Margit Kooijman

Current care | 33 could be a helpful approach. Perhaps with early detection, a once-off consultation during which advice is given will be sufficient. Regarding the use of such a wait-and-see policy by physiotherapists, the profession will need to determine the conditions under which this is possible as well as its impact on prognosis and cost-effectiveness. With regard to the physiotherapy treatment itself, the results of the present study show that in patients with shoulder syndromes, exercises aimed at functions, mobilisation and massage are the main types of intervention, which is partly in line with what is known about the treatment of shoulder injuries. Literature reviews by Green et al. 12 and Kromer et al. 15 on physiotherapy interventions for shoulder pain did not mention massage, whereas other research on the effectiveness of massage for shoulder pain provided moderate evidence for analgesic effects. Physiotherapy treatment results in a positive outcome in 64% of patients with shoulder syndromes, regardless of the mode of access. In the general patient population in physiotherapy practice, 68% fully reach the treatment goals 1 . Of the patients referred for physiotherapy, 37% go back to their GP. This is in line with previous studies indicating an unfavourable outcome in many patients resulting in high costs 3,23 . On the other hand, Kuijpers et al. found that the total costs in the six months after first consultation for shoulder pain in primary care were not alarmingly high. In that study, the cost of physiotherapy accounted for only 14% of the total costs, as few patients were referred for therapy. However, the authors concluded that higher health care costs and productivity losses may be expected when follow-up times are longer due to a poor prognosis 24 . Registration networks cover a large number of patients, providing a rich source of data. However, there are some limitations to this method of data collection. In LIPZ, information is collected on all diagnoses. This means detailed information specific to shoulder syndromes is not available; e.g. the existence of neck or back problems or repetitive or provocative movements in work or sport. Furthermore, diagnoses are based on referral letters, which can be ambiguous or imprecise. For example, terms such as ‘shoulder complaints’ are used, without giving further information. The procedure for diagnosing specific shoulder disorders is further complicated by a lack of consensus on the diagnostic criteria. Where diagnosis is difficult, complaints may be described as general shoulder complaints in the first instance, perhaps more so by less experienced clinicians. In this study, these general shoulder complaints are not included as shoulder syndromes in order to prevent heterogeneity as much as possible. Therefore, the results are based on a more homogeneous group of patients, but this may have led to an underestimation of the number of people attending the physiotherapist with shoulder syndromes. To measure the outcome of physiotherapy treatment, an indication of the extent to which the treatment goals were met is registered in LIPZ by the physiotherapist. This is a subjective outcome measure. In 2010, an indication of symptom severity at the beginning of the care episode and at the end was introduced. When patients do not come back, this information, which has to be obtained from the patient, remains unknown. As a result, this outcome measure is only