Development of a Clinical Prediction Rule for Guiding Treatment of a Subgroup of Patients With Neck Pain: Use of Thoracic Spine Manipulation, Exercise, and Patient Education

Cleland, Joshua A.; Childs, John D.; Fritz, Julie M.; Whitman, Julie M.; Eberhart, Sarah

doi:10.2522/ptj.20060155

Cited by 253 publications

(221 citation statements)

References 54 publications

(7 reference statements)

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“…We dichotomized potential moderators that were continuous variables to facilitate the analyses using cut points available in the literature. We used a cut point of Ͻ14 for the FABQ and Ͻ11 for both the anxiety and depression components of the HADS (17,20). For all other continuous outcomes where generally accepted cut points were not available, we used a median cut point (21).…”

Section: Potential Effect Moderatorsmentioning

confidence: 99%

Predicting response to a cognitive–behavioral approach to treating low back pain: Secondary analysis of the BeST data set

Underwood¹,

Mistry²,

Lall³

et al. 2011

Arthritis Care & Research

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Objective. Identifying factors that predict who is likely to gain the greatest benefit from different treatments for low back pain is an important research priority. Here we report moderator analyses of the Back Skills Training Trial (BeST) that tested a cognitive-behavioral approach for low back pain. Methods. We recruited 701 participants ages >18 years with at least moderately troublesome low back pain present for >6 weeks from 56 general practices in 7 localities across England to a trial adding a group cognitive-behavioral approach to active management advice. The cognitive-behavioral package had a moderate effect on primary outcomes (Roland Morris Disability Questionnaire [RMDQ] and modified Von Korff scales). At 12-month followup, we tested for interaction between randomized groups on 2 prespecified baseline variables (troublesomeness and fear avoidance) and 10 post hoc (exploratory) variables identified from previous studies. Results. Neither troublesomeness nor fear avoidance moderated treatment effect on any of our primary outcomes. In the final model, the only moderation by baseline variables of the effect of randomization was on the RMDQ outcome. Being younger and currently working both moderated treatment effect, resulting in larger improvements as a response to treatment. Conclusion. Although BeST is one of the larger trials of back pain treatment, it is still too small to reliably detect moderation if it exists. Since the significant moderation effects were only observed for 1 outcome measure in 3 of 10 post-hoc analyses, we cannot conclude that these are true moderation effects.

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Section: Potential Effect Moderatorsmentioning

confidence: 99%

Predicting response to a cognitive–behavioral approach to treating low back pain: Secondary analysis of the BeST data set

Underwood¹,

Mistry²,

Lall³

et al. 2011

Arthritis Care & Research

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“…The mean NDI scores were 9.76 (19.52%), 7.64 (15.28%), 6.36 (12.72%), 5.44 (10.88%) and 4.44 (8.88%) in sessions 1 through 5, respectively. A statistically significant reduction in NDI score was found at the end of the sessions (p<0.0001).…”

Section: Resultsmentioning

confidence: 98%

“…The following were the exclusion criteria: score below 5 points (10%) on the NDI, symptoms of bone weakness due to tumor, infection, congenital condition or trauma, neurological impairment, history of whiplash, vascular conditions (vertebrobasilar insufficiency and aneurysm), pregnancy and non-consent for participation 6,10,21) .…”

Section: Anmentioning

confidence: 99%

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Analysis of Thoracic Spine Thrust Manipulation for Reducing Neck Pain

et al. 2013

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Abstract.[Purpose] The cervical spine is a common site of pain, which may arise from different parts of the upper limbs or dysfunctions of the upper thoracic spine. The different sections of the spinal column are interlinked, and one region exerts an influence over another. Thus, a low range of motion (hypomobility) in the thoracic spine is an indicator of neck pain, and alterations in the cervical spine can occur due to dysfunctions of the thoracic region. The aim of the present study was to assess the efficacy of upper thoracic spine (T1-T4) thrust manipulation with regard to reduction of pain and disability in patients with neck pain. [Subjects and Methods] Twenty-five individuals with persistent neck pain upon movement participated in this study. The individuals were evaluated using the Neck Disability Index and a visual analog scale for pain. Each individual underwent five sessions of thoracic spine thrust manipulation. Data analysis involved the Student's t-test.[Results] Significant improvements were found in neck pain and disability.[Conclusion] Based on the results of the present study, thoracic spine thrust manipulation proved effective in the treatment of individuals with neck pain, leading to a reduction in both pain and disability.

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“…3,4 Certain factors are known to be prognostic for the course of neck pain, and several interventions, including those provided by physical therapists, are likely to produce a favorable outcome. [5][6][7][8][9] Approximately 35% of persons with neck pain reported being seen by a physical therapist, the most frequently visited provider, 10 and evidence suggests that physical therapy can be an effective secondary prevention strategy for neck pain. 11 In recent years, organized efforts have been made to improve clinical outcomes and standardize physical therapy treatment, including using classification system approaches.…”

mentioning

confidence: 99%

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

Horn

Brennan

George

et al. 2015

Archives of Physical Medicine and Rehabilitation

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Neck pain is the second most common musculoskeletal disorder in population surveys and is associated with high injury and disability claims. 1,2 It is generally accepted that neck pain has a favorable course of care, 3 but there is variation in short-term outcomes in patients with neck pain. 3,4 Certain factors are known to be prognostic for the course of neck pain, and several interventions, including those provided by physical therapists, are likely to produce a favorable outcome. [5][6][7][8][9] Approximately 35% of persons with neck pain reported being seen by a physical therapist, the most frequently visited provider, 10 and evidence suggests that physical therapy can be an effective secondary prevention strategy for neck pain. 11 In recent years, organized efforts have been made to improve clinical outcomes and standardize physical therapy treatment, including using classification system approaches. Fritz and Brennan 12 supported that subgrouping patients with neck pain and providing interventions matched to the patient classification improves shortterm outcomes of pain and disability from physical therapy, but this approach has not been validated nor have other classification systems published in the literature been validated. 13,14 Therefore in this study, rather than introduce a new classification system, we wished to pragmatically examine a large cohort of patients with common clinical presentations of neck pain. The purposes of this study were to describe the demographics and Disclosures: none.

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Development of a Clinical Prediction Rule for Guiding Treatment of a Subgroup of Patients With Neck Pain: Use of Thoracic Spine Manipulation, Exercise, and Patient Education

Abstract: The CPR provides the ability to a priori identify patients with neck pain who are likely to experience early success with thoracic spine thrust manipulation. However, future studies are necessary to validate the rule.

Cited by 253 publications

References 54 publications

Predicting response to a cognitive–behavioral approach to treating low back pain: Secondary analysis of the BeST data set

Predicting response to a cognitive–behavioral approach to treating low back pain: Secondary analysis of the BeST data set

Analysis of Thoracic Spine Thrust Manipulation for Reducing Neck Pain

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

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