Predictors of Favourable Outcome for Neck Pain Study Title: Predictors of favourable outcome in patients treated by chiropractors for neck pain Authors: Rubenstein S et al. Publication Information: Spine 2008; 33(13): 1451-1458. Summary: Below N Dr. Shawn Thistle is the founder and president of Research Review Service Inc., an online, subscription- based service designed to help busy practitioners to integrate current, relevant scientific evidence into their practice. Shawn graduated from CMCC and holds an Hon- ours Degree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medi- cal Acupuncture from McMaster University, and is a Certified Active Release Techniques (ART®) Pro- vider. For more information about the Research Review Service, visit www.researchreviewservice.com. eck pain is common, and is often the reason patients seek care from chiroprac- tors. In order to select the best treatment for patients and facilitate appropriate referral, it would be helpful for chiropractors to be able to identify, before com- mencing care, which patients are likely to benefit from chiropractic care (in most cases, spinal manipulation). Previous literature on neck pain suggests that higher neck pain intensity and previ- ous episodes of neck pain are poor prognostic indicators.1 Other seemingly important factors include self-perceived poor well-being, lower expectations of treatment, con- comitant low back pain, age > 40, and current neck pain episode longer than three months.2,3 In order to build on this existing literature, this prospective, practice-based cohort study was designed to examine socio-demographic and clinical factors related to outcome in patients with neck pain undergoing chiropractic care. Chiropractors in private clin- ics throughout the Netherlands recruited patients with neck pain on the first visit, and followed-up with them on the second and fourth visits, as well as at three and 12 months post-baseline. Patients were between 18-65 years of age, had not received any manual therapy in the previous three months, and had no contraindications to cervical manipula- tion. Those with specifi c pathology (tumour, infection etc.) were excluded. Data was col- lected through self-administered questionnaires at all time points. Twenty-nine patient- related, prognostic variables were examined. Clinical outcome measures included: • neck pain in the previous 24 hours measured with an 11-point numeric pain rating scale (NPRS) • neck disability measured with the Neck Disability Index (NDI) A prognostic model was developed using a multivariate, multilevel (time, patient, and chiropractor), longitudinal (linear and logistic) regression analysis. PERTINENT RESULTS OF THIS STUDY INCLUDE: 79 chiropractors (42 per cent of the available population) participated during the seven month recruitment period, 579 patients fulfi lled the inclusion criteria – 96 per cent and 87 per cent of whom completed follow-up data at the second and fourth visits, respectively (90 per cent and 92 per cent also responded to the long-term follow-up at three and 12 months) in general, patients recovered quickly (50 per cent by the fourth visit), and continued to improve up to three months (67 per cent) there was no mean change at 12 months 97 per cent of patients received a manipulative technique within the fi rst three visits shorter duration of neck pain at the fi rst visit was the only variable retained in all regression models working status, intermittent neck pain, number of days with neck pain, upper extremity paresthesia, radiating pain, prior neck pain, and hav- ing visited a general practitioner or specialist in the previous six months were the only variables significantly associated with all outcomes lower level of neck pain throughout the 12 month study period was predicted by higher education level, less tiredness, in- termittent neck pain, and fewer days with neck pain in the preceding year lower level of 12 • CANADIAN CHIROPRACTOR | OCTOBER 2008 www.canadianchiropractor.ca Shawn Thistle, BKin (Hons), DC, CSCS
Chiropractic + Naturopathic Doctor October 08: Page 12
