Papel de la predicción clínica para el pronóstico de dolor de hombro …(Inglés)

"Papel de la predicción clínica para el pronóstico de dolor de hombro en la práctica general."

Ton Kuijpersa, b, c, , , , , Daniëlle A.W.M. van der Windta, A. Joan P. Boekea, Jos W.R. Twiskd, Yvonne Vergouwee, Lex M. Boutera and Geert J.M.G. van der Heijdene

aInstitute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands bDepartment of Allied Health Care Research, Amsterdam School of Allied Health Care Education, The Netherlands cCare and Public Health Research Institute, Maastricht University, The Netherlands dDepartment of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands eJulius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands

Abstract

Shoulder pain is common in prim<ary 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.