Results of an International Survey of Practice Patterns for Establishing Prognosis in Neck Pain: The ICON Project

Physiotherapists' knowledge, attitude and practice behavior to prevent chronification in patients with non-specific, non-traumatic, acute- and subacute neck pain: A qualitative study

BACKGROUND

The purpose of this study was to explore physiotherapists' knowledge, attitude, and practice behavior in assessing and managing patients with non-specific, non-traumatic, acute- and subacute neck pain, with a focus on prognostic factors for chronification.

METHOD

A qualitative study using in-depth semi-structured interviews was conducted with 13 physiotherapists working in primary care. A purposive sampling method served to seek the broadest perspectives. The knowledge-attitude and practice framework was used as an analytic lens throughout the process. Textual data were analyzed using qualitative content analysis with an inductive approach and constant comparison.

RESULTS

Seven main themes emerged from the data; physiotherapists self-estimated knowledge and attitude, role clarity, therapeutic relationship, internal- and external barriers to practice behavior, physiotherapists' practice behaviors, and self-reflection. These findings are presented in an adjusted knowledge-attitude and practice behavior framework.

CONCLUSION

A complex relationship was found between a physiotherapist's knowledge about, attitude, and practice behavior concerning the diagnostic process and interventions for non-specific, non-traumatic, acute, and subacute neck pain. Overall, physiotherapists used a biopsychosocial view of patients with non-specific neck pain. Physiotherapists' practice behaviors was influenced by individual attitudes towards their professional role and therapeutic relationship with the patient, and individual knowledge and skills, personal routines and habits, the feeling of powerlessness to modify patients' external factors, and patients' lack of willingness to a biopsychosocial approach influenced physiotherapists' clinical decisions. In addition, we found self-reflection to have an essential role in developing self-estimated knowledge and change in attitude towards their therapeutic role and therapist-patient relationship.

Recovery from nonspecific neck pain in office workers

BACKGROUND

Neck pain has an episodic course with varying time for recovery and identification of individuals likely to recover is important.

OBJECTIVE

The aim of this study was twofold: 1a) to explore the duration of recovery from nonspecific neck pain, and 1b) to investigate the relation between recovery duration and age, and 2) to evaluate whether the NHBOW can predict duration of recovery from non-specific neck pain.

METHODS

One hundred and three from 342 office workers reported non-specific neck pain, with information collected on pain intensity and disability every month for 12 months. The time to recovery was measured from the onset of neck pain to full recovery. The 103 office workers were divided into two groups using the NHBOW score. Kaplan-Meier survival curves were used to describe the median time to recovery. The survival curves of the two NHBOW groups were compared using Cox regression analysis.

RESULTS

The median time to recovery from neck pain was 2 months. The duration of recovery was not significantly related with age of participants. There was no significant difference in time to recovery from neck pain between the NHBOW low-score group and the high-score group.

CONCLUSION

This study showed that the NHBOW was unable to predict duration of recovery from nonspecific neck pain in office workers.

Patient-Reported Outcome Measures Used for Neck Disorders: An Overview of Systematic Reviews

BACKGROUND

The evaluation of patient-reported outcome measures for the neck from multiple systematic reviews will provide a broader view of, and may identify potential conflicting or consistent results for, their psychometric properties.

OBJECTIVES

The purpose of this study was to conduct an overview of systematic reviews and synthesize evidence to establish the current state of knowledge on psychometric properties of patient-reported outcome measures for patients with neck disorders.

METHODS

In this overview of systematic reviews, an electronic search of 6 databases (MEDLINE, Embase, CINAHL, ILC, the Cochrane Central Register of Controlled Trials, and LILACS) was conducted to identify reviews that addressed at least one measurement property of outcome measures for people with neck pain. Only systematic reviews with patient-reported outcome measures were included in the analysis. Risk of bias was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR). Data on measurement properties were extracted from each systematic review.

RESULTS

From 13 systematic reviews, 8 patient-reported outcome measures were evaluated in 2 or more reviews. Risk-of-bias scores ranged from moderate (5-7) to high (4 and lower). Findings on internal consistency, test-retest reliability, construct validity, responsiveness to change, and content and structural validity were synthesized for the Neck Disability Index (NDI) in 11 systematic reviews; the Northwick Park Neck Pain Questionnaire and Neck Pain and Disability scale (NPDS) in 6 systematic reviews; the Copenhagen Neck Functional Disability Scale in 5 systematic reviews; the Neck Bournemouth Questionnaire in 4 systematic reviews; the Core Neck Pain Questionnaire and Patient-Specific Functional Scale in 3 systematic reviews, and the Whiplash Disability Questionnaire in 2 systematic reviews.

CONCLUSION

High-quality evidence was found of good to excellent internal consistency and moderate to excellent test-retest reliability for the NDI. Moderate-quality evidence was found of good to excellent internal consistency and good test-retest reliability for the Northwick Park Neck Pain Questionnaire. High-quality evidence was found of excellent test-retest reliability and good to strong construct validity with pain scales for the Copenhagen Neck Functional Disability Scale. Moderate-quality evidence was found of unclear to excellent internal consistency and moderate to strong concurrent associations with the NDI and global assessment of change for the Neck Pain and Disability scale. Moderate-quality evidence was found of excellent internal consistency for the Whiplash Disability Questionnaire and of high test-retest reliability for the Patient-Specific Functional Scale. J Orthop Sports Phys Ther 2018;48(10):775-788. Epub 22 Jun 2018. doi:10.2519/jospt.2018.8131.

The potential and perils of prognosticating persistent post-traumatic problems from a postpositivist perspective

BACKGROUND CONTEXT

Predicting recovery after traumatic neck pain has become an active area of research but is moving in several different directions with currently little consensus on the important outcomes to predict or relevant variables to predict them.

PURPOSE

This editorial explores the current state of prognostic (risk)-based tools or algorithms for predicting the likelihood of chronic problems after acute axial trauma, with a focus on traumatic neck pain (ie, whiplash-associated disorder).

STUDY DESIGN/SETTING

This paper has an editorial study design.

METHOD

This is a narrative commentary.

RESULTS

Prognostic efforts have value in guiding clinical decision-making and optimizing resource allocation to those at highest risk while minimizing iatrogenic disability for those at lower risk, but there are also several important caveats that should be observed when applying and interpreting the results of such tools. These include the biases associated with predicting outcomes based on findings from a single administration of a tool, inappropriate assumptions of causality, assumptions of linear relationships, and inability to consider the unique individual traits and contexts of patients that likely interact with clinical variables to influence the actual degree of risk they impart.

CONCLUSIONS

The paper concludes with a brief overview of trends that are likely to dramatically change the field, including creation of large clinical databases and big data analytics.

Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain

The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of published systematic reviews.During the intake, the patient is screened for serious pathologies and corresponding patterns. Patients with cervical radiculopathy can be included or excluded through corresponding signs and symptoms and possibly diagnostic tests (Spurling test, traction/distraction test, and Upper Limb Tension Test). History taking is done to gather information about patients' limitations, course of pain, and prognostic factors (eg, coping style) and answers to health-related questions.In case of a normal recovery (treatment profile A), management should be hands-off, and patients should receive advice from the physical therapist and possibly some simple exercises to supplement "acting as usual."In case of a delayed/deviant recovery (treatment profile B), the physical therapist is advised to use, in addition to the recommendations for treatment profile A, forms of mobilization and/or manipulation in combination with exercise therapy. Other interventions may also be considered. The physical therapist is advised not to use dry needling, low-level laser, electrotherapy, ultrasound, traction, and/or a cervical collar.In case of a delayed/deviant recovery with clear and/or dominant psychosocial prognostic factors (treatment profile C), these factors should first be addressed by the physical therapist, when possible, or the patient should be referred to a specialist, when necessary.In case of neck pain grade III (treatment profile D), the therapy resembles that for profile B, but the use of a cervical collar for pain reduction may be considered. The advice is to use it sparingly: only for a short period per day and only for a few weeks.

Predictors for global perceived effect after physiotherapy in patients with neck pain: an observational study

OBJECTIVE

To investigate the prognostic importance of a number of sensorimotor and psychological factors for global perceived effect (GPE) after physiotherapy in patients with neck pain. In addition to baseline values, change scores were used as independent variables to identify treatment-modifiable factors.

DESIGN

Clinical cohort study.

SETTING

Primary and secondary healthcare physiotherapy clinics.

PARTICIPANTS

Patients (n=70) with non-specific neck pain.

INTERVENTION

Usual care physiotherapy.

METHODS

A three-dimensional motion tracking system was used to measure neck motion and sensorimotor variables, in addition to self-reported outcomes covering personal, somatic and psychological factors at baseline (before treatment) and at 2 months. Logistic regression was used to analyse associations between the prognostic variables and the primary outcome (GPE) at 2 months.

RESULTS

At baseline, neck motion and motor control, pain duration and functioning were the strongest predictors for GPE, with no effect of psychological factors. Among the change variables, reduced pain intensity [odds ratio (OR) 1.86; 95% confidence interval (CI) 1.31 to 2.62], increased functioning (OR 1.46; 95% CI 1.11 to 1.92), reduced disability (OR 1.12; 95% CI 1.05 to 1.20), reduced kinesiophobia (OR 1.21; 95% CI 1.07 to 1.37), reduced catastrophising (OR 1.09; 95% CI 1.09 to 1.18) and increased self-efficacy (OR 1.12; 95% CI 1.03 to 1.21) were significantly associated with GPE.

CONCLUSIONS

Both baseline values and change in pain intensity and functioning predicted GPE at 2 months. Psychological factors such as kinesiophobia, catastrophising and self-efficacy were only able to predict outcome by their change scores, indicating that these factors are modifiable by common physiotherapy practice and are important for GPE.

Effect of manual versus mechanically assisted manipulations of the thoracic spine in neck pain patients: study protocol of a randomized controlled trial

BACKGROUND

Neck pain is a common musculoskeletal condition with a point prevalence of around 15% in males and 23% in females that often presents in physiotherapy practice. Physical therapy and/or manipulation therapy is generally the first management option for patients with mechanical neck pain. Physical therapists treat mechanical neck pain with a number of interventions including joint mobilization and/or manipulation, therapeutic exercises or education. However, manipulation of the cervical spine carries some risks. Treating the thoracic spine for neck pain is an alternative approach. Emerging evidence suggests that it may be effective for treating neck pain without the risks associated with cervical spine manipulation. A new electromechanical device has recently been developed and tested for delivering multiple high velocity, low amplitude thrust manipulations to the spine. This device incorporates both auditory and visual systems that provide real time feedback on the applied treatment. The objective of this study is to compare the short- and long-term effects of manual versus mechanically assisted manipulations of the thoracic spine for neck pain patients.

METHODS/DESIGN

A 6-month, randomized controlled trial consisting of 54 patients with acute or chronic neck pain patients will be conducted. Patients with no signs of major pathology and with little or no interference with daily activities will be recruited. Three treatment sessions with 4-day intervals will be carried out. The patients will be randomly assigned to receive either manually performed manipulations or electromechanical manipulations at the thoracic spine. The primary outcome is pain intensity as measured by the Visual Analogue Pain Rating Scale. The secondary outcome measures are neck physical disability using the Neck Disability Index, quality of life measured by the European Quality of Life 5 Dimensions 5 Levels and patients' improvement using the Patient's Global Impression of Change Scale.

DISCUSSION

It is expected that both interventions will improve neck pain. This would be a significant finding, as thoracic spine manipulation for neck pain does not carry the same risk of injury as cervical spine manipulation. In addition, the results may provide useful information about therapeutic options for health care providers and patients for the problem of neck pain.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN88585962, registered January 2013.