Original Article
High incidence and recurrence of shoulder and neck pain in nursing home employees was demonstrated during a 2-year follow-up

https://doi.org/10.1016/j.jclinepi.2004.01.022Get rights and content

Abstract

Objective

This study describes the course of shoulder and neck complaints in a working population over time.

Study Design and Setting

Questionnaires were administered on neck and shoulder complaints over 3 consecutive years.

Results

We observed 12-month incidence rates for neck and shoulder complaints of 16% to 18%, 12-month prevalence rates roughly twice as high, and 12-month recurrence rates approximately twice the prevalence rates. Each year, medical care was sought by 21% to 38% of the subjects with neck or shoulder pain, and 13% to 21% were absent from work. Although at the population level the occurrence of neck and shoulder complaints remained constant, the course of complaints within individuals demonstrated a strong episodic nature of neck and shoulder pain. Results from this study suggest that neck and shoulder complaints for most subjects run a recurrent course characterized by a strong variation in occurrence and a self-limiting course.

Conclusion

These findings suggest that clinical trials should have a sufficiently long follow-up period to demonstrate sustainability of the therapeutic results.

Introduction

Shoulder and neck pain are common problems in the general population, with 1-year prevalences varying from 7% to 47% for shoulder complaints [1], [2] and from 16% to 61% for neck complaints [3]. Shoulder and neck complaints may result in sick leave, loss of productivity, and inability to carry out household and leisure time activities [4], [5]. In the period 1987–1995, the state of Washington paid over 66 million dollars a year on work disability claims due to shoulder problems [6]. Swedish insurance data on income compensation during sick leave showed that in 1994 the costs for neck-shoulder complaints equalled the costs for back pain [7].

Despite the societal impact of these complaints, little is known about the long-term course of shoulder and neck complaints due to the lack of longitudinal studies [8], [9]. Prospective studies among patients with shoulder complaints in primary care have shown that 41% to 51% of these patients experienced recurrent episodes during an 18-month follow-up [4], [10]. In one cohort study among patients with shoulder pain, more than 50% of all subjects reported shoulder pain with disabling symptoms about 3 years later [11]. Comparable studies on the occurrence of neck pain over time are lacking. The prospective studies suggest that shoulder complaints are persistent [11] or, alternatively, vary considerably over time, with fluctuating severity of these complaints [10].

To understand the natural course of neck and shoulder complaints, we studied the dynamic patterns of incidence, recurrence, chronicity, and recovery of shoulder and neck complaints in a longitudinal cohort study with a 2-year follow-up. The aims of this study were (1) to describe the temporal changes in incidence, recurrence, chronicity, and recovery of neck and shoulder complaints over a 3-year period; (2) to identify the characteristics of pain predicting the recurrence; and (3) to evaluate the effect of the characteristics of neck and shoulder complaints on care-seeking behavior.

Section snippets

Population

The current study is part of a longitudinal study with 2-year follow-up on the development of musculoskeletal complaints in an occupational population. The source population consisted of all subjects working in four nursing homes and three homes for the elderly in the Netherlands. The health care sector is well known for its high proportion of musculoskeletal complaints among its personnel [12]. Subjects were invited to participate in the study if they had worked for more than 12 months for

Population

Characteristics of the study population at baseline and both follow-up measurements are presented in Table 1. The nonresponders in follow-up 1 (n = 240) and follow-up 2 (n = 183) were not significantly different from the responders at baseline for age, height, weight, duration of employment, and occurrence of shoulder or neck complaints.

Course of neck and shoulder complaints over time

The individual course of the subjects with shoulder or neck pain (Fig. 1, Fig. 2) showed a dynamic pattern, whereas the prevalence remained stable over the 3-year

Discussion

In this longitudinal study in a working population, we observed 12-month incidence rates for neck and shoulder complaints of 16% to 18%, 12-month prevalence rates roughly twice as high, and 12-month recurrence rates approximately twice the prevalence rates. The concurrence of both neck and shoulder complaints was reflected by the fact that 50% to 60% of all subjects with neck complaints also reported to have experienced shoulder complaints in the past 12 months. The course of neck and shoulder

Acknowledgments

We thank Ingrid J.M. Hendriksen and Arianne P. Verhagen for their critical suggestions on this article.

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