Harald S. Miedema

Prevalence and incidence of shoulder pain in the general population; a systematic review.

Objective: To investigate the incidence and prevalence of shoulder complaints in the general population. Method: A systematic review of the literature was conducted. Medline, Embase, and Cinahl were searched for relevant studies. Results: Eighteen studies on prevalence and one study on incidence met the inclusion criteria. Incidence figures of 0.9–2.5% were found for different age groups. Prevalence figures differed from 6.9 to 26% for point prevalence, 18.6–31% for 1‐month prevalence, 4.7–46.7% for 1‐year prevalence and 6.7–66.7% for lifetime prevalence. Prevalence rates decreased when the case definition was restricted, in terms of duration of pain or the presence of limited movements, and increased when the location for pain was enlarged. Conclusion: The reported prevalence figures on shoulder complaints diverged strongly. Health professionals and policymakers who estimate the amount of medical care needed and related costs should be aware of the variations in prevalence rate and the underlying reasons for these differences.

Multidisciplinary consensus on the terminology and classification of complaints of the arm, neck and/or shoulder

Background: There is no universally accepted way of labelling or defining upper-extremity musculoskeletal disorders. A variety of names are used and many different classification systems have been introduced. Objective: To agree on an “unambiguous language” concerning the terminology and classification that can be used by all relevant medical and paramedical disciplines in the Netherlands. Methods: A Delphi consensus strategy was initiated. The outcomes of a multidisciplinary conference were used as a starting point. In total, 47 experts in the field of upper-extremity musculoskeletal disorders were delegated by 11 medical and paramedical professional associations to form the expert panel for the Delphi consensus strategy. Each Delphi round consisted of a questionnaire, an analysis and a feedback report. Results: After three Delphi rounds, consensus was achieved. The experts reported the consensus in a model. This so-called CANS model describes the term, definition and classification of complaints of arm, neck and/or shoulder (CANS) and helps professionals to classify patients unambiguously. CANS is defined as “musculoskeletal complaints of arm, neck and/or shoulder not caused by acute trauma or by any systemic disease”. The experts classified 23 disorders as specific CANS, because they were judged as diagnosable disorders. All other complaints were called non-specific CANS. In addition, the experts defined “alert symptoms” on the top of the model. Conclusions: The use of the CANS model can increase accurate and meaningful communication among healthcare workers, and may also have a positive influence on the quality of scientific research, by enabling comparison of data of different studies.

Treatment of Impingement Syndrome: A Systematic Review of the Effects on Functional Limitations and Return to Work

The goal of this systematic review is to evaluate the effectiveness of different treatments for impingement syndrome and rotator cuff tear on the improvement in functional limitations and concomitant duration of sick leave. A systematic search for clinical trials or controlled studies was conducted with the following text words: should*, rotator cuff, impingement, work, sick leave, disabilit*, function*. Nineteen articles were included in this review. For functional limitations, there is strong evidence that extracorporeal shock-wave therapy is not effective, moderate evidence that exercise combined with manual therapy is more effective than exercise alone, that ultrasound is not effective, and that open and arthroscopic acromioplasty are equally effective on the long term. For all other interventions there is only limited evidence. We found many studies using range of motion and pain as outcome measures but functional limitations were less often used as an outcome measure in this type of research. Duration of sick leave was seldom included as an outcome measure.

Determinants of implementation of primary preventive interventions on patient handling in healthcare: a systematic review

Objective: This systematic review aims (1) to identify barriers and facilitators during implementation of primary preventive interventions on patient handling in healthcare, and (2) to assess their influence on the effectiveness of these interventions. Methods: PubMed and Web of Science were searched from January 1988 to July 2007. Study inclusion criteria included evaluation of a primary preventive intervention on patient handling, quantitative assessment of the effect of the intervention on physical load or musculoskeletal disorders or sick leave, and information on barriers or facilitators in the implementation of the intervention. 19 studies were included, comprising engineering (n = 10), personal (n = 6) and multiple interventions (n = 3). Barriers and facilitators were classified into individual and environmental categories of factors that hampered or enhanced the appropriate implementation of the intervention. Results: 16 individual and 45 environmental barriers and facilitators were identified. The most important environmental categories were “convenience and easy accessibility” (56%), “supportive management climate” (18%) and “patient-related factors” (11%). An important individual category was motivation (63%). None of the studies quantified their impact on effectiveness nor on compliance and adherence to the intervention. Conclusion: Various factors may influence the appropriate implementation of primary preventive interventions, but their impact on the effectiveness of the interventions was not evaluated. Since barriers in implementation are often acknowledged as the cause of the ineffectiveness of patient handling devices, there is a clear need to quantify the influence of these barriers on the effectiveness of primary preventive interventions in healthcare.

Interventions for Treating the Radial Tunnel Syndrome: A Systematic Review of Observational Studies

PURPOSE For some disorders, such as radial tunnel syndrome (RTS), no randomized controlled trials and controlled clinical trials are available. To gain insight into the effectiveness of conservative and surgical interventions for treating RTS, we systematically reviewed all available observational studies on treatment of RTS. Although the validity of case series is inferior to that of controlled trials, the case series might provide valuable data about the efficacy of treatment options. METHODS A literature search and additional reference checking resulted in 21 eligible case series for this review. Based on previous checklists, we constructed a new quality assessment and rating system to analyze the included case series. The methodological quality was assessed, and data extraction was performed. Studies with less than 50% of the maximum points on the methodological quality assessment were considered inadequate and were excluded from the analysis. To summarize the results according to the rating system for the strength of the scientific evidence for these case series, we introduced 4 levels: (1) tendency, (2) slight tendency, (3) conflicting tendency, and (4) no tendency. RESULTS After the methodological quality assessment, 6 articles were included in the final analysis. They all reported on surgical treatment. CONCLUSIONS There is a tendency that surgical decompression of the radial tunnel might be effective in patients with RTS. The effectiveness of conservative treatments for RTS is unknown because, for most treatments, no studies were available. Additional high-quality controlled studies are needed to assess the level of conclusive evidence for surgical treatment and also to evaluate conservative treatments for RTS. For this, we recommend a multicenter, randomized clinical trial. Due to the lack of a clear protocol for diagnosing RTS, a reliable and valid diagnostic tool should be developed. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Kinesiophobia in patients with non-traumatic arm, neck and shoulder complaints: a prospective cohort study in general practice

BackgroundComplaints of arm, neck and shoulder are common in Western societies. Of those consulting a general practitioner (GP) with non-traumatic arm, neck or shoulder complaints, about 50% do not recover within 6 months.Kinesiophobia (also known as fear of movement/(re)injury) may also play a role in these complaints, as it may lead to avoidance behaviour resulting in hypervigilance to bodily sensations, followed by disability, disuse and depression. However, in relation to arm, neck and shoulder complaints little is known about kinesiophobia and its associated variables.Therefore this study aimed to: describe the degree of kinesiophobia in patients with non-traumatic complaints of arm, neck and shoulder in general practice; to determine whether mean scores of kinesiophobia change over time in non-recovered patients; and to evaluate variables associated with kinesiophobia at baseline.MethodsIn this prospective cohort study set in general practice, consulters with a first or new episode of non-traumatic arm, neck or shoulder complaints (aged 18–64 years) entered the cohort. Baseline data were collected on kinesiophobia using the Tampa Scale for Kinesiophobia, the 13-item adjusted version: TSK-AV, and on patient-, complaint-, and psychosocial variables using self-administered questionnaires. The mean TSK-AV score was calculated. In non-recovered patients the follow-up TSK-AV scores at 6 and 12 months were analyzed with the general linear mixed model. Variables associated with kinesiophobia at baseline were evaluated using multivariate linear regression analyses.ResultsThe mean TSK-AV score at baseline was 24.8 [SD: 6.2]. Among non-recovered patients the mean TSK-AV score at baseline was 26.1 [SD: 6.6], which remained unchanged over 12- months follow-up period. The strongest associations with kinesiophobia were catastrophizing, disability, and comorbidity of musculoskeletal complaints. Additionally, having a shoulder complaint, low social support, high somatization and high distress contributed to the kinesiophobia score.ConclusionThe mean TSK-AV score in our population seems comparable to those in other populations in primary care.In patients who did not recover during the 12- month follow-up, the degree of kinesiophobia remained unchanged during this time period.The variables associated with kinesiophobia at baseline appear to be in line with the fear-avoidance model.

Barriers for Early Return-To-Work of Workers With Musculoskeletal Disorders According to Occupational Health Physicians and Human Resource Managers

Recent studies have indicated positive effects of modified work for workers with musculosceletal complaints. The question remains how effectively modified work can be implemented in companies. This study describes barriers for introducing modified work for workers on sickness absence due to musculoskeletal complaints. Modified work was defined as gradually increasing the physical demands at work until the worker is ready for full duty in his regular job. In order to describe barriers in implementation of modified work, a model based on health education was used, consisting of six successive stages. A questionnaire derived from this model was sent to human resource managers of different companies and their occupational health physicians. The internal consistency was estimated with the Cronbachs alpha. The results showed a large number of barriers for modified work. According to 52% of the company management and 54% of the occupational health physicians evident barriers were found due to lack of knowledge on modified work and negative attitudes of the employees. Both companies and physicians reported a barrier in the possibilities to change the work tasks (45–54%) or the organization of the work (45–38%). About 62% of the companies reported barriers due to a mismatch between the education of the sick worker and the specific requirements of modified work. Despite the assumed positive effects of modified work, the implementation process is hampered by a large number of barriers. A maximum effort from all parties involved is required for a successful rehabilitation process.

Psychosocial factors predicted nonrecovery in both specific and nonspecific diagnoses at arm, neck, and shoulder

OBJECTIVES To evaluate the differences in predictors of nonrecovery between patients with a specific diagnosis at arm, neck, and/or shoulder, vs. patients with a nonspecific diagnosis in general practice at 6 months after the first consultation. STUDY DESIGN AND SETTING New consulters with nontraumatic arm, neck, or shoulder complaints entered the cohort. Patient, complaint, and physical, psychosocial, and work characteristics were evaluated as possible predictors. Logistic regression analyses were conducted for the specific and nonspecific groups separately. RESULTS At 6 months, 38% (n=298) of the specific-group members and 49% (n=249) of the nonspecific-group members reported nonrecovery. Univariately, similar variables were related in both groups, although their strength sometimes differed. Multivariately, duration of complaints was predictive of nonrecovery in both groups. Other predictors in the specific group were as follows: more somatization, low social support, older age, high body mass index, and unemployment. In the nonspecific group, the predictors were as follows: musculoskeletal comorbidity, recurrent complaint, poor perceived general health, multiple-region complaints, and high level of kinesiophobia. CONCLUSION At 6 months, nonrecovery was reported more frequently in the group of patients with a nonspecific diagnosis. The predictive value of psychosocial factors on nonrecovery is at least of equal importance in patients with a specific diagnosis compared with patients with a nonspecific diagnosis.

Interventions for treating the posterior interosseus nerve syndrome: a systematic review of observational studies

Abstract  For the posterior interosseus nerve syndrome (PINS), no randomised controlled trials or controlled clinical trials about the effectiveness of interventions are available; only case series can be found. Although the validity of case series is inferior to controlled trials, they may provide valuable data about the efficacy of treatment options. Therefore, we systematically reviewed all available observational studies on treatment of PINS. A literature search and additional reference checking was done. On the basis of previous checklists, we constructed a quality assessment and rating system to analyse the included case series. Studies with less than 50% of the maximum points on the methodological quality assessment were excluded from the analysis. The results are summarised according to a rating system for the strength of the scientific evidence. Six eligible case series for this review were found. After the data extraction and methodological quality assessment, two higher quality studies that evaluated the effectiveness of surgical decompression of the PIN were included in the final analysis. There is a tendency for the effectiveness of surgical decompression of the PIN in patients with PINS. The effectiveness of a conservative treatment for PINS is unknown because no higher quality studies are available. Additional high‐quality controlled studies are needed to assess the level of ‘conclusive evidence’ for surgical treatment. There is also a need for high‐quality controlled trials into the effectiveness of conservative treatments for PINS.

Prognosis and Course of Disability in Patients With Chronic Nonspecific Low Back Pain: A 5- and 12-Month Follow-up Cohort Study

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=20.0) 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.