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Neck Pain: Analysis of Prognostic Factors and Treatment Effects
Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Neck pain is a highly prevalent and often long-lasting problem with substantial personal and economic consequences. Individuals with neck pain are often referred for physiotherapy treatment, but there is limited evidence of the effect of treatment in these patients, mainly because conservative interventions have not been studied in sufficient detail.

The aim of the research underlying this thesis was to improve existing knowledge about neck pain, focusing on prognoses and on the effects of physiotherapy treatment in patients with neck pain. The thesis includes four different studies. a 12-year follow-up study comparing individuals initially on sick leave due to neck/shoulder or low back diagnoses; a critical review of the literatme on randomised studies of neck pain: a prognostic study with focus on both an impairment and a disability outcome at 1-year follow-up: and a randomised study comparing active exercise and McKenzie treatment with a placebo therapy in patients with neck pain.

Compatison of individuals with neck/shoulder and low-back diagnoses revealed that the neck/shoulder group rated their present discomfort as worse than those sick listed with low back diagnoses. Only 4% of the neck/shoulder group but 25% of the low back group reported no present discomfort. Notably. both groups reported the same duration of low back discomfort dming the last year, which may indicate a higher risk for symptoms in more than one location in subjects with neck/shoulder problems.

The regression analyses identified different prognostic factors, except duration of cunent episode, depending on the focus of outcomes. Other factors for the dependent variable pain intensity were Oswestry score and similar problem during the previous 5 years: adjusted R~ was 0.24. For the dependent variable Oswestry score. the other factors were pain intensity. well being, and expectations of treatment; adjusted R2 was 0.32. Using pain intensity as outcome, 60% of the patients were identified as being at risk of poor outcome: the corresponding value for Oswestry score as outcome was only 20%.

In the critical review. twenty-seven studies were analysed, most of them of poor quality: only one-third scored≥ 50 on a scale of I 00. Positive outcome was noted for 18 of the studies. Inclusion criteria, intervention, and outcome were based mainly on impainnent in the analysed studies, thus there is a lack of evidence of treatment effect in patients with neck pain measured with outcomes focusing on functional limitation and disability.

In the randomised study, significant improvements were recorded at 12-month follow-up for all three groups in regard to the main outcomes pain intensity and Neck Disability Index. with no significant difference between the groups. In all, 79% reported that they were better or completely restored after treatment. although 51% reported constant/daily pain. The slope of recovery differed during the first three weeks, with more rapid improvement in the McKenzie group. Only 30% of the study population consumed additional health care. although the mean nmnber of visits were lowest in the McKenzie group.

Individuals with sickness absence > 28 days due to neck/shoulder or low back diagnoses appear to be a high risk group for developing long-standing symptoms with stronger evidence for the neck/shoulder group. In clinical settings, it is important to take treatment goals into consideration when choosing the outcome, since a pain-free result may be difficult to obtain if the problems have been long-lasting. Despite a lack of definite evidence. there was a tendency toward better outcome at short-term follow-up with the two active treatments than with placebo therapy, in regard to both impainnent and disability outcomes.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2001. , 61 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 662
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-28051Local ID: 12814ISBN: 91-7219-763-3 (print)OAI: oai:DiVA.org:liu-28051DiVA: diva2:248602
Public defence
2001-03-16, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-04Bibliographically approved
List of papers
1. A 12-year follow-up of subjects initially sicklisted with neck/shoulder or low back diagnoses
Open this publication in new window or tab >>A 12-year follow-up of subjects initially sicklisted with neck/shoulder or low back diagnoses
2001 (English)In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 6, no 1, 52-63 p.Article in journal (Refereed) Published
Abstract [en]

Background and Purpose Neck/shoulder and low back pain are common in the Western world and can cause great personal and economic consequences, but so far there are few long term follow-up studies of the consequences of back pain, especially studies that separate the location of back pain. More knowledge is needed about different patterns of risk factors and prognoses for neck/shoulder and low back pain, respectively, and they should not be treated as similar conditions. The aim of the present study was to investigate possible long-term differences in neck/shoulder and low back symptoms, experienced over a 12-year period, with regard to work status, present health, discomfort and influence on daily activities.

Method A retrospective cohort study of individuals sicklisted with neck/shoulder or low back diagnoses 12 years ago was undertaken. Included were all 213 people who, in 1985, lived in the municipality of Linköping, Sweden, were aged 25–34 years and who had taken at least one new period of sickleave lasting >28 days with a neck/shoulder or low back diagnosis. In 1996, a questionnaire was mailed to the 204 people who were still resident in Sweden (response rate 73%).

Results Those initially absent with neck/shoulder diagnoses rated their present state of discomfort as worse than those sicklisted with low back diagnoses. Only 4% of the neck/shoulder group reported no present discomfort compared with 25% of the low back group. Notably, both groups reported the same duration of low back discomfort during the last year, which may indicate a higher risk for symptoms in more than one location for subjects with neck/shoulder problems.

Conclusions Individuals with sickness absence of more than 28 days with neck/shoulder or low back diagnoses appear to be at high risk of developing long-standing symptoms, significantly more so for those initially having neck/shoulder diagnoses.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25754 (URN)10.1002/pri.213 (DOI)10188 (Local ID)10188 (Archive number)10188 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
2. A critical analysis of randomised clinical trials on neck pain and treatment efficacy: A review of the literature
Open this publication in new window or tab >>A critical analysis of randomised clinical trials on neck pain and treatment efficacy: A review of the literature
1999 (English)In: Scandinavian Journal of Rehabilitation Medicine, ISSN 0036-5505, E-ISSN 1940-2228, Vol. 31, no 3, 139-152 p.Article in journal (Refereed) Published
Abstract [en]

The efficacy of physiotherapy or chiropractic treatment for patients with neck pain was analysed by reviewing 27 randomised clinical trials published 1966-1995. Three different methods were employed: systematic analyses of; methodological quality; comparison of effect size; analysis of inclusion criteria, intervention and outcome according to The Disablement Process model. The quality of most of the studies was low; only one-third scored 50 or more of a possible 100 points. Positive outcomes were noted for 18 of the investigations, and the methodological quality was high in studies using electromagnetic therapy, manipulation, or active physiotherapy. High methodological quality was also noted in studies with traction and acupuncture, however, the interventions had either no effect or a negative effect on outcome. Pooling data and calculation of effect size showed that treatments used in the studies were effective for pain, range of motion, and activities of daily living. Inclusion criteria, intervention, and outcome were based on impairment in most of the analysed investigations. Broader outcome assessments probably would have revealed relationships between treatment effect and impairment, functional limitation and disability.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27834 (URN)10.1080/003655099444489 (DOI)10458312 (PubMedID)12591 (Local ID)12591 (Archive number)12591 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
3. Prognostic factors for perceived pain and function at one-year follow-up in primary care patients with neck pain
Open this publication in new window or tab >>Prognostic factors for perceived pain and function at one-year follow-up in primary care patients with neck pain
2002 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 24, no 7, 364-370 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To identify prognostic factors for perceived pain and function with focus at one-year follow-up in primary care patients treated for non-specific neck pain.

Methods: A prospective study was performed including 193 neck pain patients. Before and after treatment period, and 12 months after the start date for treatment, patients completed a questionnaire including background data and aspects of pain, function and general health. Linear multiple regression analysis was used to identify prognostic factors with the dependent variables Oswestry score and pain intensity at 12-month follow-up. Response rate 81%.

Results: At 12-month follow-up, Oswestry score identified four prognostic factors: pain intensity; well-being; expectations of treatment; and duration of current episode. Adjusted R2 for the model was 0.32, and 20% of the patients had three of the four prognostic factors at entry, indicating risk of poor outcome. The dependent variable pain intensity revealed three prognostic factors: Oswestry score; duration of current episode; and similar problem during the previous five years. Adjusted R2 was 0.24, and 60% of the patients had two of the three prognostic factors at entry, indicating risk of poor outcome.

Conclusions: Different prognostic factors (with the exception of duration of current episode) were identified by the two outcome variables. Thus the results suggest that it should be taken into account whether an impairment or disability outcome is used.

National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-26273 (URN)10.1080/09638280110101532 (DOI)10787 (Local ID)10787 (Archive number)10787 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
4. A randomised clinical trial comparing active exercise and McKenzie treatment with placebo therapy in patients with neck pain
Open this publication in new window or tab >>A randomised clinical trial comparing active exercise and McKenzie treatment with placebo therapy in patients with neck pain
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Seventy-seven patients with neck pain in the piimary health care were included in a prospective, randomised clinical trial and randomly assigned to active exercise, McKenzie treatment, or placebo therapy. Seventy patients completed the treatment; response rate 93% at 12-month follow-up. All three groups showed significant improvement regarding the main outcomes, pain intensity and Neck Disability Index (NDI), even at 12-month follow-up, but there was no significant difference between the groups. In all, 79% reported that they were better or completely restored after treatment, although 51% reported constant/daily pain. In the McKenzie group compared to placebo group, a tendency toward greater improvement was noted for pain intensity at 3 weeks and at 6-month follow-up, and for post-treatment NDI. Significant improvement in DRAM scores was shown in the McKenzie group only. The three groups had similar recurrence rates, although after 12 months the McKenzie group showed a tendency toward fewer visits for additional health care.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-80937 (URN)
Available from: 2012-09-04 Created: 2012-09-04 Last updated: 2012-09-04Bibliographically approved

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