Predictors of short- and long-term outcome in patients with chronic non-specific neck pain undergoing an exercise-based rehabilitation program: a prospective cohort study with 1-year follow-up

Abstract

The aim of this study was to describe the clinical course of patients with chronic, non-specific neck pain undergoing a public health covered, exercise-based rehabilitation program and to identify predictors of poor outcome. A prospective cohort study was carried out on patients with non-specific neck pain (6 months or longer), referred by their general practitioner to a 6-session program, including education and individually tailored exercise. The primary outcome measure for the course of neck pain was the Northwick neck pain questionnaire (NPQ) administered on baseline, discharge, and 1 year from discharge. Poor outcome was defined as NPQ score improving \30% (minimal clinically important difference-MCID-NPQ). The potential predictors included demographics, general health and psychological factors, neck pain history, and the clinical features described by NPQ. From January 2008 to June 2009, 212 patients were consecutively assessed for eligibility: 178 were enrolled and 162 completed follow-up (mean age = 65.3; 75% women). Baseline NPQ average score (40.7 ? 17.1) improved by MCID on discharge (26.1 ? 16.3) and at 1 year (28.5 ? 17.3%).The poor outcome was reported by 45% patients on discharge and by 56% at follow-up. Pain-related medication intake independently predicted poor short-(OR 4.24; 95% CI 1.83-9.84; p = 0.001) and long-term (OR 2.69; 95% CI 1.19-6.06; p = 0.017) outcome, and catastrophizing (OR 2.91; 95% CI 1.31-6.48; p = 0.009) predicted poor outcome at 1 year. Our cohort of patients with chronic neck pain undergoing an exercise-based rehabilitation program reported improvement by or beyond MICD-NPQ in 55% cases on discharge and in 44% cases at 1 year. Poor outcome was predicted by pain-related medication intake in the short and long term, and by catastrophizing in the long term.

Factors associated with increased risk for pain catastrophizing in patients with chronic neck pain

“…[8,9] Specifically, previous studies have been reported that pain catastrophizing is associated with increased pain intensity, disability, lower pain threshold/tolerance levels, poor prognosis, and a poor response to pain interventions in neck pain conditions. [9–13] …”

Pain in patients attending outpatient rehabilitation: results of a pilot study

“…Finally, as already mentioned, we did not thoroughly investigate the occurrence of anxiety and depression and life satisfaction that may have provided us more insight into a correlation with pain [41]. Moreover, while exploring catastrophism, which has been shown to be strongly associated with pain as well as with a poor rehabilitation outcome [42], we used only a single question rather than the complete tool [18], thus possibly limiting the sensitivity and specificity of our findings in this respect.…”

“…The main goal of undergoing treatment, according to the patient, was investigated with an open question (''what is your main objective in undergoing this rehabilitation treatment?'') Other questions concerned expectations regarding the treatment; life satisfaction [16] and catastrophism, scored with a question taken from the Pain Catastrophizing Scale [17,18].…”

Do findings identified on magnetic resonance imaging predict future neck pain? A systematic review

“…Neck pain is one of the most common musculoskeletal disorders and can have a significant impact on people's ability to work and carry out activities of daily living [1][2][3][4][5][6][7][8][9]. The 2010 Global Burden of Disease study ranked neck pain as the fourth highest cause of disability, as measured by years lived with disability (YLDs) [2][3][4][5][6][7][8][9][10].…”

“…Neck pain is one of the most common musculoskeletal disorders and can have a significant impact on people's ability to work and carry out activities of daily living [1][2][3][4][5][6][7][8][9]. The 2010 Global Burden of Disease study ranked neck pain as the fourth highest cause of disability, as measured by years lived with disability (YLDs) [2][3][4][5][6][7][8][9][10]. Furthermore, the annual prevalence of neck pain amongst the general population is reported to be around 30-50%, leading to a significant health and economic burden within today's society [3,5,[7][8][9][11][12][13].…”