Search

Background. Nontraumatic complaints of arm, neck, and shoulder (CANS) represent an important health issue, with a high prevalence in the general working age population and huge economic impact. Nevertheless, only few prospective cohort studies for the outcome of CANS are available. Objectives. The purpose of this study was to identify disability trajectories and associated prognostic factors during a 2-year follow-up of patients with a new episode of CANS in primary Design. This was a prospective cohort study. Methods. Data of 682 participants were collected through questionnaires at baseline and every 6 months thereafter. Disability was measured with the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Latent class growth mixture (LCGM) modeling was used to identify clinically meaningful groups of patients who were similar in their disability trajectory during follow-up. Multivariate multinomial regression analysis was used to evaluate associations between sociodemographic, complaint-related, physical, and psychosocial variables and the identified disability trajectories. Results. Three disability trajectories were identified: fast recovery (67.6%), modest recovery (23.6%), and continuous high disability (8.8%). A high level of somatization was the most important baseline predictor of continuous high disability. Furthermore, poor general health, widespread complaints, and medium level of somatization were associated with this trajectory and >3 months complaint duration, musculoskeletal comorbidity, female sex, history of trauma, low educational level, low social support, and high complaint severity were associated with both continuous high disability and modest recovery. Age, kinesiophobia, and catastrophizing showed significant associations only with modest recovery. Limitations. Loss to follow-up ranged from 10% to 22% at each follow-up measurement. Disabilities were assessed only with the DASH and not with physical tests. Misclassification by general practitioners regarding specific or nonspecific diagnostic category might have occurred. The decision for optimal LCGM model, resulting in the disability trajectories, remains arbitrary to some extent. Conclusions. Three trajectories described the course of disabilities due to CANS. Several prognostic indicators were identified that can easily be recognized in primary care. As some of these prognostic indicators may be amenable for change, their presence in the early stages of CANS may lead to more intensive or additional interventions (eg, psychological or multidisciplinary therapy). Further research focusing on the use of these prognostic indicators in treatment decisions is needed to further substantiate their predictive value., Nontraumatic complaints of the arm, neck, and shoulder (CANS) represent an important health issue, with high prevalence rates in general working age populations, ranging from 12% in the United States [...]

Background. Few data are available on the course of and predictors for disability in patients with chronic nonspecific low back pain (CNSLBP). Objective. The purpose of this study was to describe the course of disability and identify clinically important prognostic factors of low-back-pain-specific disability in patients with CNSLBP receiving multidisciplinary therapy. Design. A prospective cohort study was conducted. Methods. A total of 1,760 patients with CNSLBP who received multidisciplinary therapy were evaluated for their course of disability and prognostic factors at baseline and at 2-, 5-, and 12-month follow-ups. Recovery was defined as 30% reduction in low back pain-specific disability at follow-up compared with baseline and as absolute recovery if the score on the Quebec Back Pain Disability Scale (QBPDS) was ≤ 20 points at follow-up. Potential prognostic factors were identified using multivariable logistic regression analysis. Results. Mean patient-reported disability scores on the QBPDS ranged from 51.7 (SD=15.6) at baseline to 31.7 (SD= 15.2), 31.1 (SD=18.2), and 29.1 (SD=20.O) at 2, 5, and 12 months, respectively. The prognostic factors identified for recovery at 5 and 12 months were younger age and high scores on disability and on the 36-Item Short-Form Health Survey (SF-36) (Physical and Mental Component Summaries) at baseline. In addition, at 5-month follow-up, a shorter duration of complaints was a positive predictor, and having no comorbidity and less pain at baseline were additional predictors at 12-month follow-up. Limitations. Missing values at 5- and 12-month follow-ups were 11.1% and 45.2%, respectively. Conclusion. After multidisciplinary treatment, the course of disability in patients with CNSLBP continued to decline over a 12-month period. At 5- and 12-month follow-ups, prognostic factors were identified for a clinically relevant decrease in disability scores on the QBPDS., Prognosis and Course of Disability in Chronic Nonspecific Low Back Pain There is no strong evidence to support the claim that 80% to 90% of patients with low back pain [...]

Abstract Objectives--To assess work history and labour force participation among patients with rheumatoid arthritis (RA) in the Netherlands. Methods--A random sample of 1056 patients with RA aged 16-59 years from [...]

To identify predictors of late academic or early career dropout, and derive a simple model for identifying nursing students and novice nurses with significant increased dropout risk.

A followup study of a cohort of 444 patients aged 16 to 59 years who consulted with their general practitionersGPs in 19871988 for an incident episode of back pain.