Margit Kooijman

132 depends on the type of complaints that the patient presents. In the case of subacromial complaints or acute ruptures of the rotator cuff, general practitioners and physiotherapists generally agreed on best treatment. The treatment of patients with capsulitis adhaesiva, especially when these complaints have been around for some time, showed much more variation both within and between the groups of care providers. In general, both general practitioners and physiotherapists seemed to have a tendency to intervene, especially when pain was prominent or with persistent complaints. Meanwhile, less attention was paid to the psychosocial aspects of the complaint. II Diagnosis and prognosis In chapter 4 , a questionnaire was used to investigate the current prevalence of musculoskeletal ultrasound in Dutch physiotherapy practices and what the experiences are of physiotherapists who use it. This study showed that one in six physiotherapy practices offer musculoskeletal ultrasound. Furthermore, it appeared that physiotherapists mainly used it in patients with shoulder complaints, especially when tissue damage was suspected, to make a diagnosis and to determine the choice of treatment. Physiotherapists said the biggest advantage of musculoskeletal ultrasound is that they are better able to make a diagnosis. The main disadvantage, they indicated, is that the interpretation is difficult and the risk that the findings of musculoskeletal ultrasound are or become unrelated to the history and the results of the physical examination. Chapter 5 provides an overview of the literature and summarizes which factors are already known to be associated with the outcome of treatment in patients with shoulder complaints in primary and secondary care and in the workplace. This study showed that there is strong evidence that a higher intensity of shoulder pain, concurrent neck complaints and longer duration of the complaints have a negative influence on the outcome of the treatment in primary care. In secondary care, strong evidence was found for the relationship between higher disability or a previous episode of shoulder pain and a worse outcome of the treatment. III Context factors In chapter 6 it was investigated whether there is a therapist effect and whether characteristics of the physiotherapist's personality influence the outcome of the treatment. This research showed that there is indeed a therapist effect and that there is a relationship between the personal trait extraversion and the treatment outcome. Patients treated by physiotherapists with a more outgoing personality, that is, those who