Abstract
Hush JM, Lin CC, Michaleff ZA, Verhagen A, Refshauge KM. Prognosis of acute idiopathic
neck pain is poor: a systematic review and meta-analysis.
Objective
To conduct a systematic review and meta-analysis on the prognosis of acute idiopathic
neck pain and disability.
Data Sources
EMBASE, CINAHL, Medline, AMED, PEDro, and CENTRAL were searched from inception to
July 2009, limited to human studies. Reference lists of relevant systematic reviews
were searched by hand. Search terms included: neck pain, prognosis, inception, cohort, longitudinal, observational, or prospective study and randomized controlled trial.
Study Selection
Eligible studies were longitudinal cohort studies and randomized controlled trials
with a no treatment or minimal treatment arm that recruited an inception cohort of
acute idiopathic neck pain and reported pain or disability outcomes. Eligibility was
determined by 2 authors independently. Seven of 20,085 references were included.
Data Extraction
Pain and disability data were extracted independently by 2 authors. Risk of bias was
assessed independently by 2 authors.
Data Synthesis
Statistical pooling showed a weighted mean pain score (0–100) of 64 (95% confidence
interval [CI], 61–67) at onset and 35 (95% CI, 32–38) at 6.5 weeks. At 12 months,
neck pain severity remained high at 42 (95% CI, 39–45). Disability reduced from a
pooled weighted mean score (0–100) at onset of 30 (95% CI, 28–32) to 17 (95% CI, 15–19)
by 6.5 weeks, without further improvement at 12 months. Studies varied in length of
follow-up, design, and sample size.
Conclusions
This review provides Level I evidence that the prognosis of acute idiopathic neck
pain is worse than currently recognized. This evidence can guide primary care clinicians
when providing prognostic information to patients. Further research to identify prognostic
factors and long-term outcomes from inception cohorts would be valuable.
Key Words
List of Abbreviations:
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References
- Risk factors for neck pain: a longitudinal study in the general population.Pain. 2001; 93: 317-325
- The annual incidence and course of neck pain in the general population: a population-based cohort study.Pain. 2004; 112: 267-273
- Regional musculoskeletal pain.Baillieres Best Pract Res Clin Rheumatol. 1999; 13: 261-285
- Course and prognostic factors for neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.Spine. 2008; 33: S75-S82
- Neck pain.in: Crombie I.K. The epidemiology of pain. IASP Pr, Seattle1999: 235-255
- Cost-of-illness of neck pain in The Netherlands in 1996.Pain. 1999; 80: 629-636
- Evidence-based management of acute musculoskeletal pain.National Health and Medical Research Council, Canberra2003
- Clinical practice implications of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders: from concepts and findings to recommendations.Spine. 2008; 33: S199-S213
- Patient satisfaction with management of back pain: part 1: what is satisfaction?.Physiotherapy. 2001; 87: 4-9
- Patient satisfaction with management of back pain: part 2: an explorative, qualitative study into patients' satisfaction with physiotherapy.Physiotherapy. 2001; 87: 10-20
- Satisfaction with outpatient physiotherapy: focus groups to explore the views of patients with acute and chronic musculoskeletal conditions.Physiother Theory Pract. 2007; 23: 1-20
- Acute low back pain: systematic review of its prognosis.BMJ. 2003; 327: 323
- Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study.BMJ. 2008; 337: a171
- Course and prognostic factors of whiplash: a systematic review and meta-analysis.Pain. 2008; 138: 617-629
- The clinical course and prognostic factors of non-specific neck pain: a systematic review.Pain. 1998; 77: 1-13
- Clinical epidemiology: the essentials.3rd ed. Williams & Wilkins, Baltimore1996
- Research priorities and methodological implications: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.Spine (Phila Pa 1976). 2008; 33: S214-S220
- Treatement of acute cervical pain- a comparative group study.Pain. 1981; 10: 93-101
- Evaluation of the efficacy of subcutaneous carbon dioxide insufflations for treating acute non specific neck pain in general practice: a sham controlled randomized trial.Eur J Pain. 2008; 12: 9-16
- Clinical course and prognostic factors in acute neck pain: an inception cohort study in general practice.Pain Med. 2008; 9: 572-580
- Chiropractic for neck pain: a pilot study examining whether the duration of the pain affects the clinical outcome.Clinical Chiropractic. 2005; 8: 179-188
- Reliability and responsiveness of the Dutch version of the Neck Disability Index in patients with acute neck pain in general practice.Eur Spine J. 2006; 15: 1729-1736
- The use of fear-avoidance beliefs and nonorganic signs in predicting prolonged disability in patients with neck pain.Man Ther. 2008; 13: 239-248
- Tetrazepam in the treatment of acute cervical syndrome.Fortschritte der Medizin. 1993; 111 ([German]): 544-548
- Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale.Pain. 2001; 94: 149-158
- Predictors of outcome in neck and shoulder symptoms: a cohort study in general practice.Spine (Phila Pa 1976). 2005; 30: E459-E470
- Methods for the best evidence synthesis on neck pain and its associated disorders: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.Spine. 2008; 33: S33-S38
Article info
Publication history
Published online: April 04, 2011
Footnotes
Supported by the National Health and Medical Research Council, Australia; and an Australian Postgraduate Award provided by the Australian Commonwealth Government.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Published online April 1, 2011 at www.archives-pmr.org.
Identification
Copyright
© 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
