TY - JOUR
T1 - Development and internal validation of prognostic models for recovery in patients with non-specific neck pain presenting in primary care
AU - Wingbermühle, Roel W.
AU - Chiarotto, Alessandro
AU - van Trijffel, Emiel
AU - Koes, Bart
AU - Verhagen, Arianne P.
AU - Heymans, Martijn W.
N1 - Funding Information: Funding: This study was partly funded by a program grant of the Dutch Arthritis Foundation . The funder played no role in the design, conduct, or reporting of this study. Publisher Copyright: © 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Objectives: Development and internal validation of prognostic models for post-treatment and 1-year recovery in patients with neck pain in primary care. Design: Prospective cohort study. Setting: Primary care manual therapy practices. Participants: Patients with non-specific neck pain of any duration (n = 1193). Intervention: Usual care manual therapy. Outcome measures: Recovery defined in terms of pain intensity, disability, and global perceived improvement directly post-treatment and at 1-year follow-up. Results: All post-treatment models exhibited acceptable discriminative performance after derivation (AUC ≥ 0.7). The developed post-treatment disability model exhibited the best overall performance (R2 = 0.24; IQR, 0.22–0.26), discrimination (AUC = 0.75; 95% CI, 0.63–0.84), and calibration (slope 0.92; IQR, 0.91–0.93). After internal validation and penalization, this model retained acceptable discriminative performance (AUC = 0.74). The five other models, including those predicting 1-year recovery, did not reach acceptable discriminative performance after internal validation. Baseline pain duration, disability, and pain intensity were consistent predictors across models. Conclusion: A post-treatment prognostic model for disability was successfully developed and internally validated. This model has potential to inform primary care clinicians about a patient's individual prognosis after treatment, but external validation is required before clinical use can be recommended.
AB - Objectives: Development and internal validation of prognostic models for post-treatment and 1-year recovery in patients with neck pain in primary care. Design: Prospective cohort study. Setting: Primary care manual therapy practices. Participants: Patients with non-specific neck pain of any duration (n = 1193). Intervention: Usual care manual therapy. Outcome measures: Recovery defined in terms of pain intensity, disability, and global perceived improvement directly post-treatment and at 1-year follow-up. Results: All post-treatment models exhibited acceptable discriminative performance after derivation (AUC ≥ 0.7). The developed post-treatment disability model exhibited the best overall performance (R2 = 0.24; IQR, 0.22–0.26), discrimination (AUC = 0.75; 95% CI, 0.63–0.84), and calibration (slope 0.92; IQR, 0.91–0.93). After internal validation and penalization, this model retained acceptable discriminative performance (AUC = 0.74). The five other models, including those predicting 1-year recovery, did not reach acceptable discriminative performance after internal validation. Baseline pain duration, disability, and pain intensity were consistent predictors across models. Conclusion: A post-treatment prognostic model for disability was successfully developed and internally validated. This model has potential to inform primary care clinicians about a patient's individual prognosis after treatment, but external validation is required before clinical use can be recommended.
KW - Model development
KW - Neck pain
KW - Prognostic factors
KW - Prognostic models
KW - Recovery
UR - http://www.scopus.com/inward/record.url?scp=85115395655&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.physio.2021.05.011
DO - https://doi.org/10.1016/j.physio.2021.05.011
M3 - Article
C2 - 34563916
SN - 0031-9406
VL - 113
SP - 61
EP - 72
JO - Physiotherapy
JF - Physiotherapy
ER -