Development of a clinical prediction rule to identify patients with neck pain who are likely to benefit from home-based mechanical cervical traction


The objective of the study was to identify the population of patients with neck pain who improved with home-based mechanical cervical traction (HMCT). A prospective cohort study was conducted in a physical therapy clinic at a local hospital. Patients with neck pain referred to the clinic for physical therapy were included in the study. A HMCT program was given to participants for 2 weeks. The patient’s demographic data, Numerical Pain Scale (NPS) score, Neck Disability Index (NDI) and Fear-Avoidance Beliefs Questionnaire score were collected, and standard physical examination of the cervical spine was conducted before intervention. The NPS score, NDI and a global rating of perceived improvement were collected after the intervention was completed. A total of 103 patients participated in the study and 47 had a positive response to HMCT. A clinical prediction rule with four variables (Fear-Avoidance Beliefs Work Subscale score < 13, pre-intervention pain intensity ≥ 7/10, positive cervical distraction test and pain below shoulder) was identified. With satisfaction of at least three out of four variables (positive likelihood ratio = 4.77), the intervention’s success rate increased from 45.6% to over 80%. It appears that patients with neck pain who are likely to respond to HMCT may be identified.

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The authors thank the NUHS Medical Publication Support Unit, Singapore, for assistance in the preparation of this manuscript. We would like to thank the department senior manager, Mr. Tan Hai Yang, the former manager, Mrs. Marguerita Dass, Ms. Sharon Lim and supervisor, Mrs. Ng Chai Ming, of the Rehabilitation Department of the hospital for providing us with clinical time and resources for the study. This study was supported by the Enabling Grant of the Singapore National Medical Research Council.

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Correspondence to Congcong Cai.

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Cai, C., Ming, G. & Ng, L.Y. Development of a clinical prediction rule to identify patients with neck pain who are likely to benefit from home-based mechanical cervical traction. Eur Spine J 20, 912–922 (2011).

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  • Neck pain
  • Cervical traction
  • Clinical prediction rule
  • Classification
  • Intervention success rate