Predictive Factors for Clinical Improvement Following a Manual Therapy-Based Program in Patients with Neck Pain: A...

Background: The aim of this study was to derive and internally validate a prescriptive clinical prediction rule (CPR) for identifying baseline factors associated with short-term clinical improvement in patients with neck pain (NP) undergoing a manual therapy (MT)-based physiotherapy program. Methods: A prospective cohort study was conducted, including 71 patients with NP (18-65 years). Participants received six MT-based sessions over three weeks. Baseline assessments included Pain Intensity Numeric Rating Scale (PI-NRS), Neck Disability Index (NDI), Body Mass (BM), Body Mass Index (BMI), International Physical Activity Questionnaire-Short Form (IPAQ-SF), Hospital Anxiety and Depression Scale (HADS), Minnesota Satisfaction Questionnaire-Short Form (MSQ), and Craniovertebral Angle (CVA). Clinical improvement was defined using the Global Perceived Effect Scale (GPES-7). Univariate analyses, receiver operating characteristic (ROC) curve analysis, and forward stepwise logistic regression were performed to derive the predictive model. Results: Fifty-six participants (78.9%) reported moderate to complete improvement. BM ≥ 76.5 kg and MSQ score ≤ 42.5 were retained in the final regression model. When both predictors were present, the probability of clinical improvement increased to 96.43% (positive likelihood ratio = 7.58). The model demonstrated adequate fit (Nagelkerke R² = 0.247; Hosmer-Lemeshow p = 0.804). Internal validation yielded an optimism-corrected AUC of 0.741, suggesting minimal overfitting. Conclusions: Higher BM and lower MSQ score were associated with greater short-term improvement following MT in patients with NP. These findings highlight the relevance of integrating physical and psychosocial factors in prescriptive rehabilitation approaches. External validation of this CPR is required before clinical implementation.