| Management decisions in nontraumatic complaints of arm, neck, and shoulder in general practice. | |
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MedLine Citation:
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PMID: 19752473 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Anita Feleus; Sita M A Bierma-Zeinstra; Roos M D Bernsen; Harald S Miedema; Jan A N Verhaar; Bart W Koes |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Annals of family medicine Volume: 7 ISSN: 1544-1717 ISO Abbreviation: Ann Fam Med Publication Date: 2009 Sep-Oct |
Date Detail:
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Created Date: 2009-09-15 Completed Date: 2009-10-28 Revised Date: 2010-09-27 |
Medline Journal Info:
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Nlm Unique ID: 101167762 Medline TA: Ann Fam Med Country: United States |
Other Details:
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Languages: eng Pagination: 446-54 Citation Subset: IM |
Affiliation:
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Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands. a.feleus@erasmusmc.nl |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Arm Injuries / diagnosis*, therapy Clinical Competence / statistics & numerical data Cohort Studies Family Practice / statistics & numerical data* Female Humans Male Middle Aged Neck Pain / diagnosis*, therapy Netherlands Physician's Practice Patterns / statistics & numerical data* Population Professional Practice / statistics & numerical data Referral and Consultation / statistics & numerical data Sex Factors Shoulder Pain / diagnosis*, therapy Young Adult |
| Comments/Corrections | |
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