Predictor Variables for a Positive Long-Term Functional Outcome in Patients with Acute and Chronic Neck and Back Pain Treated with a McKenzie Approach: A Secondary Analysis

Abstract

A cognitive behavioral approach was previously compared to a biomechanical approach (the McKenzie method) for the treatment of patients with back and neck pain in a randomized trial. Few differences between the treatment interventions were found. The aim of this secondary analysis was to determine if any clinical characteristics distinguished those patients who responded best to the McKenzie approach. Treatment success was defined as 50% reduction in original functional disability scores (Roland-Morris Disability Questionnaire or Northwick Park Neck Pain Questionnaire); failure to achieve this was defined as treatment failure. A liberal definition of success was 50% improvement retained at either 6 or 12 months, whereas a strict definition of success was 50% improvement at both 6 and 12 months. Ten variables were screened by univariate regression analysis to see if they predicted success. Any significant variables (P < 0.1) underwent multiple regression analysis. Only 21 and 16 patients out of 102 were deemed treatment successes according to the liberal and strict definitions, respectively. With the liberal definition, only centralization (P = 0.065), spine region (back rather than neck pain) (P = 0.089), and duration of pain (P = 0.001) emerged as predictors from the univariate regression analysis. With the strict definition, only the latter two variables emerged: spine region (P = 0.026) and duration of pain (P <0.01). All these variables were retained in the multiple regression analysis. In this study, duration of pain was the strongest predictor of success, although back pain and centralization had some predictive ability.

Measurement of outcomes for patients with centralising versus non-centralising neck pain

“…Centralisation as seen in patients with low back pain (LBP) has been found to be an excellent predictor of a favourable outcome. [12][13][14][15][16][17][18] Although Edmond et al found individuals with neck pain who presented with CEN or a directional preference demonstrated improvements in functional outcomes, 14 the research is limited. Therefore, the purpose of this study is to determine the relationship between CEN and outcome in people with neck pain and peripheral symptoms who are treated in physical therapy according to the MDT approach.…”

Determinants, characteristics and treatment of neck pain in a tertiary care hospital in Kerala

“…9 Although certain occupations such as office and computer workers, manual labourers, and health care workers, have been found in some studies to have a higher incidence of neck pain, the major workplace factors associated with the condition are low job satisfaction and perceived poor workplace environment. 10 Unique risk factors for neck pain include trauma (e.g., traumatic brain and whiplash injuries) and certain sports injuries (eg, wrestling, ice hockey, football).In our study 14.1% of the patients gave a history of neck injury. In a study conducted by, Donald R Murphy et al it is found that individuals who have experienced trauma in the neck are at increased risk of developing neck pain and 20% of patients in his study had neck injury.…”

Pain Response Classification Does Not Predict Long-Term Outcome in Patients With Low Back Pain Who Are Sick-Listed

“…In addition, a recent secondary analysis of predictors of longterm functional outcome in patients with acute and chronic spinal pain treated by the MDT approach failed to demonstrate any significant prognostic value of pain response classification. 22 Accordingly, the predictive value of pain classification in secondary care may be questioned.…”