Abstract
ObjectivesDevelopment and internal validation of prognostic models for post-treatment and 1-year recovery in patients with neck pain in primary care. DesignProspective cohort study. SettingPrimary care manual therapy practices. ParticipantsPatients with non-specific neck pain of any duration (n=1193). InterventionUsual care manual therapy. Outcome measuresRecovery defined in terms of pain intensity, disability, and global perceived improvement directly post-treatment and at 1-year follow-up. ResultsAll post-treatment models exhibited acceptable discriminative performance after derivation (AUC≥0.7). The developed post-treatment disability model exhibited the best overall performance (R2=0.24; IQR, 0.22–0.26), discrimination (AUC=0.75; 95% CI, 0.63–0.84), and calibration (slope 0.92; IQR, 0.91–0.93). After internal validation and penalization, this model retained acceptable discriminative performance (AUC=0.74). The five other models, including those predicting 1-year recovery, did not reach acceptable discriminative performance after internal validation. Baseline pain duration, disability, and pain intensity were consistent predictors across models. ConclusionA post-treatment prognostic model for disability was successfully developed and internally validated. This model has potential to inform primary care clinicians about a patient’s individual prognosis after treatment, but external validation is required before clinical use can be recommended.
Highlights
MethodsNeck pain is a top five cause of Years Lived with Disability in high and middle income countries and, after low back pain, the second worldwide largest cause of musculoskeletal disability [1]
A post-treatment prognostic model for disability was successfully developed and internally validated. This model has potential to inform primary care clinicians about a patient’s individual prognosis after treatment, but external validation is required before broad clinical use can be recommended
The authors propose that, if all adequately performing during external validation, the future potential clinical use will be of all the three separate models developed in this study
Summary
MethodsNeck pain is a top five cause of Years Lived with Disability in high and middle income countries and, after low back pain, the second worldwide largest cause of musculoskeletal disability [1]. Prognostic prediction models (in short: prognostic models) provide probabilities for patients based on their individual combination of predictor values and can support clinicians in their clinical decisions [12]. A recent systematic review concluded that the clinical utility of currently available prognostic models in people with neck pain is limited [15]. There is a need to develop a prognostic model for recovery in patients with neck pain that exhibits satisfactory prediction. This model should be developed in a cohort of patients with adequate sample size, and it should be internally validated
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