Determinants of the clinical course of musculoskeletal complaints in general practice: design of a cohort study

BACKGROUND: Musculoskeletal complaints are frequent and have large consequences for public health. Information about the prognosis after presentation in general practice is far from complete. Knowledge about determinants of the clinical course of musculoskeletal complaints is essential for management decisions and to inform patients about their prognosis. The purpose of this study is to provide information about the prognosis of musculoskeletal complaints other than low back pain by studying the course of these complaints in general practice and to identify determinants of this course. METHODS: Patients of 18 years and older, who present in general practice with a new episode of a musculoskeletal complaint of the neck, shoulder, elbow, wrist, hand, arm, hip, knee, ankle or foot, are recruited by their general practitioner (GP). Participants will receive complaint-specific questionnaires by mail at baseline and after 3, 6, 12 and 18 months. The following putative determinants of the course of the complaints will be investigated: sociodemographic characteristics, characteristics of the complaint, psychosocial job characteristics, physical workload, physical activity during leisure time, pain coping, mood, kinesiophobia, social support, optimism. The primary outcomes are perceived recovery, pain, functional status, sick leave and overall quality of life

Health-related and overall quality of life of patients with chronic hip and knee complaints in general practice

BACKGROUND: Information about quality of life of patients with chronic hip or knee complaints in general practice is scarce. This study describes the health-related and overall quality of life (HRQL) of these complaints. METHODS: Data were obtained from a cohort study in general practice. HRQL at three months follow-up was analysed. HRQL was measured as: symptoms, physical, psychological and social functioning, and general health perceptions, using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the MOS 36-item short-form-health survey (SF-36). Overall quality of life was measured using a 5-point rating scale. RESULTS: The results show that patients with chronic hip or knee complaints have a substantial lower HRQL compared to patients who had recovered from baseline hip or knee complaints. The largest effect was found on symptoms and physical functioning: up to 2.9 standard deviations below patients who had recovered from baseline hip or knee complaints. Scores of patients with both chronic hip and knee complaints were significantly worse than scores of patients with only knee complaints on most subscales. CONCLUSION: In patients with chronic hip or knee complaints the worst scores were seen on scales that measure symptoms and physical functioning, but still a substantially lower score was obtained for overall quality of life. Quality of life was poorer for patients with both chronic hip and knee complaints compared to those with chronic hip or knee complaints onl

How to promote healthy behaviours in patients? An overview of evidence for behaviour change techniques

To identify the evidence for the effectiveness of behaviour change techniques, when used by health-care professionals, in accomplishing health-promoting behaviours in patients. Reviews were used to extract data at a study level. A taxonomy was used to classify behaviour change techniques. We included 23 systematic reviews: 14 on smoking cessation, 6 on physical exercise, and 2 on healthy diets and 1 on both exercise and diets. None of the behaviour change techniques demonstrated clear effects in a convincing majority of the studies in which they were evaluated. Techniques targeting knowledge (n = 210 studies) and facilitation of behaviour (n = 172) were evaluated most frequently. However, self-monitoring of behaviour (positive effects in 56% of the studies), risk communication (52%) and use of social support (50%) were most often identified as effective. Insufficient insight into appropriateness of technique choice and quality of technique delivery hinder precise conclusions. Relatively, however, self-monitoring of behaviour, risk communication and use of social support are most effective. Health professionals should avoid thinking that providing knowledge, materials and professional support will be sufficient for patients to accomplish change and consider alternative strategies which may be more effective

Identification of regulatory variants associated with genetic susceptibility to meningococcal disease.

Non-coding genetic variants play an important role in driving susceptibility to complex diseases but their characterization remains challenging. Here, we employed a novel approach to interrogate the genetic risk of such polymorphisms in a more systematic way by targeting specific regulatory regions relevant for the phenotype studied. We applied this method to meningococcal disease susceptibility, using the DNA binding pattern of RELA - a NF-kB subunit, master regulator of the response to infection - under bacterial stimuli in nasopharyngeal epithelial cells. We designed a custom panel to cover these RELA binding sites and used it for targeted sequencing in cases and controls. Variant calling and association analysis were performed followed by validation of candidate polymorphisms by genotyping in three independent cohorts. We identified two new polymorphisms, rs4823231 and rs11913168, showing signs of association with meningococcal disease susceptibility. In addition, using our genomic data as well as publicly available resources, we found evidences for these SNPs to have potential regulatory effects on ATXN10 and LIF genes respectively. The variants and related candidate genes are relevant for infectious diseases and may have important contribution for meningococcal disease pathology. Finally, we described a novel genetic association approach that could be applied to other phenotypes

The impact of non-traumatic hip and knee disorders on health-related quality of life as measured with the SF-36 or SF-12. A systematic review

Objectives: The purpose of this review is to summarize the available evidence on the impact of non-traumatic hip or knee disorders on health-related quality of life (HRQL), as measured with the Short Form 36 Health Survey (SF-36) or Short Form 12 Health Survey (SF-12), by comparing this with data from reference populations. Methods: Studies were identified by an electronic search of the MEDLINE, PsychInfo and Cinahl databases. Studies with the following features were included: study population included patients with non-traumatic hip or knee disorders, the SF-36 or SF-12 was used as an outcome measure and mean scores on these HRQL measures were presented. Using mean HRQL scores from the selected studies and scores from reference populations, z-scores were computed. Pooled estimates were computed for subgroups of studies with similar patients in similar settings. Results: A total of 40 studies met the inclusion criteria. Patients with non-traumatic hip and knee disorders scored up to 2.5 standard deviations (SDs) below reference population values, especially on the physical aspects of HRQL. Social and mental aspects were up to 1 SD below reference population values, especially in patients in clinical settings. Conclusions: The impact of non-traumatic hip or knee disorders on HRQL is substantial, especially on the physical aspects of HRQL

Health-related and overall quality of life of patients with chronic hip and knee complaints in general practice

Background: Information about quality of life of patients with chronic hip or knee complaints in general practice is scarce. This study describes the health-related and overall quality of life (HRQL) of these complaints. Methods: Data were obtained from a cohort study in general practice. HRQL at three months follow-up was analysed. HRQL was measured as: symptoms, physical, psychological and social functioning, and general health perceptions, using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the MOS 36-item short-form-health survey (SF-36). Overall quality of life was measured using a 5-point rating scale. Results: The results show that patients with chronic hip or knee complaints have a substantial lower HRQL compared to patients who had recovered from baseline hip or knee complaints. The largest effect was found on symptoms and physical functioning: up to 2.9 standard deviations below patients who had recovered from baseline hip or knee complaints. Scores of patients with both chronic hip and knee complaints were significantly worse than scores of patients with only knee complaints on most subscales. Conclusion: In patients with chronic hip or knee complaints the worst scores were seen on scales that measure symptoms and physical functioning, but still a substantially lower score was obtained for overall quality of life. Quality of life was poorer for patients with both chronic hip and knee complaints compared to those with chronic hip or knee complaints only

The course and prognosis of hip complaints in general practice

Background: The general practitioner needs to discriminate complaints with need of specialist care from those that can be managed in primary care. However, no previous research has studied prognostic indicators for the course of hip complaints in a primary care population. Purpose: The purpose of this study was to investigate the course of hip complaints presented in general practice and to identify relevant prognostic indicators of outcome. Methods: Data were collected by means of self-administered questionnaires containing questions about sociodemographic variables, characteristics of the complaints, and several intraindividual and extraindividual factors, including several psychosocial variables (e.g., pain coping, distress, and kinesiophobia). After 3 and 12 months of follow-up perceived recovery, change in pain intensity and change in functioning were assessed. Multiple regression analyses were performed to investigate the association between the potential prognostic indicators and the 3 outcome measures. Results: We included 139 patients with hip complaints, presented in general practice. Only 24% reported recovery after 3 months, increasing to 37% after 12 months. A history of hip complaints, a longer duration of the current episode of hip complaints, or more severe complaints, were associated with a less favorable prognosis. Furthermore, more vital patients and patients who met the Norm for Healthy Activity had a higher probability of a favorable outcome. Pain transformation and worrying were significant associated with recovery and changes in functioning after 3 months. Conclusions: Different prognostic indicators were found to be associated with perceived recovery, changes in pain intensity, and changes in functioning. Future research should aim at investigating the mechanisms that can underlie these associations

Predictors of outcome in neck and shoulder symptoms: a cohort study in general practice.

STUDY DESIGN: An observational prospective cohort study in general practice. OBJECTIVES: To describe the clinical course and to identify predictors of recovery, changes in pain intensity, and changes in functional disability in patients with neck or shoulder symptoms at 3- and 12-month follow-up. SUMMARY OF BACKGROUND DATA: Knowledge on the clinical course and predictors of outcome in neck and shoulder symptoms is limited. Such knowledge would facilitate treatment decisions and may help to inform patients about their prognosis. METHODS: Four hundred and forty-three patients who consulted their general practitioner with neck or shoulder symptoms participated in the study. Baseline scores of pain and disability, symptom characteristics, sociodemographic and psychological factors, social support, physical activity, general health, and comorbidity were investigated as possible predictors of recovery, changes in pain intensity, and changes in functional disability using multiple regression analyses. RESULTS: The recovery rate was low; 24% of the patients reported recovery at 3 months and 32% reported recovery at 12-month follow-up. Duration of the symptoms before consulting the GP and a history of neck or shoulder symptoms increased the probability of an unfavorable outcome. Furthermore, less vitality and more worrying were consistently associated with poorer outcome after 3 and 12 months. The area under the receiver-operator characteristic curve for the model predicting recovery was 0.8 at 3 months and 0.75 at 12 months. The explained variance of the models on pain and functional disability ranged from 43 to 54%. CONCLUSIONS: The results found in this study indicate that besides clinical characteristics, psychological factors also predict the outcome of neck and shoulder symptoms