In a secondary care setting, differences between neck pain subgroups classified using the Quebec task force classification system were typically small – a longitudinal study

Abstract

BackgroundThe component of the Quebec Task Force Classification System that subgroups patients based on the extent of their radiating pain and neurological signs has been demonstrated to have prognostic implications for patients with low back pain but has not been tested on patients with neck pain (NP).The main aim of this study was to examine the association between these subgroups, their baseline characteristics and outcome in chronic NP patients referred to an outpatient hospital department.MethodsThis was an observational study of longitudinal data extracted from systematically collected, routine clinical data. Patients were classified into Local NP only, NP + arm pain above the elbow, NP + arm pain below the elbow, and NP with signs of nerve root involvement (NP + NRI). Outcome was pain intensity and activity limitation. Associations were tested in longitudinal linear mixed models.ResultsA total of 1,852 people were classified into subgroups (64 % females, mean age 49 years). Follow ups after 3, 6 and 12 months were available for 45 %, 32 % and 40 % of those invited to participate at each time point.A small improvement in pain was observed over time in all subgroups. There was a significant interaction between subgroups and time, but effect sizes were small. The local NP subgroup improved slightly less after 3 months as compared with all other groups, but continued to have the lowest level of pain. After 6 and 12 months, those with NP + pain above the elbow had improved the least and patients with NP + NRI had experienced the largest improvements in pain intensity. Similar results were obtained for activity limitation.ConclusionsThis study found baseline and outcome differences between neck pain subgroups classified using the Quebec Task Force Classification System. However, differences in outcome were typically small in size and mostly differentiated the local NP subgroup from the other subgroups. A caveat to these results is that they were obtained in a cohort of chronic neck pain patients who only displayed small improvements over time and the results may not apply to other cohorts, such as people at earlier stages of their clinical course and in other clinical settings.

Local and Widespread Pressure Pain Hyperalgesia Is Not Side Specific in Females with Unilateral Neck Pain that Can Be Reproduced during Passive Neck Rotation

“…Thus, we used pain during neck rotation as the main factor with which to group our sample participants. In previous research, clusters of patients with NSNP have been made based on pressure pain sensitivity responses [5], levels of self-perceived neck disability [30], movement restriction in side flexion and rotation [65], neck posture [66], or the extent of their radiating pain and neurological signs [67]. The differences in the factors used to sub-classify NSNP patients problematizes further comparison among studies.…”

Neck motion, motor control, pain and disability: A longitudinal study of associations in neck pain patients in physiotherapy treatment

“…A recent study evaluated the prognostic value of the Quebec Task Force Classification system (which shares similarities with the abovementioned system) in chronic neck pain patients and found small differences in the clinical course between the subgroups (Rasmussen et al, 2015). The clinical utility of the classifications system described above are therefore questionable.…”

Exploring the definition of «acute» neck pain: a prospective cohort observational study comparing the outcomes of chiropractic patients with 0–2 weeks, 2–4 weeks and 4–12 weeks of symptoms

“…Aware of the need for a standardized categorization that could improve prediction of treatment outcome and allow better targeting of care, recent spinal pain research has increasingly been addressing the identification of specific patient subgroups which may have more or less favourable outcomes [ 23 – 25 ]. There have been several studies conducted with the purpose to identify predictors for treatment response of neck pain patients to chiropractic SMT [ 12 , 26 – 32 ].…”

“…However, there is no consistent definition in the literature relating to the time frames used to categorize patients since onset of pain [ 35 ]. While most clinical studies agree about the time cut-off point for “chronic” patients at >3 or >6 months [ 1 , 36 ], categorisation of “acute” neck pain varies widely from <1 week [ 19 ], <3 weeks [ 28 ], <4 weeks [ 19 , 27 , 29 ], <6 weeks [ 9 ] or even longer [ 23 ]. However, it is unknown if patients in these various ‘acute’ categories have similar outcomes when receiving similar treatments.…”