Prognostic factors of complaints of arm, neck, and/or shoulder: a systematic review of prospective cohort studies

Pain. 2015 May;156(5):765-788. doi: 10.1097/j.pain.0000000000000117.


Complaints of the arm, neck, or shoulder are common musculoskeletal disorders. To gain insight in prognostic factors of complaints of the arm, neck, or shoulder that are associated with recovery, we conducted a systematic review. We included longitudinal prognostic cohort studies that investigated associations between prognostic factors and recovery in terms of symptoms, disability, or sickness absence. Twenty-six papers reporting on 20 cohorts were included following a search of electronic databases (PubMed, Embase, Cinahl, and PsycINFO). The risk of bias (ROB) was independently assessed by 2 reviewers using the Quality in Prognosis Studies tool. Sixteen studies were assessed as having "low" ROB, and 10 studies were assessed as having "high" ROB. Because of heterogeneity in included studies, pooling was not possible. In the qualitative analysis, the number of studies that evaluated a factor, the ROB of each cohort, and consistency of available evidence were taken into account when summarizing the evidence. We examined whether follow-up duration altered the association of prognostic factors with recovery. The results of our best evidence synthesis showed that for short-term follow-up (<6 months), longer duration of complaints, higher symptom severity, more functional limitations, the use of specific coping styles, and accident as "patients' opinion regarding cause" were negatively associated with recovery. For long-term follow-up, we found that longer duration of complaints at presentation had an unfavorable prognostic value for recovery. Our evidence synthesis revealed strong evidence for no prognostic impact of many factors that are suggested to be associated with recovery according to the primary studies.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Arm / physiopathology*
  • Cohort Studies
  • Disability Evaluation*
  • Humans
  • Musculoskeletal Diseases / physiopathology*
  • Musculoskeletal Diseases / rehabilitation
  • Musculoskeletal Diseases / therapy
  • Neck / physiopathology*
  • Prognosis
  • Recovery of Function*
  • Severity of Illness Index
  • Shoulder / physiopathology*
  • Time Factors