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Predictors for persistent neck/shoulder pain, medical care-seeking due to neck/shoulder pain and sickness absence

Department of Public Health Sciences, Division of Occupational Medicine, Karolinska Institutet and Department of Occupational and Environmental Health, Stockholm County Council, Stockholm, Sweden, for the MUSIC Norrtälje Study Group, Wim.Grooten{at}ki.se

Objective: To determine whether symptoms and clinical signs can predict persistent neck/shoulder pain, future medical care-seeking and sickness absence.

Design: A population-based cohort was followed prospectively over a 5—6 year period.

Setting: Subjects from the district of Norrtälje (Sweden).

Subjects: Subjects with self-rated neck/shoulder pain were included (n = 1471).

Main measures: Cox regression analyses were used to test the predictive value of single and combinations of symptoms and clinical signs obtained with questionnaires and simple tests concerning persistent neck/shoulder pain, future medical care-seeking and sickness absence.

Results: Several symptoms and clinical signs were associated with the outcomes of interest: the relative risk (RR) for persistent neck/shoulder pain was 1.38 (95% confidence interval (CI) 1.14—1.52) for subjects with pain for over three months at baseline and concerning future medical care-seeking RR was 2.10 (95% CI 1.73—2.54) for subjects who had previously sought medical care. An episode of sickness absence during the year of enrolment increased the risk for future sickness absence (RR = 2.42, 95% CI 1.95—3.00). Having five or seven concurrent symptoms and clinical signs was common and more strongly associated with persistent pain (RR = 1.77, 95% CI 1.39 — 2.27) and future medical care-seeking (RR = 4.51, 95% CI 2.54—9.94), respectively, but not concerning sickness absence.

Conclusion: By simply counting the number of concurrent symptoms and clinical signs, it is possible to predict persistent neck/shoulder pain and future medical care-seeking, but not sickness absence.

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