Visual trajectory pattern as prognostic factors for neck pain

Abstract

Background A novel approach capturing both temporal variation and pain intensity of neck pain is by visual trajectory patterns. Recently, both previous and expected visual trajectory patterns were identified as stronger predictors of outcome than traditional measures of pain history and psychological distress. Our aim was to examine patient characteristics within the various previous and expected patterns, relationship between the two patterns and predictive value of a variable combining the previous and expected patterns. Methods Patients with neck pain (n = 932) consulting chiropractors were included. Baseline measures included pain intensity, disability, psychological variables and symptom history and expectations. Participants reported global perceived effect after 12 weeks. Analyses included descriptive statistics and logistic regression. Results Pain intensity, disability, psychological and worse outcome expectations increased from a single pain episode to severe ongoing pain of previous and expected patterns. Having a severe pain history was associated with poor prognosis, particularly if combined with negative expectations. The variable combining previous and expected patterns had a discriminative ability similar to that of other predictors AUC = 0.64 (95% CI = 0.60–0–67) versus AUC = 0.66 (95% CI = 0.62–0.70). The model with highest discriminative ability was achieved when adding the combined patterns to other predictors AUC = 0.70 (95% CI = 0.66–0.73). Conclusion The study indicates that pain expectations are formed by pain history. The patients’ expectations were similar to or more optimistic compared with their pain history. The prognostic ability of the model including a simplified combination of previous and expected patterns, together with a few other predictors, suggests that the trajectory patterns might have potential for clinical use. Significance The dynamic nature of neck pain can be captured by visual illustrations of trajectory patterns. We report, that trajectory patterns of pain history and future expectations to some extent are related. The patterns also reflect a difference in severity assessed by higher degree of symptoms and distress. Moreover, the visual trajectory patterns predict outcome at 12‐weeks. Since the patterns are easily applicable, they might have potential as a clinical tool.

The association between different outcome measures and prognostic factors in patients with neck pain: a cohort study

“…Independent of outcome measure, the pain patterns and baseline values of outcomes were the predictors that contributed the most to prediction. Previously, neck pain history (including previous episodes and duration) and future expectations assessed by traditional measures (i.e., numeric scales) have been found to be predictors of GPE, pain and disability [ 17 , 19 , 22 , 30 , 45 ]. These findings support our results on pain history and expectations as consistent prognostic factors.…”

“…The association with outcome for the remaining predictors (radiating pain to shoulder and/or elbow, physical leisure activity, MSK pain-sites and education level) were less consistent, in line with previous research on prognostic factors and models for neck pain [ 18 , 20 , 22 ]. Consultation-type has previous proven to be associated with outcome [ 20 ], but not to interact with other predictors [ 20 , 30 ]. A recent study used a set of predefined prognostic factors to develop prognostic models for recovery of patients with neck pain [ 22 ].…”

“…The five pain patterns were based on existing literature on trajectory patterns [ 28 ]. These pain patterns illustrate an increasing severity from the Single pain episode to the Severe ongoing pain pattern [ 29 , 30 ].…”

The clinical course of neck pain: Are trajectory patterns stable over a 1‐year period?

“…Decisions regarding treatment and follow-up were at the chiropractors' discretion. Descriptions of cohort recruitment and study procedures, including the comparison of our cohort with a cohort of LBP patients from Kongsted et al, are published previously (Irgens et al, 2020;Myhrvold et al, 2019Myhrvold et al, , 2020). The Regional Committee for Medical and Health Research Ethics (2015/89) approved the study protocol.…”

“…A next step should therefore examine if the trajectories can be found in drawings of corresponding visual patterns. The knowledge of such self-reported versus data-driven trajectories is emerging (Dunn et al, 2017;Hestbaek et al, 2019;Myhrvold et al, 2019Myhrvold et al, , 2020, and visual trajectories have the potential to substitute long-term follow-ups in research. Our study can form a basis for applying the same approach to NP.…”