Clinical course and prognostic factors in acute neck pain: an inception cohort study in general practice.
OBJECTIVE
To describe the natural course of patients with acute neck pain presenting in general practice and to identify prognostic factors for recovery and sick leave.


METHODS
We conducted a prospective cohort study with a 1-year follow-up in general practice. Questionnaires were collected at baseline and after 6, 12, 26, and 52 weeks. Days of sick leave were dichotomized into two groups: below and above 7 days of sick leave. Logistic regression was used to identify prognostic factors for recovery and sick leave.


METHODS
Consecutive patients with nonspecific neck pain lasting no longer than 6 weeks were invited to participate.


RESULTS
One hundred eighty-seven patients were included and 138 (74%) provided follow-up data. After 1 year, 76% of the patients stated to be fully recovered or much improved, although 47% reported to have ongoing neck pain. Almost half of the patients on sick leave at baseline returned to work within 7 days. Multivariate analysis showed that the highest association with recovery was the advice of the general practitioner (GP) "to wait and see" (odds ratio [OR] 6.7, 95% confidence interval [CI] 1.6-31.8). For sick leave, referral by the GP, for physical therapy or to a medical specialist, showed the highest association (OR 2.8, 95% CI 1.0-8.4).


CONCLUSIONS
Acute neck pain had a good prognosis for the majority of patients, but still a relatively high proportion of patients reported neck pain after 1-year follow-up. The advice given by the GP "to wait and see" was associated with recovery, and "referral" was associated with prolonged sick leave.
Department of General Practice, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands. c.vos@erasmusmc.nl
Cees J
CJ
Vos
Arianne P
AP
Verhagen
Jan
J
Passchier
Bart W
BW
Koes
D000328:Adult; D015331:Cohort Studies; D004185:Disability Evaluation; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019547:Neck Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000534:rehabilitation* / Q000628:therapy; D010821:Physicians, Family; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D018582:Sick Leave / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome