Few promising multivariable prognostic models exist for recovery of people with non-specific neck pain in musculoskeletal primary care: a systematic review

Wingbermühle, Roel W.; Trijffel, Emiel van; Nelissen, Paul M; Koes, Bart W.; Verhagen, Arianne P.

doi:10.1016/j.jphys.2017.11.013

Cited by 24 publications

(40 citation statements)

References 88 publications

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“…Prognostic factors have shifted over time in the direction of chronicity, to the prediction of delayed or no recovery of patients with WAD. 65,73,74,[81][82][83][84][85][86] The prevalence of chronic pain in patients with WAD, in combination with delayed recovery (sub-chronic) and no recovery (chronic), was high in our study. About half of the patients had been re-referred following previous cervical collar, pain medication and physiotherapy treatment as negative prognostic factors.…”

Section: Relationship Between Selected Context and Outcome Variablesmentioning

confidence: 50%

<p>Relationships Between Context, Process, and Outcome Indicators to Assess Quality of Physiotherapy Care in Patients with Whiplash-Associated Disorders: Applying Donabedian’s Model of Care</p>

Oostendorp

Elvers²,

Trijffel³

et al. 2020

PPA

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Background: Quality indicators (QIs) are measurable elements of practice performance and may relate to context, process, outcome and structure. A valid set of QIs have been developed, reflecting the clinical reasoning used in primary care physiotherapy for patients with whiplash-associated disorders (WAD). Donabedian's model postulates relationships between the constructs of quality of care, acting in a virtuous circle. Aim: To explore the relative strengths of the relationships between context, process, and outcome indicators in the assessment of primary care physiotherapy in patients with WAD. Materials and Methods: Data on WAD patients (N=810) were collected over a period of 16 years in primary care physiotherapy practices by means of patients records. This routinely collected dataset (RCD-WAD) was classified in context, process, and outcome variables and analyzed retrospectively. Clinically relevant variables were selected based on expert consensus. Associations were expressed, using zero-order, as Spearman rank correlation coefficients (criterion: r s >0.25 [minimum: fair]; α-value = 0.05). Results: In round 1, 62 of 85 (72.9%) variables were selected by an expert panel as relevant for clinical reasoning; in round 2, 34 of 62 (54.8%) (context variables 9 of 18 [50.0%]; process variables 18 of 34 [52.9]; outcome variables 8 of 10 [90.0%]) as highly relevant. Associations between the selected context and process variables ranged from 0.27 to 0.53 (p≤0.00), between selected context and outcome variables from 0.26 to 0.55 (p≤0.00), and between selected process and outcome variables from 0.29 to 0.59 (p≤0.00). Moderate associations (r s >0.50; p≤0.00) were found between "pain coping" and "fear avoidance" as process variables, and "pain intensity" and "functioning" as outcome variables. Conclusion: The identified associations between selected context, process, and outcome variables were fair to moderate. Ongoing work may clarify some of these associations and provide guidance to physiotherapists on how best to improve the quality of clinical reasoning in terms of relationships between context, process, and outcome in the management of patients with WAD.

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Section: Relationship Between Selected Context and Outcome Variablesmentioning

confidence: 50%

<p>Relationships Between Context, Process, and Outcome Indicators to Assess Quality of Physiotherapy Care in Patients with Whiplash-Associated Disorders: Applying Donabedian’s Model of Care</p>

Oostendorp

Elvers²,

Trijffel³

et al. 2020

PPA

Self Cite

View full text Add to dashboard Cite

show abstract

“…Nevertheless, despite the development and validation of this clinical prediction rule, and the availability of other risk‐stratification approaches (e.g. the STarTBack Screening Tool or Örebro Musculoskeletal Pain Questionnaire) there is not yet sufficient evidence in populations with WAD or neck pain to indicate that risk‐stratified treatment provides improved outcomes . However, there is growing evidence from other musculoskeletal conditions, such as low back pain, that a risk‐stratified approach is both cost‐effective and does improve outcomes compared to usual care, but the evidence in neck pain is still emerging.…”

Section: Discussionmentioning

confidence: 99%

“…the STarTBack Screening Tool 69 or Örebro Musculoskeletal Pain Questionnaire 70 ) there is not yet sufficient evidence in populations with WAD or neck pain to indicate that risk-stratified treatment provides improved outcomes. 71 However, there is growing evidence from other musculoskeletal conditions, such as low back pain, that a risk-stratified approach is both cost-effective and does improve outcomes compared to usual care, 72 but the evidence in neck pain is still emerging. With this in mind, the ED clinician could consider applying the principles from risk-stratification methods to assist in determining appropriate onward referral until firm guidance is in evidence.…”

Section: Discussionmentioning

confidence: 99%

Review article: Best practice management of neck pain in the emergency department (part 6 of the musculoskeletal injuries rapid review series)

Strudwick

McPhee

Bell

et al. 2018

Emerg Medicine Australasia

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Neck pain and whiplash injuries are a common presentation to the ED, and a frequent cause of disability globally. This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017. Primary studies, systematic reviews and guidelines were considered for inclusion. English-language articles published in the past 12 years addressing acute neck pain assessment, management or prognosis in the ED were included. Data extraction was conducted, followed by quality appraisal to rate levels of evidence where possible. The search revealed 2080 articles, of which 51 were included (n = 22 primary articles, n = 13 systematic reviews and n = 16 guidelines). Consistent evidence was found to support the use of 'red flags' to screen for serious pathologies, judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance. Clinicians may also consider applying risk-stratification methods, such as using a clinical prediction rule, to guide patient discharge and referral plans; however, the evidence is still emerging in this population. This rapid review provides clinicians managing neck pain in the ED a summary of the best available evidence to enhance quality of care and optimise patient outcomes.

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“…These objectives either fall under the umbrella of exploratory studies (description, association, and prediction model development) or confirmatory studies (prediction model external validation and investigation of causal relationships). Most prognostic studies published in our research fields have been exploratory [4,9,[39][40][41]. These are initially carried out when little is known about a health condition.…”

Section: Main Textmentioning

confidence: 99%

A conceptual framework for prognostic research

Kent

Cancelliere

Boyle

et al. 2020

BMC Med Res Methodol

102

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Background: Prognostic research has many important purposes, including (i) describing the natural history and clinical course of health conditions, (ii) investigating variables associated with health outcomes of interest, (iii) estimating an individual's probability of developing different outcomes, (iv) investigating the clinical application of prediction models, and (v) investigating determinants of recovery that can inform the development of interventions to improve patient outcomes. But much prognostic research has been poorly conducted and interpreted, indicating that a number of conceptual areas are often misunderstood. Recent initiatives to improve this include the Prognosis Research Strategy (PROGRESS) and the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) Statement. In this paper, we aim to show how different categories of prognostic research relate to each other, to differentiate exploratory and confirmatory studies, discuss moderators and mediators, and to show how important it is to understand study designs and the differences between prediction and causation. Main text: We propose that there are four main objectives of prognostic studiesdescription, association, prediction and causation. By causation, we mean the effect of prediction and decision rules on outcomes as determined by intervention studies and the investigation of whether a prognostic factor is a determinant of outcome (on the causal pathway). These either fall under the umbrella of exploratory (description, association, and prediction model development) or confirmatory (prediction model external validation and investigation of causation). Including considerations of causation within a prognostic framework provides a more comprehensive roadmap of how different types of studies conceptually relate to each other, and better clarity about appropriate model performance measures and the inferences that can be drawn from different types of prognostic studies. We also propose definitions of 'candidate prognostic factors', 'prognostic factors', 'prognostic determinants (causal)' and 'prognostic markers (non-causal)'. Furthermore, we address common conceptual misunderstandings related to study design, analysis, and interpretation of multivariable models from the perspectives of association, prediction and causation. Conclusion: This paper uses a framework to clarify some concepts in prognostic research that remain poorly understood and implemented, to stimulate discussion about how prognostic studies can be strengthened and appropriately interpreted.

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Few promising multivariable prognostic models exist for recovery of people with non-specific neck pain in musculoskeletal primary care: a systematic review

Cited by 24 publications

References 88 publications

<p>Relationships Between Context, Process, and Outcome Indicators to Assess Quality of Physiotherapy Care in Patients with Whiplash-Associated Disorders: Applying Donabedian’s Model of Care</p>

<p>Relationships Between Context, Process, and Outcome Indicators to Assess Quality of Physiotherapy Care in Patients with Whiplash-Associated Disorders: Applying Donabedian’s Model of Care</p>

Review article: Best practice management of neck pain in the emergency department (part 6 of the musculoskeletal injuries rapid review series)

A conceptual framework for prognostic research

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