Department of Physical Therapy Faculty Articles
Development of a Preliminary Clinical Prediction Rule to Identify Patients with Neck Pain That May Benefit from a Standardized Program of Stretching and Muscle Performance Exercise: A Prospective Cohort Study
Publication Title
International Journal of Sports Physical Therapy
ISSN
2159-2896
Publication Date
12-1-2013
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.
Volume
8
Issue
6
First Page
756
Last Page
776
Disciplines
Medicine and Health Sciences
NSUWorks Citation
Hanney, William J; Kolber, Morey J; George, Steven Z; Young, Ian; Patel, Chetan K; and Cleland, Joshua A, "Development of a Preliminary Clinical Prediction Rule to Identify Patients with Neck Pain That May Benefit from a Standardized Program of Stretching and Muscle Performance Exercise: A Prospective Cohort Study" (2013). Department of Physical Therapy Faculty Articles. 139.
https://nsuworks.nova.edu/hpd_pt_facarticles/139