Management decisions in nontraumatic complaints of arm, neck, and shoulder in general practice
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.
|Keywords||Arm, Neck, Patient care management, Primary health care, Shoulder, Upper extremity|
|Persistent URL||dx.doi.org/10.1370/afm.993, hdl.handle.net/1765/32587|
Feleus, A, Bierma-Zeinstra, S.M, Bernsen, R.M.D, Miedema, H.S, Verhaar, J.A.N, & Koes, B.W. (2009). Management decisions in nontraumatic complaints of arm, neck, and shoulder in general practice. Annals of Family Medicine, 7(5), 446–454. doi:10.1370/afm.993