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Prognostic studies on neck pain are scarce and are typically restricted to short-term follow-up only. In this prospective cohort study, indicators of short- and long-term outcomes of neck pain were identified that can easily be measured in general practice. Patients between 18 and 70 years of age, suffering for at least 2 weeks from neck pain were recruited by 42 general practitioners (GPs). Perceived recovery, pain intensity and neck dysfunction after 7 and 52 weeks were considered as outcome measures. Indicators of prognosis were identified by means of logistic regression analyses (perceived recovery) and linear regression analyses (pain intensity and neck dysfunction). In total, 183 patients were included. After 1 year, 63% had recovered. The prognostic models showed differences between short- and long-term indicators. At the short term, besides the baseline values of the respective outcome measurements, only older age (≥40) and concomitant low back pain and headache were associated with poor outcome. At the long term, in addition to age and concomitant low back pain, previous trauma, a long duration of neck pain, stable neck pain during the 2 weeks prior to baseline measurement, and previous neck pain predicted poor prognosis. The predictive power of the models was weak: the explained variance (R2) varied from 24 to 36%. Patient history and physical examination give GPs little handholds to predict the prognosis for patients with sub-acute and chronic neck pain. A few indicators of a less favourable prognosis of neck pain were identified, of which older age and concomitant low back pain was the most consistent. [Copyright &y& Elsevier]

Abstract: The objective of this study was to examine which factors during pregnancy and postpartum predict pelvic girdle pain (PGP) at 12weeks postpartum among working women. A total of 548 Dutch pregnant employees were recruited in 15 companies, mainly health care, child care, and supermarkets. The definition of PGP was any pain felt in the pelvic girdle region at 12weeks postpartum. Participants received questionnaires at 30weeks of pregnancy and at 6 and 12weeks postpartum with demographic, work-related, pregnancy-related, fatigue, psychosocial, PGP-related and delivery-related questions. Univariate and multiple logistic regression analyses were performed. Almost half of the women experienced pain in their pelvic girdle at 12weeks postpartum. However, the level of pain and the degree of disability due to postpartum PGP was low. Pregnancy-related predictors for PGP at 12weeks were history of low back pain, higher somatisation, more than 8hours of sleep or rest per day, and uncomfortable postures at work. The pregnancy and postpartum-related predictors were: more disability at 6weeks, having PGP at 6weeks, higher mean pain at 6weeks, higher somatisation during pregnancy and at 6weeks postpartum, higher birth weight of the baby, uncomfortable postures at work and number of days of bed rest. Based on these results, it is concluded that extra attention should be given to women who experience PGP during pregnancy to prevent serious PGP during late pregnancy and postpartum. More research is needed to confirm the roles of hours of sleep, somatisation, and bed rest in relation to PGP. [Copyright &y& Elsevier]

Abstract: Shoulder pain is common in primary care and has an unfavourable outcome in many patients. Information about predictors of outcome is scarce and inconsistent. The objective of this study was to develop clinical prediction rules for calculating the absolute risk of persistent shoulder symptoms for individual patients, 6 weeks and 6 month after the first consultation in general practice. A prospective cohort study with 6 months follow-up was carried out in three geographic areas in The Netherlands. In this study, 587 patients with a new episode of shoulder pain were included. The main outcome measure was persistent symptoms at 6 weeks and 6 months, perceived by the patient. Potential predictors included the results of a physical examination, sociodemographic variables, disease characteristics (duration of symptoms, pain intensity, disability and comorbidity), physical activity, physical workload and psychosocial factors. Response rates to the follow-up questionnaires were 83% at 6 weeks and 92% at 6 months. A longer duration of symptoms, gradual onset of pain and high pain severity at presentation were consistently associated with persistent symptoms at 6 weeks and 6 months. The discriminative validity of our prediction rules was satisfactory with area under the curves of 0.74 (95% CI 0.70, 0.79) at 6 weeks and 0.67 (95% CI 0.63, 0.71) at 6 months. The performance of our rules needs to be tested in other populations of patients with shoulder pain to enable valid and reliable use of the rules in everyday clinical practice. [Copyright &y& Elsevier]