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An observational prospective cohort study in general practice.To describe the clinical course and to identify predictors of recovery, changes in pain intensity, and changes in functional disability in patients with neck or shoulder symptoms at 3- and 12-month follow-up.Knowledge on the clinical course and predictors of outcome in neck and shoulder symptoms is limited. Such knowledge would facilitate treatment decisions and may help to inform patients about their prognosis.Four hundred and forty-three patients who consulted their general practitioner with neck or shoulder symptoms participated in the study. Baseline scores of pain and disability, symptom characteristics, sociodemographic and psychological factors, social support, physical activity, general health, and comorbidity were investigated as possible predictors of recovery, changes in pain intensity, and changes in functional disability using multiple regression analyses.The recovery rate was low; 24% of the patients reported recovery at 3 months and 32% reported recovery at 12-month follow-up. Duration of the symptoms before consulting the GP and a history of neck or shoulder symptoms increased the probability of an unfavorable outcome. Furthermore, less vitality and more worrying were consistently associated with poorer outcome after 3 and 12 months. The area under the receiver-operator characteristic curve for the model predicting recovery was 0.8 at 3 months and 0.75 at 12 months. The explained variance of the models on pain and functional disability ranged from 43 to 54%.The results found in this study indicate that besides clinical characteristics, psychological factors also predict the outcome of neck and shoulder symptoms.