Predicting the evolution of neck pain episodes in routine clinical practice
Francisco M Kovacs1,2, Jesús Seco-Calvo3,4,5, Borja M Fernández-Félix3,6,7
1Unidad de la Espalda Kovacs, Hospital Universitario HLA-Moncloa. University Hospital, Avenida de Menéndez Pelayo, 67, 28009, Madrid, Spain. fmkovacs@kovacs.org.
Background:
The objective of this study was to develop models for predicting the evolution of a neck pain (NP) episode.
Methods:
Three thousand two hundred twenty-five acute and chronic patients seeking care for NP, were recruited consecutively in 47 health care centers. Data on 37 variables were gathered, including gender, age, employment status, duration of pain, intensity of NP and pain referred down to the arm (AP), disability, history of neck surgery, diagnostic procedures undertaken, imaging findings, clinical diagnosis, and treatments used. Three separate multivariable logistic regression models were developed for predicting a clinically relevant improvement in NP, AP and disability at 3 months.
Results:
Three thousand one (93.5%%) patients attended follow-up. For all the models calibration was good. The area under the ROC curve was ≥0.717 for pain and 0.664 for disability. Factors associated with a better prognosis were: a) For all the outcomes: pain being acute (vs. chronic) and having received neuro-reflexotherapy. b) For NP: nonspecific pain (vs. pain caused by disc herniation or spinal stenosis), no signs of disc degeneration on imaging, staying at work, and being female. c) For AP: nonspecific NP and no signs of disc degeneration on imaging. d) For disability: staying at work and no signs of facet joint degeneration on imaging.
Conclusions:
A prospective registry can be used for developing valid predictive models to quantify the odds that a given patient with NP will experience a clinically relevant improvement.
