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Exploring the Clinical Course of Neck Pain in Physical Therapy: A Longitudinal Study

Published:September 20, 2013DOI:https://doi.org/10.1016/j.apmr.2013.09.004

      Abstract

      Objective

      To investigate the short-term trajectory of recovery from mechanical neck pain, and predictors of trajectory.

      Design

      Prospective, longitudinal cohort study with 5 repeated measurements over 4 weeks.

      Setting

      Community-based physical therapy clinics.

      Participants

      Convenience sample of community-dwelling adults (N=50) with uncomplicated mechanical neck disorders of any duration.

      Interventions

      Usual physical therapy care.

      Main Outcome Measures

      Neck Disability Index (NDI), numeric rating scale (NRS) of pain intensity.

      Results

      A total of 50 consecutive subjects provided 5 data points over 4 weeks. Exploratory modeling using latent class growth analysis revealed a linear trend in improvement, at a mean of 1.5 NDI points and 0.5 NRS points per week. Within the NDI trajectory, 3 latent classes were identified, each with a unique trend: worsening (14.5%), rapid improvement (19.6%), and slow improvement (65.8%). Within the NRS trajectory, 2 unique trends were identified: stable (48.0%) and improving (52.0%). Predictors of trajectory class suggest that it may be possible to predict the trajectory. Results are described in view of the sample size.

      Conclusions

      The mean trajectory of improvement in neck pain adequately fits a linear model and suggests slow but stable improvement over the short term. However, up to 3 different trajectories have been identified that suggest neck pain, and recovery thereof, is not homogenous. This may hold value for the design of clinical trials.

      Keywords

      List of abbreviations:

      BIC (Bayesian information criterion), BLRT (bootstrapped likelihood ratio test), CI (confidence interval), LCGA (latent class growth analysis), NDI (Neck Disability Index), NRS (numeric rating scale), TSK-11 (Tampa Scale for Kinesiophobia 11-item version)
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      References

        • Croft P.R.
        • Lewis M.
        • Papageorgiou A.C.
        • et al.
        Risk factors for neck pain: a longitudinal study in the general population.
        Pain. 2001; 93: 317-325
        • Gross A.R.
        • Hoving J.L.
        • Haines T.A.
        • et al.
        Manipulation and mobilisation for mechanical neck disorders.
        Cochrane Database Syst Rev. 2004; : CD004249
        • Teasell R.W.
        • McClure J.A.
        • Walton D.
        • et al.
        A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): part 4—noninvasive interventions for chronic WAD.
        Pain Res Manag. 2010; 15: 313-322
        • Sterling M.
        • Hendrikz J.
        • Kenardy J.
        Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: a prospective study.
        Pain. 2010; 150: 22-28
        • Jensen M.P.
        • Karoly P.
        • Braver S.
        The measurement of clinical pain intensity: a comparison of six methods.
        Pain. 1986; 27: 117-126
        • Vlaeyen J.W.
        • Kole-Snijders A.M.
        • Boeren R.G.
        • van Eek H.
        Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance.
        Pain. 1995; 62: 363-372
        • Vernon H.
        • Mior S.
        The Neck Disability Index: a study of reliability and validity.
        J Manipulative Physiol Ther. 1991; 14: 409-415
        • Walton D.
        • Elliott J.
        A higher-order analysis supports use of the Tampa Scale for Kinesiophobia 11-item version in people with neck pain.
        Phys Ther. 2013; 93: 60-68
        • Vernon H.
        The Neck Disability Index: state-of-the-art, 1991-2008.
        J Manipulative Physiol Ther. 2008; 31: 491-502
        • Jung T.
        • Wickrama K.A.S.
        An introduction to latent class growth analysis and growth mixture modeling.
        Soc Personal Psychol Compass. 2008; 2: 302-317
        • Nylund K.
        • Asparouhov T.
        • Muthén B.
        Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study.
        Struct Equ Modeling. 2007; 14: 535-569
        • MacDermid J.C.
        • Walton D.M.
        • Avery S.
        • et al.
        Measurement properties of the Neck Disability Index: a systematic review.
        J Orthop Sports Phys Ther. 2009; 39: 400-417
        • Cleland J.A.
        • Childs J.D.
        • Whitman J.M.
        Psychometric properties of the Neck Disability Index and numeric pain rating scale in patients with mechanical neck pain.
        Arch Phys Med Rehabil. 2008; 89: 69-74
        • Ghahramani S.
        Fundamentals of probability, with stochastic processes.
        3rd ed. Pearson, 2004
      1. Faul F. G*Power v3.1.2. Kiel (Germany): Universitat Kiel; 2009. Available at: http://www.psycho.uni-duesseldorf.de/abteilungen/aap/gpower3/download-and-register. Accessed February 2010.

        • Hogg-Johnson S.
        • van der Velde G.
        • Carroll L.J.
        • et al.
        The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.
        J Manipulative Physiol Ther. 2009; 32: S46-S60