Subacronial shoulder complaints in physiotherapy an general practice.

Purpose: The aim of this study is to describe the patient population and the process of care in patients with subacromial shoulder complaints both in physiotherapy and in general practice. Relevance: Shoulder complaints are common in the daily practice of a general practitioner (GP) and physiotherapist. They often have a recurrent and lengthy clinical course and substantial disability in daily livingmayresult from it, leading to consumption of medical health care and sick leave from work. About 80% of all these shoulder complaints concern subacromial complaints but according to recent systematic reviews information about the patient population and process of care is lacking. Participants: From two electronic registration networks for general practitioners and physiotherapists, patients were selected that visited their GP in 2008 (4227) or physiotherapist between 2003 and 2010 (2068) for shoulder syndromes (ICPC L92). Methods: Observational study using data from electronic registration networks. Analysis: Descriptive statistics were calculated for all variables. Chi-square tests (α = 0.05) were used to test differences in categorical data between patients with subacromial complaints and the general populations; two-sample t-tests were used for continuous data. Results: In general and physiotherapy practice, 43% of the patients with subacromial complaints were male and the mean age was 54 years. On average, patients with subacromial complaints visited their general practitioner (GP) 1.5 times a year. In 63% of the patients medicines were described, mostly anti-inflammatory drugs. 27% of all patients received an injection with corticosteroids. Almost 8% of the patients were referred for physiotherapy. In the average physiotherapy practice almost 76% of the patients with subacromial complaints were referred by a GP, 13% by a medical specialist and 11% came via direct access. More than half of the patients visited the physiotherapist within three months since the complaints began. On average, physiotherapists treated patients with subacromial complaints 16 times in 13 weeks. Most frequently, physiotherapists focussed their treatment on mobility and pain to restore function of the arm and hand. To realise this, functions and skills were trained. Also manual mobilisation and massage were regularly used interventions. At the end of the treatment, according to the physiotherapists, the treatment goals were accomplished in 59% of all patients. Conclusions: Compared to the total group of patients with musculoskeletal problems, patients with subacromial complaints visit their GP more often. In comparison with the general patient population that visits a physiotherapist, patients with subacromial complaints are older and wait longer before they access a physiotherapist. They also receive more treatment sessions. Mobility is chosen more frequently as a treatment goal and muscle functions less often than in the general population. According to the physiotherapists, at the end of treatment, the goals are reached less often in patients with subacromial complaints. Implications: These results can be used as benchmark information for practice and research. For example whether the recruited patient population in new trails is representative of the average population with subacromial complaints. In addition, it provides leads for possible improvements in treatment, e.g., is earlier treatment by a physiotherapist associated with better outcome?