Development and Internal Validation of a Multivariable Prognostic Model to Predict Chronic Pain After a New Episode of Non-specific Idiopathic, Non-traumatic Neck Pain in Physiotherapy Primary Care Practice

Overview

Journal BMJ Open

Specialty General Medicine

Date 2024 Aug 25

PMID 39182932

Authors

Martine J Verwoerd

Harriet Wittink

Francois Maissan

Marc Teunis

Sander M J van Kuijk

Rob J E M Smeets

Affiliations

Soon will be listed here.

Abstract

Objective: To develop and internally validate a prognostic model to predict chronic pain after a new episode of acute or subacute non-specific idiopathic, non-traumatic neck pain in patients presenting to physiotherapy primary care, emphasising modifiable biomedical, psychological and social factors.

Design: A prospective cohort study with a 6-month follow-up between January 2020 and March 2023.

Setting: 30 physiotherapy primary care practices.

Participants: Patients with a new presentation of non-specific idiopathic, non-traumatic neck pain, with a duration lasting no longer than 12 weeks from onset.

Baseline Measures: Candidate prognostic variables collected from participants included age and sex, neck pain symptoms, work-related factors, general factors, psychological and behavioural factors and the remaining factors: therapeutic relation and healthcare provider attitude.

Outcome Measures: Pain intensity at 6 weeks, 3 months and 6 months on a Numeric Pain Rating Scale (NPRS) after inclusion. An NPRS score of ≥3 at each time point was used to define chronic neck pain.

Results: 62 (10%) of the 603 participants developed chronic neck pain. The prognostic factors in the final model were sex, pain intensity, reported pain in different body regions, headache since and before the neck pain, posture during work, employment status, illness beliefs about pain identity and recovery, treatment beliefs, distress and self-efficacy. The model demonstrated an optimism-corrected area under the curve of 0.83 and a corrected R of 0.24. Calibration was deemed acceptable to good, as indicated by the calibration curve. The Hosmer-Lemeshow test yielded a p-value of 0.7167, indicating a good model fit.

Conclusion: This model has the potential to obtain a valid prognosis for developing chronic pain after a new episode of acute and subacute non-specific idiopathic, non-traumatic neck pain. It includes mostly potentially modifiable factors for physiotherapy practice. External validation of this model is recommended.

Citing Articles

The Predictive Value and Influencing Factors of Craniocervical Flexion Test for Patients with Chronic Non-Specific Neck Pain: A Case Control Study.

Wu M, Yi W, Su Q, Huang Y, Zhao Q, Liu S J Pain Res. 2024; 17:3817-3828.

PMID: 39583196 PMC: 11583758. DOI: 10.2147/JPR.S482325.

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