Clinical prediction rules for prognosis and treatment prescription in neck pain: A systematic review

Abstract

Clinical prediction rules (CPRs) developed to identify sub-groups of people with neck pain for different prognoses (i.e. prognostic) or response to treatments (i.e. prescriptive) have been recommended as a research priority to improve health outcomes for these conditions. A systematic review was undertaken to identify prognostic and prescriptive CPRs relevant to the conservative management of adults with neck pain and to appraise stage of development, quality and readiness for clinical application. Six databases were systematically searched from inception until 4th July 2016. Two independent reviewers assessed eligibility, risk of bias (PEDro and QUIPS), methodological quality and stage of development. 9840 records were retrieved and screened for eligibility. Thirty-two studies reporting on 26 CPRs were included in this review. Methodological quality of included studies varied considerably. Most prognostic CPR development studies employed appropriate designs. However, many prescriptive CPR studies (n = 12/13) used single group designs and/or analysed controlled trials using methods that were inadequate for identifying treatment effect moderators. Most prognostic (n = 11/15) and all prescriptive (n = 11) CPRs have not progressed beyond the derivation stage of development. Four prognostic CPRs relating to acute whiplash (n = 3) or non-traumatic neck pain (n = 1) have undergone preliminary validation. No CPRs have undergone impact analysis. Most prognostic and prescriptive CPRs for neck pain are at the initial stage of development and therefore routine clinical use is not yet supported. Further validation and impact analyses of all CPRs are required before confident conclusions can be made regarding clinical utility.

Clinical predictive modelling of post-surgical recovery in individuals with cervical radiculopathy: a machine learning approach

“…Standard post-surgical rehabilitation (weeks [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Participants in this group were treated in accordance with the Swedish standard post-surgical care of individuals with CR.…”

“…Prognostic models play an important role not only in the clinical prediction of future health outcomes, but also identifying the most influential predictors that could inform either clinical management or lead to the development of novel therapeutic interventions 6 . Compared to other musculoskeletal disorders such as low back pain (LBP) and idiopathic neck pain (NP) 7 – 9 , there is comparatively fewer prognostic studies in the area of CR 10 , 11 . Current prognostic studies in CR have focused largely either on self-reported predictors 11 , 12 , or on objective physical measures 13 .…”

“…back pain (LBP) and idiopathic neck pain (NP) [7][8][9] , there is comparatively fewer prognostic studies in the area of CR 10,11 . Current prognostic studies in CR have focused largely either on self-reported predictors 11,12 , or on objective physical measures 13 .…”

Return to Work in Employees on Sick Leave due to Neck or Shoulder Pain: A Randomized Clinical Trial Comparing Multidisciplinary and Brief Intervention with One-Year Register-Based Follow-Up

“…For whiplash-associated disorders, a tool predicting both chronic disability and full recovery has been developed [ 51 , 52 ]. For neck pain however, current evidence does not support clinical use of neither prognostic nor prescriptive clinical prediction rules [ 53 ].…”

Consensus of potential modifiable prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: results of nominal group and Delphi technique approach

“…The quality of the available evidence was graded as low to very low and included only a few modifiable factors. Psychosocial factors as passive coping, catastrophizing, fear-avoidance beliefs, depressive symptoms, distress, and anxiety are potentially modifiable factors that were found to be associated with chronic neck pain, whiplash related neck pain, and low back pain [ 9 – 19 ]. These findings concern other subgroups of musculoskeletal pain, and can therefore not be generalized to patients with idiopathic nonspecific, non-traumatic, acute or subacute neck pain.…”