Margit Kooijman

74 Background Shoulder complaints are common in the general population. A systematic review by Luime et al. (2004) indicates that prevalence figures range from 7 to 26 % for point prevalence, up to 67 % for lifetime prevalence 1 . In the Netherlands, the annual consulting incidence in general practice for shoulder symptoms is estimated at 29 per 1000 person years 2 . In physiotherapy practice, 9.8 % of patients present themselves with shoulder complaints which makes it the most common complaint of the extremities 3 . From previous studies, it is known that there is an unfavourable long-term outcome in many patients with shoulder complaints 4,5 . This is troublesome for patients as well as clinicians and in time for employers and insurance. Although treatment of patients with shoulder problems is mainly an issue for primary care 6 . previous research shows that a relatively small group of patients is responsible for high costs for secondary care and sick leave, which accounts for a large part of total costs of shoulder pain 7 . To optimize the treatment of shoulders complaints, it is helpful to obtain insight into prognostic factors related to shoulder complaints. Prognostic information is important for clinicians to identify patients with a higher risk for developing chronic pain or disability. When shown robust and modifiable, this information can facilitate clinical decision-making and if necessary, timely and specific consultation with or referral to other health care providers. For patients, it can provide adequate knowledge about the expected course of their shoulder problems and facilitate adequate coping with them. In 2004, a systematic review was published on prognostic studies on shoulder disorders 8 . It included six high quality and ten low quality studies, mostly performed in a secondary care setting. The review reported strong evidence that high pain intensity predicts a poorer outcome in primary care populations and that middle age predicts poorer outcome in occupational populations. Moderate evidence was found for long duration of complaints and high disability at baseline as predictors of poorer outcome in primary care. Because the results were based on a small number of studies and the majority was conducted in secondary care, they need to be interpreted with caution. Because new studies, especially in the primary care setting, have been published on predictors of outcome we decided to update the evidence on prognostic factors on the out- come of shoulder disorders. The research question was which factors have prognostic value on (un)favourable outcome in patients with shoulder complaints in primary care, secondary care and occupational setting. Methods Search strategy This review updates previous work by Kuijpers et al. (2004) 8 . Therefore, a computerized literature search was performed in PubMed and Embase using the same search strategy