Are within and/or between session improvements in pain and function prognostic of medium and long-term improvements
Nils Runge1, Alessandro Aina2, Stephen May3
1Remedy Physio, Remedy House, Wilkinson Street, Sheffield, S10 2GB, UK; Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
Background:
Initial or between session improvements in pain and/or function are often considered to be predictive of ultimate outcomes in musculoskeletal problems.
Objective:
To determine the long-term prognostic value of within and between session improvements to pain and function.
Design:
Systematic review of relevant literature.
Method:
A search was made of multiple databases (Pubmed/Medline, Cochrane, Cinahl, and AMed) using relevant search terms. Titles, abstracts, and then full texts were filtered to find articles that met the strict inclusion/exclusion criteria. Searching, data extraction, and quality assessment, using GRADE, were done independently by two authors. Disagreements were resolved by consensus.
Results:
Only 13 articles met the criteria for inclusion. For the effect of pain location or pain intensity changes in the first treatment session on medium or long-term pain, disability, return-to-work, or global outcomes nine outcomes were available. Findings were mostly inconclusive (5) or negative (3). There was only one study evaluating between session improvements with ambiguous results. There were no studies evaluating the prognostic value of early improvements in function.
Conclusions:
There is no conclusive evidence to support the concept that early changes in pain location or pain intensity offer a good longer-term prognosis on a variety of outcomes; and no evidence relating to early improvements in function. The idea that patients who appear to improve in the first treatment session will do well longer term is not supported by the literature.
