Kooijman Margit K, Barten Di-Janne A, Swinkels Ilse C S, Kuijpers Ton, de Bakker Dinny, Koes Bart W, Veenhof Cindy
NIVEL Netherlands Institute of Health Services Research, Utrecht, The Netherlands.
Dutch College of General Practitioners, Utrecht, The Netherlands.
BMC Musculoskelet Disord. 2015 Oct 9;16:288. doi: 10.1186/s12891-015-0738-4.
Shoulder complaints are common and have an unfavourable prognosis in many patients. Prognostic information is helpful for both patients and clinicians in managing the complaints. The research question was which factors have prognostic value on (un)favourable outcome in patients with shoulder complaints in primary care, secondary care and occupational settings.
Update of a systematic review in primary care, secondary care and occupational settings.
Nine articles were published since the original review in 2004. Six were of high quality covering a wide variety of prognostic factors and outcome measures. Four studies were conducted in primary care settings. A best evidence synthesis, including the results of the previous systematic review on this topic shows that there is strong evidence that higher shoulder pain intensity, concomitant neck pain and a longer duration of symptoms predict poorer outcome in primary care settings. In secondary care populations, strong evidence was found for the association between greater disability and poorer outcome and between the existence of previous shoulder pain and poorer outcome.
Clinicians may take these factors into account in the management of their patients. Those with a worse prognosis may be monitored more frequently and the treatment plan modified if complaints persist.
肩部疾病很常见，许多患者预后不佳。预后信息对患者和临床医生处理这些疾病均有帮助。研究问题是在初级保健、二级保健和职业环境中，哪些因素对肩部疾病患者的（不）良结局具有预后价值。
对初级保健、二级保健和职业环境中的系统评价进行更新。
自2004年首次综述以来，共发表了9篇文章。其中6篇质量较高，涵盖了各种预后因素和结局指标。4项研究在初级保健环境中进行。一项最佳证据综合分析，包括此前关于该主题的系统评价结果显示，有强有力的证据表明，在初级保健环境中，肩部疼痛强度较高、伴有颈部疼痛以及症状持续时间较长预示着结局较差。在二级保健人群中，有强有力的证据表明残疾程度较高与结局较差之间存在关联，以及既往有肩部疼痛与结局较差之间存在关联。
临床医生在管理患者时可考虑这些因素。预后较差的患者可能需要更频繁地监测，如果症状持续，治疗方案需进行调整。
