Arm, neck and shoulder complaints in physical therapy practice: course and prognosis

This thesis describes studies about the course and treatment of arm, neck and shoulder complaints in physical therapy practice. A prospective cohort study of 624 new patients with arm, neck and shoulder complaints in physical therapy practice evaluated the short and the long term follow-up and the prognostic factors influencing the course. After 6 months and after 24 months follow-up about 40% of the patients reported persisting complaints. During the same period 58% reported recurrent complaints. Mainly social and psychological factors influenced the course and the recurrence of arm, neck and shoulder complaints. The treatment for this population given by the physical therapists mostly consists of exercises (93%) and massage (87%) or a combination of both. At baseline 33% reported sickness absence. Social and psychological (at work) factors influenced the occurrence of sickness absence in patients with a arm, neck and shoulder complaints. Factors related to recovery after treatment with physical therapy or manual therapy were also evaluated. Only patients with non-specific neck pain were selected for this substudy. The severity of the complaints and catastrophising influenced the treatment success. Finally by means of reviewing the literature the evidence of the effectiveness of conservative interventions for work-related complaints at arm, neck and shoulder were evaluated. The quality of most studies was poor. For some interventions limited evidence was found (exercises, some keyboards, breaks during computer work, and massage or manual therapy as add on treatment). For other interventions no evidence was found.

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