William J Hanney1, Morey J Kolber2, Steven Z George3, Ian Young4, Chetan K Patel5, Joshua A Cleland6. 1. University of Central Florida, Orlando, FL, USA. 2. Nova Southeastern University, Fort Lauderdale, FL, USA. 3. University of Florida, Gainesville, FL, USA. 4. Spine and Sport, Savannah, GA, USA. 5. The Spine Health Institute, Altamonte, FL, USA. 6. Franklin Pierce University, Concord, NH, USA.
Abstract
BACKGROUND AND PURPOSE: Neck pain is a significant problem and many treatment options exist. While some studies suggest exercise is beneficial for individuals with non-specific neck pain clinicians have few tools to assist in the decision making process. Therefore, the purpose of this study was to derive a preliminary clinical prediction rule (CPR) for identifying patients with neck pain (NP) who may respond to an exercise-based treatment program. Exercise-based interventions have demonstrated positive outcomes in patients with NP, however it is unclear which patients are more likely to respond to this treatment approach. METHODS: Consecutive patients with a primary report of nonspecific NP with or without arm pain were recruited. All patients participated in a standardized exercise program and then were classified as having a successful or non-successful outcome at 6 weeks. Potential predictor variables were entered into a stepwise regression analysis. Variables retained in the regression model were used to develop a multivariate CPR that can be used to classify patients with NP that may benefit from exercise-based treatment. A 6-month follow up of the patients was used to evaluate the long-term effects. RESULTS: Ninety-one patients were enrolled in the study of which 50 had a successful outcome. A CPR with 5 variables was identified (Neck Disability Index score < 18/50, presence of shoulder protraction during static postural assessment, patient does not bicycle for exercise, cervical side bending < 32°, and Fear Avoidance Belief Questionnaire-Physical Activity Score < 15). If 4 of the 5 variables were present, the probability of a successful outcome shifted from 56% to 78% (+LR 2.97). At 6 months no significant difference existed in self-reported outcomes between those considered positive on the rule for a successful outcome and those negative on the rule for a successful outcome. CONCLUSIONS: The proposed CPR may identify patients with NP likely to benefit from exercise-based treatment in the short term. However, long-term follow up did not demonstrate a significant difference between groups. LEVEL OF EVIDENCE: 2b.
BACKGROUND AND PURPOSE:Neck pain is a significant problem and many treatment options exist. While some studies suggest exercise is beneficial for individuals with non-specific neck pain clinicians have few tools to assist in the decision making process. Therefore, the purpose of this study was to derive a preliminary clinical prediction rule (CPR) for identifying patients with neck pain (NP) who may respond to an exercise-based treatment program. Exercise-based interventions have demonstrated positive outcomes in patients with NP, however it is unclear which patients are more likely to respond to this treatment approach. METHODS: Consecutive patients with a primary report of nonspecific NP with or without arm pain were recruited. All patients participated in a standardized exercise program and then were classified as having a successful or non-successful outcome at 6 weeks. Potential predictor variables were entered into a stepwise regression analysis. Variables retained in the regression model were used to develop a multivariate CPR that can be used to classify patients with NP that may benefit from exercise-based treatment. A 6-month follow up of the patients was used to evaluate the long-term effects. RESULTS: Ninety-one patients were enrolled in the study of which 50 had a successful outcome. A CPR with 5 variables was identified (Neck Disability Index score < 18/50, presence of shoulder protraction during static postural assessment, patient does not bicycle for exercise, cervical side bending < 32°, and Fear Avoidance Belief Questionnaire-Physical Activity Score < 15). If 4 of the 5 variables were present, the probability of a successful outcome shifted from 56% to 78% (+LR 2.97). At 6 months no significant difference existed in self-reported outcomes between those considered positive on the rule for a successful outcome and those negative on the rule for a successful outcome. CONCLUSIONS: The proposed CPR may identify patients with NP likely to benefit from exercise-based treatment in the short term. However, long-term follow up did not demonstrate a significant difference between groups. LEVEL OF EVIDENCE: 2b.
Authors: Lucia Domingues; Eduardo B Cruz; Fernando M Pimentel-Santos; Sofia Ramiro; Helena Donato; Santiago Rodrigues Manica; Jill Alison Hayden; Rachelle Buchbinder; Jaime C Branco Journal: BMJ Open Date: 2018-11-25 Impact factor: 2.692