Development and internal validation of prognostic models for recovery in patients with non-specific neck pain presenting in primary care. (December 2021)

• Record Type: Journal Article
• Authors: Wingbermühle, Roel W.; Chiarotto, Alessandro; van Trijffel, Emiel; Koes, Bart; Verhagen, Arianne P.; Heymans, Martijn W.
• Is Part Of: Physiotherapy. Volume 113(2021)
• Page Start: 61
• Page End: 72
• Publication Date: 2021-12
• Subjects: Neck pain -- Recovery -- Prognostic models -- Model development -- Prognostic factors; Physical therapy -- Periodicals; Therapeutics, Physiological -- Periodicals; 615.8205
• DOI: 10.1016/j.physio.2021.05.011
• Languages: English
• ISSNs: 0031-9406

Abstract

Abstract: Objectives: Development and internal validation of prognostic models for post-treatment and 1-year recovery in patients with neck pain in primary care. Design: Prospective cohort study. Setting: Primary care manual therapy practices. Participants: Patients with non-specific neck pain of any duration ( n = 1193). Intervention: Usual care manual therapy. Outcome measures: Recovery defined in terms of pain intensity, disability, and global perceived improvement directly post-treatment and at 1-year follow-up. Results: All post-treatment models exhibited acceptable discriminative performance after derivation (AUC ≥ 0.7). The developed post-treatment disability model exhibited the best overall performance (R 2 = 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. Conclusion: 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 clinical use can be recommended.