9OTblv-U2iszdx6zMYGH72FcI13WK7SnGMtzXBTGsPM-YJzocl0x2o5f8Q9aY2aBQ</recordid><startdate>20090901</startdate><enddate>20090901</enddate><creator>Feleus, Anita, PhD</creator><creator>Bierma-Zeinstra, Sita M.A., PhD</creator><creator>Bernsen, Roos M.D., PhD</creator><creator>Miedema, Harald S., MD</creator><creator>Verhaar, Jan A.N., PhD</creator><creator>Koes, Bart W., PhD</creator><general>American Academy of Family Physicians</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20090901</creationdate><title>Management Decisions in Nontraumatic Complaints of Arm, Neck, and Shoulder in General Practice</title><author>Feleus, Anita, PhD ; Bierma-Zeinstra, Sita M.A., PhD ; Bernsen, Roos M.D., PhD ; Miedema, Harald S., MD ; Verhaar, Jan A.N., PhD ; Koes, Bart W., PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-77df556b8fea75314a13513095b99a334a0dcc036affc4090f793291f00bba473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Arm Injuries - diagnosis</topic><topic>Arm Injuries - therapy</topic><topic>Clinical Competence - statistics & numerical data</topic><topic>Cohort Studies</topic><topic>Family Practice - statistics & numerical data</topic><topic>Female</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neck Pain - diagnosis</topic><topic>Neck Pain - therapy</topic><topic>Netherlands</topic><topic>Original Research</topic><topic>Population</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Professional Practice - statistics & numerical data</topic><topic>Referral and Consultation - statistics & numerical data</topic><topic>Sex Factors</topic><topic>Shoulder Pain - diagnosis</topic><topic>Shoulder Pain - therapy</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Feleus, Anita, PhD</creatorcontrib><creatorcontrib>Bierma-Zeinstra, Sita M.A., PhD</creatorcontrib><creatorcontrib>Bernsen, Roos M.D., PhD</creatorcontrib><creatorcontrib>Miedema, Harald S., MD</creatorcontrib><creatorcontrib>Verhaar, Jan A.N., PhD</creatorcontrib><creatorcontrib>Koes, Bart W., PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of family medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Feleus, Anita, PhD</au><au>Bierma-Zeinstra, Sita M.A., PhD</au><au>Bernsen, Roos M.D., PhD</au><au>Miedema, Harald S., MD</au><au>Verhaar, Jan A.N., PhD</au><au>Koes, Bart W., PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management Decisions in Nontraumatic Complaints of Arm, Neck, and Shoulder in General Practice</atitle><jtitle>Annals of family medicine</jtitle><addtitle>Ann Fam Med</addtitle><date>2009-09-01</date><risdate>2009</risdate><volume>7</volume><issue>5</issue><spage>446</spage><epage>454</epage><pages>446-454</pages><issn>1544-1709</issn><eissn>1544-1717</eissn><abstract>Abstract Objective We wanted to evaluate associations between diagnosis and characteristics of the patient, complaint, and general practitioner (GP), as well as 6 common management decisions, in patients with nontraumatic arm, neck, and shoulder complaints at the time of the first consultation with their physician. Methods We undertook an observational cohort study set in 21 Dutch general practices, including 682 patients with nontraumatic complaints of arm, neck, and shoulder. The outcome measure was application (yes/no) of a specific management option: watchful waiting, additional diagnostic tests, prescription of medication, corticosteroid injection, referral for physiotherapy, and referral for medical specialist care. Results Separate multilevel analyses showed that overall, the diagnostic category, having long duration of complaints, and reporting many functional limitations were most frequently associated with the choice of a management option. For watchful waiting, only complaint variables played a role (long duration of complaints, high complaint severity, many functional limitations, recurrent complaint). All these variables were negatively associated with watchful waiting. When opting for 1 of the 5 other management options, several physician characteristics played a role as well. Less clinical experience was associated with additional diagnostic tests and referral to a medical specialist. GPs working in a solo practice more frequently referred to a medical specialist. GPs working in a rural area more frequently referred for physiotherapy. Female GPs prescribed medication less frequently. Physicians with special interest in musculoskeletal complaints gave corticosteroid injections more frequently. Conclusions Diagnostic category, long duration of complaints, and high functional limitations were key variables in management decisions with these complaints. In addition, several physician characteristics played a role as well.</abstract><cop>United States</cop><pub>American Academy of Family Physicians</pub><pmid>19752473</pmid><doi>10.1370/afm.993</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Arm Injuries - diagnosis Arm Injuries - therapy Clinical Competence - statistics & numerical data Cohort Studies Family Practice - statistics & numerical data Female Humans Internal Medicine Male Middle Aged Neck Pain - diagnosis Neck Pain - therapy Netherlands Original Research Population Practice Patterns, Physicians' - statistics & numerical data Professional Practice - statistics & numerical data Referral and Consultation - statistics & numerical data Sex Factors Shoulder Pain - diagnosis Shoulder Pain - therapy Young Adult |
| title | Management Decisions in Nontraumatic Complaints of Arm, Neck, and Shoulder in General Practice |
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