Original research| Volume 96, ISSUE 10, P1756-1762, October 2015

Description of Common Clinical Presentations and Associated Short-Term Physical Therapy Clinical Outcomes in Patients With Neck Pain



      To determine the effect of clinical presentations of neck pain on short-term physical therapy outcomes.


      Retrospective analysis of pair-matched groups from a clinical cohort.


      Thirteen outpatient physical therapy clinics in 1 health care system.


      Patients (N=1069) grouped by common clinical presentations of neck pain: nonspecific neck pain (NSNP) with duration <4 weeks; NSNP with duration >4 weeks; neck pain with arm pain; neck pain with headache; and neck pain from whiplash.


      Conservative interventions provided by physical therapists.

      Main Outcome Measures

      Neck Disability Index (NDI) and numerical pain rating scale (NPRS) recorded at the initial and last visits. The main outcome of interest was achieving recovery status on the NDI. Changes in NDI and NPRS were compared between clinical presentation groups.


      Compared with patients presenting with NSNP >4 weeks, patients with NSNP <4 weeks had increased odds of achieving recovery status on the NDI (P<.0001) and demonstrated the greatest changes in clinical outcomes of pain (P≤.0001) and disability (P≤.0001). Patients with neck pain and arm pain demonstrated an increased odds of achieving recovery status on the NDI (P=.04) compared with patients presenting with NSNP >4 weeks.


      Treating patients with NSNP within <4 weeks of onset of symptoms may lead to improved clinical outcomes from physical therapy compared with other common clinical presentations.


      List of abbreviations:

      CI (confidence interval), CPT (Current Procedural Terminology), DOT (duration of treatment), NDI (Neck Disability Index), NSNP (nonspecific neck pain), NPRS (numerical pain rating scale)
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        • Ferrari R.
        • Russell A.S.
        Regional musculoskeletal conditions: neck pain.
        Best Pract Res Clin Rheumatol. 2003; 17: 57-70
        • McBeth J.
        • Macfarlane G.J.
        • Benjamin S.
        • Morris S.
        • Silman A.J.
        The association between tender points, psychological distress, and adverse childhood experiences: a community-based study.
        Arthritis Rheum. 1999; 42: 1397-1404
        • Di Fabio R.P.
        • Boissonnault W.
        Physical therapy and health-related outcomes for patients with common orthopaedic diagnoses.
        J Orthop Sports Phys Ther. 1998; 27: 219-230
        • Bot S.D.
        • van der Waal J.M.
        • Terwee C.B.
        • et al.
        Predictors of outcome in neck and shoulder symptoms—a cohort study in general practice.
        Spine. 2005; 30: E459-E470
        • Showalter C.
        • O'Hearn M.
        Cervical and thoracic mobilization versus manipulation for mechanical neck pain. Letter.
        J Orthop Sports Phys Ther. 2012; 42 (author reply 386-92): 385-386
        • Puentedura E.J.
        • Cleland J.A.
        • Landers M.R.
        • Mintken P.E.
        • Louw A.
        • Fernandez-de-Las-Penas C.
        Development of a clinical prediction rule to identify patients with neck pain likely to benefit from thrust joint manipulation to the cervical spine.
        J Orthop Sports Phys Ther. 2012; 42: 577-592
        • Cleland J.A.
        • Mintken P.E.
        • Carpenter K.
        • et al.
        Examination of a clinical prediction rule to identify patients with neck pain likely to benefit from thoracic spine thrust manipulation and a general cervical range of motion exercise: multi-center randomized clinical trial.
        Phys Ther. 2010; 90: 1239-1250
        • Cleland J.A.
        • Childs J.D.
        • Fritz J.M.
        • Whitman J.M.
        • Eberhart S.L.
        Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: use of thoracic spine manipulation, exercise, and patient education.
        Phys Ther. 2007; 87: 9-23
        • Childs J.D.
        • Cleland J.A.
        Development and application of clinical prediction rules to improve decision making in physical therapist practice.
        Phys Ther. 2006; 86: 122-131
        • Goode A.P.
        • Freburger J.
        • Carey T.
        Prevalence, practice patterns, and evidence for chronic neck pain.
        Arthritis Care Res. 2010; 62: 1594-1601
        • Linton S.J.
        • van Tulder M.W.
        Preventive interventions for back and neck pain problems: what is the evidence?.
        Spine. 2001; 26: 778-787
        • Fritz J.M.
        • Brennan G.P.
        Preliminary examination of a proposed treatment-based classification system for patients receiving physical therapy interventions for neck pain.
        Phys Ther. 2007; 87: 513-524
        • Wang W.T.
        • Olson S.L.
        • Campbell A.H.
        • Hanten W.P.
        • Gleeson P.B.
        Effectiveness of physical therapy for patients with neck pain: an individualized approach using a clinical decision-making algorithm.
        Am J Phys Med Rehabil. 2003; 82 (quiz 219-21): 203-218
        • Childs J.D.
        • Cleland J.A.
        • Elliott J.M.
        • et al.
        Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association.
        J Orthop Sports Phys Ther. 2008; 38: A1-34
        • Fritz J.M.
        • Cleland J.A.
        • Brennan G.P.
        Does adherence to the guideline recommendation for active treatments improve the quality of care for patients with acute low back pain delivered by physical therapists?.
        Med Care. 2007; 45: 973-980
        • Childs J.D.
        • Piva S.R.
        • Fritz J.M.
        Responsiveness of the numeric pain rating scale in patients with low back pain.
        Spine. 2005; 30: 1331-1334
        • 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
        • Pietrobon R.
        • Coeytaux R.R.
        • Carey T.S.
        • Richardson W.J.
        • DeVellis R.F.
        Standard scales for measurement of functional outcome for cervical pain or dysfunction: a systematic review.
        Spine. 2002; 27: 515-522
        • Hains F.
        • Waalen J.
        • Mior S.
        Psychometric properties of the Neck Disability Index.
        J Manipulative Physiol Ther. 1998; 21: 75-80
        • Riddle D.L.
        • Stratford P.W.
        Use of generic versus region-specific functional status measures on patients with cervical spine disorders.
        Phys Ther. 1998; 78: 951-963
        • Westaway M.D.
        • Stratford P.W.
        • Binkley J.M.
        The Patient-Specific Functional Scale: validation of its use in persons with neck dysfunction.
        J Orthop Sports Phys Ther. 1998; 27: 331-338
        • Wheeler A.H.
        • Goolkasian P.
        • Baird A.C.
        • Darden II, B.V.
        Development of the Neck Pain and Disability Scale. Item analysis, face, and criterion-related validity.
        Spine. 1999; 24: 1290-1294
        • 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
        • Honet J.C.
        • Puri K.
        Cervical radiculitis: treatment and results in 82 patients.
        Arch Phys Med Rehabil. 1976; 57: 12-16
        • Radhakrishnan K.
        • Litchy W.J.
        • O'Fallon W.M.
        • Kurland L.T.
        Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990.
        Brain. 1994; 117: 325-335
        • Hoving J.L.
        • de Vet H.C.
        • Twisk J.W.
        • et al.
        Prognostic factors for neck pain in general practice.
        Pain. 2004; 110: 639-645
        • Bunketorp L.
        • Nordholm L.
        • Carlsson J.
        A descriptive analysis of disorders in patients 17 years following motor vehicle accidents.
        Eur Spine J. 2002; 11: 227-234
        • Borghouts J.A.
        • Koes B.W.
        • Bouter L.M.
        The clinical course and prognostic factors of non-specific neck pain: a systematic review.
        Pain. 1998; 77: 1-13
        • Fritz J.M.
        • Hunter S.J.
        • Tracy D.M.
        • Brennan G.P.
        Utilization and clinical outcomes of outpatient physical therapy for Medicare beneficiaries with musculoskeletal conditions.
        Phys Ther. 2011; 91: 330-345
      1. Horn ME, Brennan GP, George SZ, Harman JS, Bishop MD. Clinical outcomes, utilization, and charges in persons with neck pain receiving guideline adherent physical therapy. Eval Health Prof. 2015 Apr 27. [Epub ahead of print]

        • Vernon H.
        The Neck Disability Index: state-of-the-art, 1991-2008.
        J Manipulative Physiol Ther. 2008; 31: 491-502
        • Sterling M.
        • Kenardy J.
        The relationship between sensory and sympathetic nervous system changes and posttraumatic stress reaction following whiplash injury—a prospective study.
        J Psychosom Res. 2006; 60: 387-393
        • Cochran W.G.
        Matching in analytical studies.
        Am J Public Health. 1953; 43: 684-691
        • Rubin D.B.
        Matching to remove bias in observational studies.
        Biometrics. 1973; 29: 159-183
        • Austin P.C.
        An introduction to propensity score methods for reducing the effects of confounding in observational studies.
        Multivariate Behav Res. 2011; 46: 399-424
        • Carroll L.J.
        • Hogg-Johnson S.
        • van der Velde G.
        • et al.
        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: S75-82
        • Donabedian A.
        Methods for deriving criteria for assessing the quality of medical care.
        Med Care Rev. 1980; 37: 653-698
        • Carroll L.J.
        • Holm L.W.
        • Hogg-Johnson S.
        • et al.
        Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.
        Spine. 2008; 33: S83-92
        • Cote P.
        • van der Velde G.
        • Cassidy J.D.
        • et al.
        The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.
        Spine. 2008; 33: S60-74
        • Cote P.
        • Cassidy J.D.
        • Carroll L.J.
        • Kristman V.
        The annual incidence and course of neck pain in the general population: a population-based cohort study.
        Pain. 2004; 112: 267-273
        • Farrar J.T.
        • Young Jr., J.P.
        • LaMoreaux L.
        • Werth J.L.
        • Poole R.M.
        Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale.
        Pain. 2001; 94: 149-158
        • Vernon H.
        • Humphreys B.K.
        • Hagino C.
        The outcome of control groups in clinical trials of conservative treatments for chronic mechanical neck pain: a systematic review.
        BMC Musculoskelet Disord. 2006; 7: 58
        • Leaver A.M.
        • Maher C.G.
        • McAuley J.H.
        • Jull G.
        • Latimer J.
        • Refshauge K.M.
        People seeking treatment for a new episode of neck pain typically have rapid improvement in symptoms: an observational study.
        J Physiother. 2013; 59: 31-37
        • Childs J.D.
        • Fritz J.M.
        • Wu S.S.
        • et al.
        Implications of early and guideline adherent physical therapy for low back pain on utilization and costs.
        BMC Health Serv Res. 2015; 15: 150
        • Spitzer W.O.
        • Skovron M.L.
        • Salmi L.R.
        • et al.
        Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management.
        Spine. 1995; 20: 1S-73S