Development of a clinical prediction rule to identify patients with neck pain who are likely to benefit from home-based mechanical cervical traction

Abstract

The objective of the study was to identify the population of patients with neck pain who improved with home-based mechanical cervical traction (HMCT). A prospective cohort study was conducted in a physical therapy clinic at a local hospital. Patients with neck pain referred to the clinic for physical therapy were included in the study. A HMCT program was given to participants for 2 weeks. The patient's demographic data, Numerical Pain Scale (NPS) score, Neck Disability Index (NDI) and FearAvoidance Beliefs Questionnaire score were collected, and standard physical examination of the cervical spine was conducted before intervention. The NPS score, NDI and a global rating of perceived improvement were collected after the intervention was completed. A total of 103 patients participated in the study and 47 had a positive response to HMCT. A clinical prediction rule with four variables (Fear-Avoidance Beliefs Work Subscale score \ 13, pre-intervention pain intensity C 7/10, positive cervical distraction test and pain below shoulder) was identified. With satisfaction of at least three out of four variables (positive likelihood ratio = 4.77), the intervention's success rate increased from 45.6% to over 80%. It appears that patients with neck pain who are likely to respond to HMCT may be identified.

Continuous cyclic mechanical tension increases ank expression in endplate chondrocytes through the TGF-β1 and p38 pathway

“…Mechanical cervical traction is an intervention that is often recommended for the treatment of patients with neck pain 8 . However, intermittent cyclic mechanical tension (ICMT) could induce the calcification of endplate chondrocytes and long-term mechanical stimulation decreased the ank gene expression as was evident from our previous study 9 .…”

Exercise Only, Exercise With Mechanical Traction, or Exercise With Over-Door Traction for Patients With Cervical Radiculopathy, With or Without Consideration of Status on a Previously Described Subgrouping Rule: A Randomized Clinical Trial

“…6,34 In this study, we examined previously defined subgrouping criteria 34 and found that the validity of these criteria was underpowered and only suggestive of a subgroup-specific effect, based on the disability outcome after 6 months. The overall findings of this study indicate that patients who have cervical radiculopathy but do not meet the subgrouping criteria are still likely to optimize outcomes with mechanical traction in addition to an exercise program.…”

“…Motorized devices are typically used in clinical settings, but home units that use an over-door suspension system are also commonly provided to patients. Anecdotal reports suggest that home units may provide clinical benefit for patients with cervical radiculopathy, 6,12,38 but the effectiveness of these devices had not been previously evaluated in clinical trials. We found some benefit relative to an exercise-only approach, particularly among patients who seemed comfortable with the devices.…”

“…18,40,48 Several factors might have influenced the effectiveness of cervical traction in prior clinical trials. Previous studies 6,34 have suggested that inadequate specificity in patient selection may be at least partly responsible for the lack of effectiveness. Improved targeting of treatment to patients most likely to benefit has shown promise toward enhancing effect sizes in clinical trials, 26 yet the characteristics of patients likely to benefit from cervical traction remain mostly a matter of opinion and low-level evidence.…”

“…Observational studies and practice guidelines suggest that traction may be most effective in the subgroup of patients with neck pain who exhibit signs of cervical radiculopathy. 6,8,9,16 Raney and colleagues 34 identified even more-specific criteria associated with clinical benefit from treatment that includes cervical traction. Five clinical factors were predictive of benefit: (1) peripheralization of symptoms with lower cervical mobility testing, (2) positive shoulder abduction sign, (3) positive manual distraction test, (4) positive upper-limb tension test, and (5) age of 55 years or older.…”