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Predictors of failure to achieve minimal clinical important difference for pain and disability after mechanical diagnosis and therapy (MDT)-based multimodal rehabilitation for neck pain: a retrospective analysis of 4998 patients

Abstract

Purpose

To determine predictors of failure to achieve minimal clinical important difference (MCID) for pain and disability at discharge after mechanical diagnosis and therapy (MDT)-based multimodal rehabilitation for neck pain (NP).

Methods

Pre- and post-treatment numerical pain rating scale (NPRS) and neck disability index (NDI) in patients with mechanical NP were analysed in this retrospective study. Multivariate analysis was performed to investigate the effect of covariates such as age, gender, lifestyle, body mass index, presentation, diabetes, osteoporosis, response to repeated movement testing, treatment sessions, compliance rate, and pre-treatment NPRS and NDI scores on failure to achieve MCID of ≥ 30% for NPRS and NDI scores post-treatment.

Results

In the 4998 patients analysed for this study, 7% and 14.5% of patients failed to achieve MCID for NPRS and NDI scores, respectively, at the end of treatment. Age > 70 years, diabetes, osteoporosis, partial or non-response to repeated movements, lesser treatment sessions, and lower compliance rate were associated with increased risk for failure to achieve MCID for NPRS and NDI scores. A higher pre-treatment NDI score was associated with failure to achieve MCID for NPRS score, whereas lower pre-treatment NPRS and NDI scores were associated with failure to achieve MCID for NDI score.

Conclusion

Although MDT-based multimodal rehabilitation helped to achieve significant reduction in pain and disability in mechanical NP, several baseline risk factors were associated with failure to achieve MCID for pain and disability after treatment. Identifying and modifying these factors as part of rehabilitation treatment may help to achieve better outcomes in mechanical NP.

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Data availability

All data and material related to the current study are available from the corresponding author on reasonable request.

References

  1. Safiri S, Kolahi AA, Hoy D, Buchbinder R, Mansournia MA, Bettampadi D, Ashrafi-Asgarabad A, Almasi-Hashiani A, Smith E, Sepidarkish M, Cross M, Qorbani M, Moradi-Lakeh M, Woolf AD, March L, Collins G, Ferreira ML (2020) Global, regional, and national burden of neck pain in the general population, 1990–2017: systematic analysis of the global burden of disease study 2017. BMJ 368:m791. https://doi.org/10.1136/bmj.m791

    Article  PubMed  PubMed Central  Google Scholar 

  2. Cohen SP, Hooten WM (2017) Advances in the diagnosis and management of neck pain. BMJ 358:j3221. https://doi.org/10.1136/bmj.j3221

    Article  PubMed  Google Scholar 

  3. Jun D, Zoe M, Johnston V, O’Leary S (2017) Physical risk factors for developing non-specific neck pain in office workers: a systematic review and meta-analysis. Int Arch Occup Environ Health 90:373–410. https://doi.org/10.1007/s00420-017-1205-3

    Article  PubMed  Google Scholar 

  4. Hogg-Johnson S, van der Velde G, Carroll LJ, Holm LW, Cassidy JD, Guzman J, Côté P, Haldeman S, Ammendolia C, Carragee E, Hurwitz E, Nordin M, Peloso P (2008) The burden and determinants of neck pain in general population: results of the bone and joint decade 2000–2010 task force on neck pain and it associated disorders. Spine 33:S39–S51. https://doi.org/10.1016/j.jmpt.2008.11.010

    Article  PubMed  Google Scholar 

  5. Martin-Gomez C, Sestelo-Diaz R, Carrillo-Sanjuan V, Navarro-Santana MJ, Bardon-Romero J, Plaza-Manzano G (2019) Motor control using cranio-cervical flexion exercises versus other treatments for non-specific chronic neck pain: a systematic review and meta-analysis. Musculoskelet Sci Pract 42:52–59. https://doi.org/10.1016/j.msksp.2019.04.010

    Article  PubMed  Google Scholar 

  6. Domingues L, Pimentel-Santos FM, Cruz EB, Sousa AC, Santos A, Cordovil A, Correia A, Torres LS, Silva A, Branco PS, Branco JC (2019) Is a combined programme of manual therapy and exercise more effective than usual care in patients with non-specific chronic neck pain? A randomized controlled trial. Clin Rehabil 33:1908–1918. https://doi.org/10.1177/0269215519876675

    Article  PubMed  Google Scholar 

  7. Lam OT, Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM (2018) Effectiveness of the McKenzie method of mechanical diagnosis and therapy for treating low back pain: literature review with meta-analysis. J Orthop Sports Phys Ther 48:476–490. https://doi.org/10.2519/jospt.2018.7562

    Article  PubMed  Google Scholar 

  8. Takasaki H, May S (2014) Mechanical diagnosis and therapy has similar effects on pain and disability as ‘wait and see’ and other approaches in people with neck pain: a systematic review. J Physiother 60:78–84. https://doi.org/10.1016/j.jphys.2014.05.006

    Article  PubMed  Google Scholar 

  9. Long A, May S, Fung T (2008) The comparative prognostic value of directional preference and centralization: a useful tool for front-line clinicians? J Man Manip Ther 16:248–254. https://doi.org/10.1179/106698108790818332

    Article  PubMed  PubMed Central  Google Scholar 

  10. Petersen T, Christensen R, Juhl C (2015) Predicting a clinically important outcome in patients with low back pain following McKenzie therapy or spinal manipulation: a stratified analysis in a randomized controlled trial. BMC Musculoskelet Disord. https://doi.org/10.1186/s12891-015-0526-1

    Article  PubMed  PubMed Central  Google Scholar 

  11. Beattie PF, Silfies SP, Jordon M (2016) The evolving role of physical therapists in the long-term management of chronic low back pain: longitudinal care using assisted self-management strategies. Braz J Phys Ther 20:580–591. https://doi.org/10.1590/bjpt-rbf.2014.0180

    Article  PubMed  PubMed Central  Google Scholar 

  12. Setchell J, Costa N, Ferreira M, Hodges PW (2019) What decreases low back pain? A qualitative study of patient perspectives. Scand J Pain 19:597–603. https://doi.org/10.1515/sjpain-2019-0018

    Article  PubMed  Google Scholar 

  13. Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, de Vet HC (2008) Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine 33:90–94. https://doi.org/10.1097/BRS.0b013e31815e3a10

    Article  PubMed  Google Scholar 

  14. Pires D, Cruz E, Canhão H, Nunes C (2020) Minimum important change values for pain and disability: which is the best to identify a meaningful response in patients with chronic nonspecific low back pain? Physiother Theory Pract. https://doi.org/10.1080/09593985.2020.1843210

    Article  PubMed  Google Scholar 

  15. Childs JD, Cleland JA, Elliott JM, Teyhen DS, Wainner RS, Whitman JM, Sopky BJ, Godges JJ, Flynn TW, Association APT (2008) Neck pain: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopedic section of the american physical therapy association. J Orthop Sports Phys Ther 38:A1–A34. https://doi.org/10.2519/jospt.2008.0303

    Article  PubMed  Google Scholar 

  16. Locke CT, Craig CL, Thyfault JP, Spence JC (2013) A step defined sedentary lifestyle index <5000 steps/day. Appl Physiol Nutr Metab 38(2):100–114. https://doi.org/10.1139/apnm-2012-0235

    Article  Google Scholar 

  17. Oja P, Titze S (2011) Physical activity recommendations for public health: development and policy context. EPMA J 2(3):253–259. https://doi.org/10.1007/s13167-011-0090-1

    Article  PubMed  PubMed Central  Google Scholar 

  18. McKenzie R, May S (2003) The Cervical and thoracic spine: mechanical diagnosis and therapy, 2nd edn. Spinal Publications, Wellington

    Google Scholar 

  19. Childs JD, Piva SR, Fritz JM (2005) Responsiveness of the numeric pain rating scale in patients with low back pain. Spine 30:1331–1334. https://doi.org/10.1097/01.brs.0000164099.92112.29

    Article  PubMed  Google Scholar 

  20. Vernon H (2008) The neck disability index: state-of-the-art, 1991–2008. J Manip Physiol Ther 31:491–502. https://doi.org/10.1016/j.jmpt.2008.08.006

    Article  Google Scholar 

  21. McMakin CR (2011) Frequency specific microcurrent in pain management. Churchill Livingstone-Elsevier, Philadelphia

    Google Scholar 

  22. Alexander R, Ole H, Natalia CB, Susanne MW, Alexander C, Martin B (2020) Microcurrent therapy in the treatment of knee osteoarthritis: could it be more than a placebo effect? A randomized controlled trial. Eur J Phys Rehabil Med. https://doi.org/10.23736/S1973-9087.20.05921-3

    Article  Google Scholar 

  23. Koopman JSHA, Vrinten DH, van Wijck AJM (2009) Efficacy of microcurrent therapy in the treatment of chronic nonspecific back pain: a pilot study. Clin J Pain 25(6):495–499. https://doi.org/10.1097/AJP.0b013e31819a6f3e

    Article  PubMed  Google Scholar 

  24. Saranya B, Ahmed J, Shenoy N, Ongole R, Sujir N, Natarajan S (2019) Comparison of transcutaneous electric nerve stimulation (TENS) and microcurrent nerve stimulation (MENS) in the management of masticatory muscle pain: a comparative study. Pain Res Manag 2019:1–5. https://doi.org/10.1155/2019/8291624

    Article  Google Scholar 

  25. Shetty GM, Rawat P, Sharma A (2020) Effect of adjuvant frequency-specific microcurrents on pain and disability in patients treated with physical rehabilitation for neck and low back pain. J Bodyw Mov Ther 24(4):168–175. https://doi.org/10.1016/j.jbmt.2020.07.013

    Article  PubMed  Google Scholar 

  26. De Pauw R, Kregel J, De Blaiser C, Van Akeleyen J, Logghe T, Danneels L, Cagnie B (2015) Identifying prognostic factors predicting outcome in patients with chronic neck pain after multimodal treatment: a retrospective study. Man Ther 20:592–597. https://doi.org/10.1016/j.math.2015.02.001

    Article  PubMed  Google Scholar 

  27. Bohman T, Bottai M, Björklund M (2019) Predictive models for short-term and long-term improvement in women under physiotherapy for chronic disabling neck pain: a longitudinal cohort study. BMJ Open 9:e024557. https://doi.org/10.1136/bmjopen-2018-024557

    Article  PubMed  PubMed Central  Google Scholar 

  28. Weigl M, Letzel J, Angst F (2021) Prognostic factors for the improvement of pain and disability following multidisciplinary rehabilitation in patients with chronic neck pain. BMC Musculoskelet Disord 22:330. https://doi.org/10.1186/s12891-021-04194-9

    Article  PubMed  PubMed Central  Google Scholar 

  29. Zebis MK, Andersen CH, Sundstrup E, Pedersen MT, Sjøgaard G, Andersen LL (2014) Time-wise change in neck pain in response to rehabilitation with specific resistance training: implications for exercise prescription. PLoS ONE 9:e93867. https://doi.org/10.1371/journal.pone.0093867

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. Edmond SL, Cutrone G, Werneke M, Ward J, Grigsby D, Weinberg J, Oswald W, Oliver D, McGill T, Hart DL (2014) Association between centralization and directional preference and functional and pain outcomes in patients with neck pain. J Orthop Sports Phys Ther 44:68–75. https://doi.org/10.2519/jospt.2014.4632

    Article  PubMed  Google Scholar 

  31. Jimenez-Garcia R, Del Barrio JL, Hernandez-Barrera V, de Miguel-Díez J, Jimenez-Trujillo I, Martinez-Huedo MA, Lopez-de-Andres A (2018) Is there an association between diabetes and neck pain and lower back pain? Results of a population-based study. J Pain Res 11:1005–1015. https://doi.org/10.2147/JPR.S158877

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wang XR, Kwok TCY, Griffith JF, Man YBW, Leung JCS, Wáng YXJ (2019) Prevalence of cervical spine degenerative changes in elderly population and its weak association with aging, neck pain, and osteoporosis. Ann Transl Med 7(18):486–486. https://doi.org/10.21037/atm.2019.07.80

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Gautam M. Shetty.

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Informed consent was taken from all patients regarding the use of their anonymized demographic and clinical data for this study.

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Shetty, G.M., Vakil, P., Jain, S. et al. Predictors of failure to achieve minimal clinical important difference for pain and disability after mechanical diagnosis and therapy (MDT)-based multimodal rehabilitation for neck pain: a retrospective analysis of 4998 patients. Eur Spine J 31, 1291–1299 (2022). https://doi.org/10.1007/s00586-022-07167-1

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Keywords

  • Prognosis
  • Rehabilitation
  • Physical therapy
  • Mechanical neck pain
  • Multimodal treatment