Disorders of the shoulder: an often unrecognised cause of disability in elderly people.

Abstract

A major aim of the government's white paper Working f6r Patients is to make the services provided by general practitioners more responsive to patients' needs.' Patients consider that the convenience of surgery hours is important," but no reliable information exists to show what appointment times patients prefer. We therefore collected and analysed data on this subject. Subjects, methods, and resultsWe performed the study in a general practice in Leyland, Lancashire, that had seven partners and a list of 11 655 patients. Surgeries were held continuously from 8 am to 6 pm on Mondays to Fridays. All patients on the age-sex register of the practice who were over 18 and had their birthday in April were sent a questionnaire that asked what time they would prefer to attend the surgery, both generally and for specific clinics; how often they had visited a doctor at the surgery in the past year; and whether inconvenient times of access had caused problems. Patients with children were asked what time they would prefer to have appointments for them, and whether this differed from their choice for their own appointment. Patients were also asked when they worked and whether they would like surgeries at weekends.We sent 949 questionnaires and 586 (62%) were returned completed. Four hundred and fifty three patients had a convenient time in mind when they made a routine appointment. Clinics before 9 am were preferred by 133 patients, from 9 to 11 am (the conventional time of morning clinics) by 192, from 3 to 6 pm by 147, and after 6 pm by only 29 (table). Appointments between 9 and 11 am were preferred by the largest proportion (44%) of parents with children aged under 5. Women with children aged under 5 were significantly more likely to want an appointment between 9 am and 11 am for their children than for themselves (p<0-0001, X2 test). One hundred and nine (57%) parents with children of school age preferred appointments for them between 3 and 6 pm. Patterns ofwork influenced preferences: the 29 patients who preferred appointments after 6 pm all worked during the day, and the 20 who worked only in the afternoons preferred to attend during the morning. The table shows the appointment times preferred by people attending well woman clinics and for health checks.

A Patient-derived Constant-Murley Score is Comparable to a Clinician-derived Score

“…Shoulder pain is a common problem that can pose difficult diagnostic and therapeutic challenges [1,7,8,24], and it accounts for 5% of all general practitioner musculoskeletal consultations [22,23]. There are various validated scores for assessment of the shoulder; these scores often require objective measurements performed by the clinicians and can be time consuming [6,9,12,16,18,19].…”

Reliability by Surgical Status of Self-Reported Outcomes in Patients Who Have Shoulder Pathologies

“…For example, shoulder problems have been found to affect as many as 34% of persons 65 and older, 4 39% of persons with paraplegia, 13 78% of those with quadriplegia, 20 and 64% of those with a stroke. 22 Shoulder dysfunction can result in substantial disabilities affecting a person's activities of daily living (eg, bathing, dressing, and toileting) and the ability to function independently (eg, ability to board public transportation).…”

Effectiveness of Passive Joint Mobilisation for Shoulder Dysfunction: A Review of the Literature

“…As mentioned previously, surveys have reported a high prevalence of chronic shoulder problems in the elderly in the general community, with rates ranging from 26% (Chard et al, 1987(Chard et al, , 1991 to 34% (Chakravarty & Webley, 1990) to 74% (Vecchio et al, 1995). Shoulder pain, either alone or in conjunction with pain in other joints, has a substantial impact on the function and well-being of older adults (Chakravarty & Webley, 1990).…”

“…Shoulder pain, either alone or in conjunction with pain in other joints, has a substantial impact on the function and well-being of older adults (Chakravarty & Webley, 1990). Of those aged 85 years and over who reported shoulder joint problems, most had difficulty or were dependent on others in activities in daily living (Badley & Tennant, 1992).…”

“…It has been estimated that the proportion of the population seeking treatment ranged from between 20% to 50% (Picavet and In particular, Chakravarty & Webley (1990) found only 47% of elderly patients had consulted their general practitioner about shoulder pain. Chard & Hazleman (1987, 1991 found underreporting of disorders of shoulder in elderly patients in the hospital and in the community.…”