Clinical course and prognosis of hand and wrist problems in primary care

Abstract

To describe the course of a new episode of hand and wrist problems in general practice and to identify predictors that are associated with poor outcome at short-term and long-term followup. Patients consulting their general practitioner with hand or wrist problems (no prior consultation in the preceding 3 months) were sent a questionnaire at baseline and at 3, 6, and 12 months of followup. Potential predictors included sociodemographic variables, characteristics of the symptoms, physical activity, and psychosocial factors. General practitioners recorded information on symptoms, signs, and medical diagnosis. The main outcome measure was insufficient improvement of symptoms using the Symptom Severity Scale at short-term (3 months) and long-term (12 months) followup. Twenty-three percent of patients reported complete recovery after 3 months, increasing to 42% at 1 year after first presentation. Higher probability of poor outcome at 3 months was associated with being female, low pain intensity at baseline, and lower personal control at baseline; at 12 months it was associated with older age, being female, reporting symptoms for >3 months at baseline, low scores on the coping strategy "reducing demands," and a higher score on somatization. Discriminative ability of the models was moderate, with areas under the curve after bootstrapping of 0.60 and 0.69 at 3 and 12 months, respectively. More than half of all patients reported residual symptoms at 1 year. Although poor outcome was difficult to predict, age, sex, duration of symptoms, and psychosocial factors were associated with poor outcome of hand and wrist problems.