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Original article
Sick leave in workers with arm, neck and/or shoulder complaints; defining occurrence and discriminative trajectories over a 2-year time period
  1. A Feleus1,
  2. H S Miedema1,
  3. S M A Bierma-Zeinstra2,3,
  4. T Hoekstra4,5,
  5. B W Koes2,
  6. A Burdorf6
  1. 1Research Center Innovations in Care, Rotterdam University, Rotterdam, The Netherlands
  2. 2Department of General Practice, Erasmus MC, Rotterdam, The Netherlands
  3. 3Department of Orthopaedic Surgery, Erasmus MC, Rotterdam, The Netherlands
  4. 4Department of Health Sciences, VU University, Amsterdam, The Netherlands
  5. 5Department of Epidemiology and Biostatistics, VU University Medical Center, the EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
  6. 6Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Dr A Feleus, Research Center Innovations in Care, room RS 02.123, Rotterdam University, Rochussenstraat 198, 3015 EK Rotterdam; P. O. Box 25035, Rotterdam 3001 HA, The Netherlands; a.feleus{at}


Objectives Impediments due to complaints of non-traumatic arm, neck and/or shoulder (CANS) during work often leads to consultation in primary care. This study examines the occurrence of sick leave among workers with new CANS, and evaluates sick leave trajectories and their characteristics.

Methods This prospective 2-year cohort study included workers with a new CANS presenting in general practice. Participants filled out postal questionnaires on sick leave at 6-monthly intervals. Latent class growth mixture modelling was used to identify distinct trajectories of sick leave. Multinomial regression analyses identified characteristics of the subgroups.

Results During follow-up, of the 533 participants 190 reported at least one episode of sick leave due to CANS. Three sick leave trajectories were distinguished: (1) ‘low-risk’ trajectory (n=366), with a constant low probability over time; (2) ‘intermediate risk’ trajectory, with a high probability at first consultation followed by a steep decrease in probability of sick leave (n=122); (3) ‘high-risk’ trajectory (n=45), with a constant high probability of sick leave. Compared to the ‘low-risk’ trajectory, the other trajectories were characterised by more functional limitations, less specific diagnoses, more work-related symptoms and low coworker support. Specific for the ‘high-risk’ subgroup were more recurrent symptoms, more musculoskeletal comorbidity, high score on somatisation and low score on job demands.

Conclusions Three trajectories of sick leave were distinguished, graded from favourable to unfavourable. Several complaint-related and work-related factors and somatisation contributed modestly to identify an unfavourable trajectory of sick leave when presenting in primary care with CANS.

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  • Contributors SMAB-Z and BWK are responsible for the initial idea to conduct a prospective cohort study in primary care, to study the course and outcome of patients with CANS. SMAB-Z, BWK, AF, HSM and AB were responsible for the study design, choice of measures and content of the questionnaires. AF conducted data collection under the supervision of SMAB-Z, BWK and HSM. AF, SMAB-Z and BWK were involved in the organisation of the network of GPs that participated in this study. AF, HSM, AB and BWK were responsible for the planning of the analyses of the 2-year follow-up data. TH is a statistician and was consulted for specific advice regarding the use of LCGM in Mplus and interpretation of the results. AF performed all the analyses for this study and drafted the manuscript. All authors were involved in discussions about the study results, commented on drafts of this manuscript, and all approved the final version. All authors are accountable for all aspects of the work.

  • Funding The study was supported by internal funding from Erasmus MC (Revolving Fund) Rotterdam, and by the Rotterdam University of Applied Sciences.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Medical Ethical Committee of the Erasmus Medical Centre approved the study, and written informed consent was obtained from each participant.

  • Provenance and peer review Not commissioned; externally peer reviewed.