Neck Pain : Analysis of Prognostic Factors and Treatment Effects

Abstract: Neck pain is a highly prevalent and often long-lasting problem with substantial personal and economic consequences. Individuals with neck pain are often referred for physiotherapy treatment, but there is limited evidence of the effect of treatment in these patients, mainly because conservative interventions have not been studied in sufficient detail.The aim of the research underlying this thesis was to improve existing knowledge about neck pain, focusing on prognoses and on the effects of physiotherapy treatment in patients with neck pain. The thesis includes four different studies. a 12-year follow-up study comparing individuals initially on sick leave due to neck/shoulder or low back diagnoses; a critical review of the literatme on randomised studies of neck pain: a prognostic study with focus on both an impairment and a disability outcome at 1-year follow-up: and a randomised study comparing active exercise and McKenzie treatment with a placebo therapy in patients with neck pain.Compatison of individuals with neck/shoulder and low-back diagnoses revealed that the neck/shoulder group rated their present discomfort as worse than those sick listed with low back diagnoses. Only 4% of the neck/shoulder group but 25% of the low back group reported no present discomfort. Notably. both groups reported the same duration of low back discomfort dming the last year, which may indicate a higher risk for symptoms in more than one location in subjects with neck/shoulder problems.The regression analyses identified different prognostic factors, except duration of cunent episode, depending on the focus of outcomes. Other factors for the dependent variable pain intensity were Oswestry score and similar problem during the previous 5 years: adjusted R~ was 0.24. For the dependent variable Oswestry score. the other factors were pain intensity. well being, and expectations of treatment; adjusted R2 was 0.32. Using pain intensity as outcome, 60% of the patients were identified as being at risk of poor outcome: the corresponding value for Oswestry score as outcome was only 20%.In the critical review. twenty-seven studies were analysed, most of them of poor quality: only one-third scored≥ 50 on a scale of I 00. Positive outcome was noted for 18 of the studies. Inclusion criteria, intervention, and outcome were based mainly on impainnent in the analysed studies, thus there is a lack of evidence of treatment effect in patients with neck pain measured with outcomes focusing on functional limitation and disability.In the randomised study, significant improvements were recorded at 12-month follow-up for all three groups in regard to the main outcomes pain intensity and Neck Disability Index. with no significant difference between the groups. In all, 79% reported that they were better or completely restored after treatment. although 51% reported constant/daily pain. The slope of recovery differed during the first three weeks, with more rapid improvement in the McKenzie group. Only 30% of the study population consumed additional health care. although the mean nmnber of visits were lowest in the McKenzie group.Individuals with sickness absence > 28 days due to neck/shoulder or low back diagnoses appear to be a high risk group for developing long-standing symptoms with stronger evidence for the neck/shoulder group. In clinical settings, it is important to take treatment goals into consideration when choosing the outcome, since a pain-free result may be difficult to obtain if the problems have been long-lasting. Despite a lack of definite evidence. there was a tendency toward better outcome at short-term follow-up with the two active treatments than with placebo therapy, in regard to both impainnent and disability outcomes.