Background Chronic nonspecific neck pain (CNP) is a common health problem worldwide. Previous studies identified sociodemographic and clinical factors associated with successful outcomes in patients at discharge of physiotherapy treatment. However, the prognostic factors associated with an early response to physiotherapy treatment in patients with CNP are unclear. This knowledge may allow to identify a profile of patients with higher odds of improvement at the beginning of treatment, supporting clinical decision-making considering benefits versus non-benefits at short-term.
Objectives This study aimed to identify prognostic factors associated with an early successful response to Physiotherapy treatment in patients with CNP. The successful response was defined as a reduction on disability of ≥30% after 3-weeks of physiotherapy treatment.
Methods A prospective cohort study was conducted on 52 patients with CNP lasting ≥3 months, undergoing a physiotherapy treatment programme of mobilisation and exercise (coordination, strength, endurance). Patients were assessed at baseline, and then 3-weeks later. Participants were categorised as having a successful outcome if they scored a difference in their disability above the Minimal Clinical Important Difference (MCID) of the Neck Disability Index (NDI). Logistic regression analysis (backward stepwise conditional method) was used to identify the associations between baseline prognostic factors and outcome. Socio-demographic and clinical characteristics of CNP were included as potential prognostic factors.
Results A total of 51 participants completed the intervention. At 3-weeks post-treatment, 75% (38/51) of the participants achieved a successful response to physiotherapy treatment. In the final multivariate model (Omnibus Tests p<0.001), an early successful response to Physiotherapy treatment was significantly associated with the disability score (OR 1.16 – CI 95% 1.02-1.32), and pain intensity (OR 1.81 – CI 95% 1.03-3.20) at the baseline. This model improves the classification ability from 74.5 to 86.3%, explaining 50.6% of the outcome, with good predictive ability of sensibility (94.5%) and modest specificity (61.5%). The area under the ROC curve for disability score (0.8; 95% CI: 0.6-0.9) and pain intensity (0.7; 95% CI: 0.5-0.9) indicated good and acceptable discriminatory ability, respectively. After 3-weeks of mobilisation and exercise, the patients with scores ≥12 on NDI and ≥7 on Numeric Pain Rating Scale at baseline have increased odds of achieving an early response to treatment in the presence of both variables (+LR=1.71 95% CI: 0.84-3.50) or one variable (+LR=1.45 95% CI: 0.69-3.04).
Conclusion This study suggests that patients with medium to high levels of disability and high levels of pain at the baseline, treated with a physiotherapy programme of mobilisation and exercise, are more likely to experience an early reduction on their disability score. References:
Disclosure of Interests Lucia Domingues: None declared, Eduardo B. Cruz: None declared, Fernando Pimentel dos Santos Grant/research support from: From Abbvie and Novartis, Speakers bureau: Abbvie, Novartis, Pfizer, Biogen, Jaime Branco: None declared
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