title: Development of a preliminary clinical prediction rule to identify patients with neck pain that may benefit from a standardized program of stretching and muscle performance exercise: a prospective cohort study.
abstract: OBJECTIVE
  Neck pain is a significant problem and many treatment options exist. While some studies suggest exercise is beneficial for individuals with non-specific neck pain clinicians have few tools to assist in the decision making process. Therefore, the purpose of this study was to derive a preliminary clinical prediction rule (CPR) for identifying patients with neck pain (NP) who may respond to an exercise-based treatment program. Exercise-based interventions have demonstrated positive outcomes in patients with NP, however it is unclear which patients are more likely to respond to this treatment approach.
  
  
  METHODS
  Consecutive patients with a primary report of nonspecific NP with or without arm pain were recruited. All patients participated in a standardized exercise program and then were classified as having a successful or non-successful outcome at 6 weeks. Potential predictor variables were entered into a stepwise regression analysis. Variables retained in the regression model were used to develop a multivariate CPR that can be used to classify patients with NP that may benefit from exercise-based treatment. A 6-month follow up of the patients was used to evaluate the long-term effects.
  
  
  RESULTS
  Ninety-one patients were enrolled in the study of which 50 had a successful outcome. A CPR with 5 variables was identified (Neck Disability Index score < 18/50, presence of shoulder protraction during static postural assessment, patient does not bicycle for exercise, cervical side bending < 32°, and Fear Avoidance Belief Questionnaire-Physical Activity Score < 15). If 4 of the 5 variables were present, the probability of a successful outcome shifted from 56% to 78% (+LR 2.97). At 6 months no significant difference existed in self-reported outcomes between those considered positive on the rule for a successful outcome and those negative on the rule for a successful outcome.
  
  
  CONCLUSIONS
  The proposed CPR may identify patients with NP likely to benefit from exercise-based treatment in the short term. However, long-term follow up did not demonstrate a significant difference between groups.
  
  
  METHODS
  2b.
authors.affiliation: University of Central Florida, Orlando, FL, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Hanney
authors.affiliation: Nova Southeastern University, Fort Lauderdale, FL, USA.
authors.forename: Morey J
authors.initials: MJ
authors.lastname: Kolber
authors.affiliation: University of Florida, Gainesville, FL, USA.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
authors.affiliation: Spine and Sport, Savannah, GA, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Young
authors.affiliation: The Spine Health Institute, Altamonte, FL, USA.
authors.forename: Chetan K
authors.initials: CK
authors.lastname: Patel
authors.affiliation: Franklin Pierce University, Concord, NH, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cleland
keywords: Clinical prediction rule; exercise; neck pain