Preliminary Examination of a Proposed Treatment-Based Classification System for Patients Receiving Physical Therapy Interventions for Neck Pain

Abstract

Background and PurposeNeck pain frequently is managed by physical therapists. The development of classification methods for matching interventions to subgroups of patients may improve clinical outcomes. The purpose of this study was to describe a proposed classification system for patients with neck pain by examining data for consecutive patients receiving physical therapy interventions.Subjects and MethodsStandardized methods for collecting baseline and intervention data were used for all patients receiving physical therapy interventions for neck pain over 1 year. Outcome variables were the Neck Disability Index (NDI), numeric pain rating, and number of visits. Treatment was provided at the discretion of the physical therapist. After the completion of treatment, each patient was classified by use of baseline variables. The interventions received by the patient were categorized as being matched or not matched to the classification. Outcomes for patients who received matched interventions were compared with those for patients who received nonmatched interventions. The interrater reliability of the classification algorithm was examined with a subset of 50 patients.ResultsA total of 274 patients were included in this study (74% women; age [X̄±SD]=44.4±16.0 years). The most common classification was centralization (34.7%); next were exercise and conditioning (32.8%) and mobility (17.5%). The interrater reliability for classification decisions was high (kappa=.95, 95% confidence interval [CI]=0.87–1.0). A total of 113 patients (41.2%) received interventions matched to the classification. Receiving matched interventions was associated with greater improvements in the NDI (mean difference=5.6 points, 95% CI=2.6–8.6) and in pain ratings (mean difference=0.74 point, 95% CI=0.21–1.3) than receiving nonmatched interventions.Discussion and ConclusionThe development of classification methods for patients with neck pain may improve the outcomes of physical therapy intervention. This study was done to examine a previously proposed classification system for patients receiving physical therapy interventions for neck pain. Receiving interventions matched to the classification system was associated with better outcomes than receiving nonmatched interventions. Although the design of this study prohibited drawing conclusions about the effectiveness of the system, the results suggest that further research on the system may be warranted.

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

“…18,19,40 Despite a lack of evidence, traction appears to be a common intervention provided by physical therapists, particularly for patients with neck pain accompanied by signs of radiculopathy. 8,16,17 Most studies examining the effectiveness of traction, however, have included patients with nonspecific neck pain and generally have not supported the intervention. 3,10,31,49 The few previous studies examining only patients with radiculopathy have produced mixed results.…”

“…Cervical traction is another frequently recommended, yet inadequately researched, treatment for patients with cervical radiculopathy. 35,36 Despite its common use by physical therapists and other providers, 15,16 clinical trials that have examined cervical traction have not found the intervention to be superior to other strategies. 18,40,48 Several factors might have influenced the effectiveness of cervical traction in prior clinical trials.…”

“…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.…”

Multimodal Treatment Program Comparing 2 Different Traction Approaches for Patients With Discogenic Cervical Radiculopathy: A Randomized Controlled Trial

“…While preliminary reports suggest that a multimodal treatment program consisting of manual therapy and exercise may result in positive outcomes for patients with CR, [6][7][8][9][10] efforts to successfully add cervical traction to a multimodal treatment program remain elusive. A study by Ragonese 11 concluded that when treating patients with a diagnosis of CR, an approach that combines manual therapy (including cervical traction) and therapeutic exercise appears to be superior to either intervention alone.…”

Description of Common Clinical Presentations and Associated Short-Term Physical Therapy Clinical Outcomes in Patients With Neck Pain

“…The criteria were implemented to permit the evaluation of clinical outcomes. 12,15 that exceed measurement error. 16,17 The study protocol was approved by the Institutional Review Board of Intermountain Healthcare.…”