Which subgroups of patients with non-specific neck pain are more likely to benefit from spinal manipulation therapy, physiotherapy, or usual care?
The objective of this study is to identify subgroups of patients with non-specific neck pain who are more likely to benefit from either physiotherapy, spinal manipulation therapy, or usual care, on the short- and long-term. Data of three recently finished randomised controlled trials, with similar design and setting, were combined. The combined study population consisted of 329 patients with non-specific neck pain in an adult (18-70years) primary care population in the Netherlands. The primary outcome measure was global perceived recovery and was measured at the end of the treatment period and after 52 weeks of follow-up. Fourteen candidate variables were selected for the analysis. Predictors were identified by multivariable logistic regression analysis and were tested for interaction with treatment. Based on the multivariable models with interaction terms a decision model for treatment choice was developed. The analysis revealed three predictors for recovery of which the effect is modified by treatment: pain intensity (0-10 scale) in the short-term model, age and (no) accompanying low back pain in the long-term model. With these predictors a clinically relevant improvement in recovery rate (up to 25% improvement) can be established in patients receiving a tailored instead of a non-advised treatment. In conclusion we identified three characteristics that facilitate a deliberate treatment choice, to optimise benefit of treatment in patients with non-specific neck pain: age, pain intensity, and (no) accompanying low back pain.
Schellingerhout
Jasper Mattijs
JM
Department of General Practice, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands Department of Methodology and Applied Biostatistics, VU University, Amsterdam, The Netherlands.
Verhagen
Arianne Petra
AP
Heymans
Martinus Wilhelmus
MW
Pool
Jan Jacobus Maria
JJM
Vonk
Frieke
F
Koes
Bart Willem
BW
de Vet
Henrica Cornelia Wilhelmina
HCW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D020393:Manipulation, Spinal; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000188:drug therapy / Q000628:therapy*; D019547:Neck Pain / Q000188:drug therapy / Q000628:therapy*; D017060:Patient Satisfaction; D018579:Patient Selection; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal
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