The clinical course and prognostic factors of non-specific neck pain: a systematic review

Abstract

Neck pain occurs frequently in western societies. In the majority of cases, no specific cause can be identified. In order to gain insight into the clinical course and prognostic factors of non-specific neck pain, a systematic review was conducted. A computerized literature search was carried out to identify observational studies on non-specific neck pain and randomized clinical trials (RCTs) on conservative treatment of non-specific neck pain. Two reviewers scored independently, the methodological quality of all identified publications, using a standardized set of 13 criteria which were divided into five categories according to: study population, study design, follow-up, outcome measures and analysis/data presentation. To determine prognosis per study, an overall percentage of recovery for the most important outcome measures (pain, general improvement, functional status, health care utilization and lost days of work) was calculated. In total 23 eligible publications were identified (six observational studies and 17 RCTs). Only seven of 23 studies scored 50% or more of the 13 items, indicating a generally poor quality of methods. The most prevalent methodological shortcomings appeared to be selection of the study population, the sample size and analysis techniques. Most information regarding the clinical course is available for the group of patients with complaints for more than 6 months, who are treated in a secondary care or an occupational setting. In this group of patients, 46% (median) had less pain, with a range of 22-79% and a general improvement that ranged between 37 and 95% (47% median). The reduction in the use of analgesics ranged between 32 and 80% (37% median). Six studies reported on prognostic factors. Bearing in mind the limited number of studies and the low methodological quality, there are some indications that the localization (radiation to the arms/neurologic signs) and radiologic findings (degenerative changes in the discs and joints) are not associated with a worse prognosis. A higher severity of pain and a history of previous attacks however, seems to be associated with a worse prognosis.

Lymphedema beyond breast cancer

“…[9][10][11] Similar adaptations have recently been used in a systematic review of quality of life issues facing long-term breast cancer survivors. 12 Each article was independently scored by 2 authors (R.L.A.…”

“…Only 1 study in this group used objective measurement methods (circumference), whereas the remainder assessed lymphedema subjectively. The length of follow-up ranged from 9 to 115 months, and the median quality score for these studies was 5 (range, [3][4][5][6][7][8][9].…”

Course of functional status and pain in osteoarthritis of the hip or knee: A systematic review of the literature

“…The methodologic quality of each included study was independently assessed by 2 reviewers (GMD and CV) using a standardized set of 11 predefined criteria (Table 1). These criteria were based on lists of methodologic criteria used in previous reviews of prognosis and observational studies in the field of musculoskeletal disorders (5,22,23) and included items for both internal and external validity. Conflicting scores for the various items were discussed until consensus was reached.…”

“…A distinction was made between studies with a followup of 6 -36 months and studies with a followup Ͼ3 years, because this criterion was used as a cutoff point for higher methodologic quality in our list of criteria for methodologic quality and in previous reviews (5,22,23).…”

“…In our opinion, both validity aspects are important in studies of clinical course and prognostic factors (22,48). Because studies scored better on items of internal validity, we may conclude that using both internal and external validity criteria is stricter than using just internal validity criteria.…”