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BMC Musculoskeletal Disorders

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Open Access 01-12-2022 | Neck Pain | Research

The association between different outcome measures and prognostic factors in patients with neck pain: a cohort study

Authors: Birgitte Lawaetz Myhrvold, Alice Kongsted, Pernille Irgens, Hilde Stendal Robinson, Nina K Vøllestad

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Background

Health domains like pain, disability, and health-related quality of life are commonly used outcomes for musculoskeletal disorders. Most prognostic studies include only one outcome, and it is unknown if prognostic factors and models may be generic across different outcomes. The objectives of this study were to examine the correlation among commonly used outcomes for neck pain (pain intensity, disability, and health-related quality of life) and to explore how the predictive performance of a prognostic model differs across commonly used outcomes.

Methods

We conducted an observational prospective cohort study with data from patients with neck pain aged 18–84 years consulting Norwegian chiropractors. We used three different outcomes: pain intensity (Numeric Pain Rating Scale), the Neck Disability Index (NDI), and health-related quality of Life (EQ-5D). We assessed associations between change in outcome scores at 12-weeks follow-up with Pearson’s correlation coefficient. We used multivariable linear regression models to explore differences in explained variance and relationship between predictors and outcomes.

Results

The study sample included 1313 patients and 941 (72%) completed follow-up at 12 weeks. The strongest correlation was between NDI and EQ-5D (r = 0.57) while the weakest correlation was between EQ-5D and pain intensity (r = 0.39). The correlation between NDI and pain intensity was moderate (r = 0.53) In the final regression models, the explained variance ranged from adjusted R² of 0.26 to 0.60, highest with NDI and lowest with pain intensity as outcome. The predictive contributions of the included predictors were similar across outcomes. Among the investigated predictors, pain patterns and the baseline measure of the corresponding outcome measure contributed the most to explained variance across all outcomes.

Conclusions

The highest correlation was found between NDI and EQ-5D and the lowest with pain intensity. The same prognostic model showed highest predictive performance with NDI as outcome and poorest with pain intensity as outcome. These results suggest that we need more knowledge on the reasons for the differences in predictive performance variation across outcomes.

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Turk DC, Dworkin RH, Revicki D, Harding G, Burke LB, Cella D, et al. Identifying important outcome domains for chronic pain clinical trials: an IMMPACT survey of people with pain. Pain. 2008;137(2):276–85. https://doi.org/10.1016/j.pain.2007.09.002.CrossRefPubMed

Henry SG, Bell RA, Fenton JJ, Kravitz RL. Goals of chronic pain management: Do patients and primary care physicians agree and does it matter? Clin J Pain. 2017;33(11):955–61. https://doi.org/10.1097/AJP.0000000000000488.CrossRefPubMedPubMedCentral

Gardner T, Refshauge K, McAuley J, Goodall S, Hubscher M, Smith L. Patient-led Goal Setting: A pilot study investigating a promising approach for the management of chroniclLow back pain. Spine. 2016;41(18):1405–13. https://doi.org/10.1097/BRS.0000000000001545.CrossRefPubMed

Picavet HS, Schouten JS. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain. 2003;102(1–2):167–78. https://doi.org/10.1016/s0304-3959(02)00372-x.CrossRefPubMed

Amundsen O, Vollestad NK, Meisingset I, Robinson HS. Associations between treatment goals, patient characteristics, and outcome measures for patients with musculoskeletal disorders in physiotherapy practice. BMC Musculoskelet Disord. 2021;22(1):182. https://doi.org/10.1186/s12891-021-04048-4.CrossRefPubMedPubMedCentral

Zeppieri G Jr, Bialosky J, George SZ. Importance of outcome domain for patients with musculoskeletal pain: Characterizing subgroups and their response to treatment. Phys Ther. 2020;100(5):829–45. https://doi.org/10.1093/ptj/pzaa009.CrossRefPubMed

Bobos P, MacDermid JC, Walton DM, Gross A, Santaguida PL. Patient-Reported Outcome Measures used for neck disorders: An overview of systematic reviews. J Orthop Sports Phys Ther. 2018;48(10):775–88. https://doi.org/10.2519/jospt.2018.8131.CrossRefPubMed

Macdermid JC, Walton DM, Cote P, Santaguida PL, Gross A, Carlesso L, et al. Use of outcome measures in managing neck pain: an international multidisciplinary survey. Open Orthop J. 2013;7:506–20. https://doi.org/10.2174/1874325001307010506.CrossRefPubMedPubMedCentral

Turk DC, Dworkin RH, Allen RR, Bellamy N, Brandenburg N, Carr DB, et al. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain. 2003;106(3):337–45. https://doi.org/10.1016/j.pain.2003.08.001.CrossRefPubMed

10.

Carreon LY, Bratcher KR, Das N, Nienhuis JB, Glassman SD. Estimating EQ-5D values from the Neck Disability Index and numeric rating scales for neck and arm pain. J Neurosurg Spine. 2014;21(3):394–9. https://doi.org/10.3171/2014.5.SPINE13570.CrossRefPubMed

11.

Chiu TT, Lam TH, Hedley AJ. Correlation among physical impairments, pain, disability, and patient satisfaction in patients with chronic neck pain. Arch Phys Med Rehabil. 2005;86(3):534–40. https://doi.org/10.1016/j.apmr.2004.02.030.CrossRefPubMed

12.

DeVine J, Norvell DC, Ecker E, Fourney DR, Vaccaro A, Wang J, et al. Evaluating the correlation and responsiveness of patient-reported pain with function and quality-of-life outcomes after spine surgery. Spine. 2011;36(21 Suppl):S69-74. https://doi.org/10.1097/BRS.0b013e31822ef6de.CrossRefPubMed

13.

Hemingway H, Croft P, Perel P, Hayden JA, Abrams K, Timmis A, et al. Prognosis research strategy (PROGRESS) 1: a framework for researching clinical outcomes. BMJ (Clinical research ed). 2013;346:e5595.

14.

Mansell G, Corp N, Wynne-Jones G, Hill J, Stynes S, van der Windt D. Self-reported prognostic factors in adults reporting neck or low back pain: An umbrella review. Eur J Pain. 2021;25(8):1627–43. https://doi.org/10.1002/ejp.1782.CrossRefPubMed

15.

Green DJ, Lewis M, Mansell G, Artus M, Dziedzic KS, Hay EM, et al. Clinical course and prognostic factors across different musculoskeletal pain sites: A secondary analysis of individual patient data from randomised clinical trials. Eur J Pain. 2018;22(6):1057–70. https://doi.org/10.1002/ejp.1190.CrossRefPubMed

16.

Walton DM, Carroll LJ, Kasch H, Sterling M, Verhagen AP, Macdermid JC, et al. An Overview of systematic reviews on prognostic factors in neck pain: Results from the International Collaboration on Neck Pain (ICON) Project. Open Orthop J. 2013;7:494–505. https://doi.org/10.2174/1874325001307010494.CrossRefPubMedPubMedCentral

17.

Bishop MD, Mintken PE, Bialosky JE, Cleland JA. Patient expectations of benefit from interventions for neck pain and resulting influence on outcomes. J Orthop Sports Phys Ther. 2013;43(7):457–65. https://doi.org/10.2519/jospt.2013.4492.CrossRefPubMedPubMedCentral

18.

Verwoerd M, Wittink H, Maissan F, de Raaij E, Smeets R. Prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: A systematic review. Musculoskelet Sci Pract. 2019;42:13–37. https://doi.org/10.1016/j.msksp.2019.03.009.CrossRefPubMed

19.

Wingbermuhle RW, van Trijffel E, Nelissen PM, Koes B, Verhagen AP. Few promising multivariable prognostic models exist for recovery of people with non-specific neck pain in musculoskeletal primary care: a systematic review. J Physiother. 2018;64(1):16–23. https://doi.org/10.1016/j.jphys.2017.11.013.CrossRefPubMed

20.

Myhrvold BL, Kongsted A, Irgens P, Robinson HS, Thoresen M, Vollestad NK. Broad external validation and update of a prediction model for persistent neck pain after 12 weeks. Spine. 2019;44(22):E1298–310.

21.

Pool JJ, Ostelo RW, Knol D, Bouter LM, de Vet HC. Are psychological factors prognostic indicators of outcome in patients with sub-acute neck pain? Man Ther. 2010;15(1):111–6. https://doi.org/10.1016/j.math.2009.08.001.CrossRefPubMed

22.

Wingbermuhle RW, Chiarotto A, van Trijffel E, Koes B, Verhagen AP, Heymans MW. Development and internal validation of prognostic models for recovery in patients with non-specific neck pain presenting in primary care. Physiotherapy. 2021;113:61–72. https://doi.org/10.1016/j.physio.2021.05.011.CrossRefPubMed

23.

von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Epidemiology. 2007;18(6):800–4. https://doi.org/10.1097/EDE.0b013e3181577654.CrossRef

24.

Vasseljen O, Woodhouse A, Bjorngaard JH, Leivseth L. Natural course of acute neck and low back pain in the general population: the HUNT study. Pain. 2013;154(8):1237–44. https://doi.org/10.1016/j.pain.2013.03.032.CrossRefPubMed

25.

Nyiro L, Peterson CK, Humphreys BK. Exploring the definition of neck pain: a prospective cohort observational study comparing the outcomes of chiropractic patients with 0–2 weeks, 2–4 weeks and 4–12 weeks of symptoms. Chiropr Man Therap. 2017;25:24. https://doi.org/10.1186/s12998-017-0154-y.CrossRefPubMedPubMedCentral

26.

Kongsted A, Kent P, Hestbaek L, Vach W. Patients with low back pain had distinct clinical course patterns that were typically neither complete recovery nor constant pain. A latent class analysis of longitudinal data. Spine J. 2015;15(5):885–94.http://dx.doi.org/https://doi.org/10.1016/j.spinee.2015.02.012

27.

Schellingerhout JM, Heymans MW, Verhagen AP, Lewis M, de Vet HC, Koes BW. Prognosis of patients with nonspecific neck pain: development and external validation of a prediction rule for persistence of complaints. Spine. 2010;35(17):E827-35. https://doi.org/10.1097/BRS.0b013e3181d85ad5.CrossRefPubMed

28.

Kongsted A, Kent P, Axen I, Downie AS, Dunn KM. What have we learned from ten years of trajectory research in low back pain? BMC Musculoskelet Disord. 2016;17:220. https://doi.org/10.1186/s12891-016-1071-2.CrossRefPubMedPubMedCentral

29.

Dunn KM, Campbell P, Jordan KP. Validity of the Visual Trajectories Questionnaire for Pain. J Pain. 2017;18(12):1451–8. https://doi.org/10.1016/j.jpain.2017.07.011.CrossRefPubMedPubMedCentral

30.

Myhrvold BL, Irgens P, Robinson HS, Engebretsen K, Natvig B, Kongsted A, et al. Visual trajectory pattern as prognostic factors for neck pain. Eur J Pain. 2020;24(9):1752–64. https://doi.org/10.1002/ejp.1622.CrossRefPubMed

31.

Myburgh C, Brandborg-Olsen D, Albert H, Hestbaek L. The Nordic maintenance care program: what is maintenance care? Interview based survey of Danish chiropractors. Chiropr Man Therap. 2013;21(1):27. https://doi.org/10.1186/2045-709X-21-27.CrossRefPubMedPubMedCentral

32.

Von Korff M, Jensen MP, Karoly P. Assessing global pain severity by self-report in clinical and health services research. Spine. 2000;25(24):3140–51. https://doi.org/10.1097/00007632-200012150-00009.CrossRef

33.

Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14(7):409–15.PubMed

34.

Johansen JB, Andelic N, Bakke E, Holter EB, Mengshoel AM, Roe C. Measurement properties of the Norwegian version of the Neck Disability Index in chronic neck pain. Spine. 2013;38(10):851–6. https://doi.org/10.1097/BRS.0b013e31827fc3e9.CrossRefPubMed

35.

Vernon H. The Neck Disability Index: state-of-the-art, 1991–2008. J Manipulative Physiol Ther. 2008;31(7):491–502. https://doi.org/10.1016/j.jmpt.2008.08.006.CrossRefPubMed

36.

Schellingerhout JM, Verhagen AP, Heymans MW, Koes BW, de Vet HC, Terwee CB. Measurement properties of disease-specific questionnaires in patients with neck pain: a systematic review. Qual Life Res. 2012;21(4):659–70. https://doi.org/10.1007/s11136-011-9965-9.CrossRefPubMed

37.

Brooks R. EuroQol: the current state of play. Health Policy. 1996;37(1):53–72. https://doi.org/10.1016/0168-8510(96)00822-6.CrossRefPubMed

38.

Solberg TK, Olsen JA, Ingebrigtsen T, Hofoss D, Nygaard OP. Health-related quality of life assessment by the EuroQol-5D can provide cost-utility data in the field of low-back surgery. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2005;14(10):1000–7.http://dx.doi.org/https://doi.org/10.1007/s00586-005-0898-2

39.

Wahlberg M, Zingmark M, Stenberg G, Munkholm M. Rasch analysis of the EQ-5D-3L and the EQ-5D-5L in persons with back and neck pain receiving physiotherapy in a primary care context. European Journal of Physiotherapy. 2021;23(2):102–9. https://doi.org/10.1080/21679169.2019.1646801.CrossRef

40.

Mukaka MM. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012;24(3):69–71.PubMedPubMedCentral

41.

Schober P, Boer C, Schwarte LA. Correlation coefficients: Appropriate use and interpretation. Anesth Analg. 2018;126(5):1763–8. https://doi.org/10.1213/ane.0000000000002864.CrossRefPubMed

42.

Cohen J. Statistical power analysis for the behavioral sciences: Routledge; 2013.

43.

Collins GS, Reitsma JB, Altman DG, Moons KGM. Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): the TRIPOD Statement. BMC medicine. 2015;13:1-.http://dx.doi.org/https://doi.org/10.1186/s12916-014-0241-z

44.

Riley RD, Ensor J, Snell KIE, Harrell FE Jr, Martin GP, Reitsma JB, et al. Calculating the sample size required for developing a clinical prediction model. BMJ (Clinical research ed). 2020;368:m441.

45.

Hoving JL, de Vet HCW, Twisk JWR, Deville W, van der Windt D, Koes BW, et al. Prognostic factors for neck pain in general practice. Pain. 2004;110(3):639–45. https://doi.org/10.1016/j.pain.2004.05.002.CrossRefPubMed

46.

Jensen MP, Tome-Pires C, Sole E, Racine M, Castarlenas E, de la Vega R, et al. Assessment of pain intensity in clinical trials: individual ratings vs composite scores. Pain Med. 2015;16(1):141–8. https://doi.org/10.1111/pme.12588.CrossRefPubMed

47.

Chiarotto A, Maxwell LJ, Ostelo RW, Boers M, Tugwell P, Terwee CB. Measurement properties of Visual Analogue Scale, Numeric Rating Scale, and Pain Severity Subscale of the Brief Pain Inventory in patients with low back pain: A systematic review. J Pain. 2019;20(3):245–63. https://doi.org/10.1016/j.jpain.2018.07.009.CrossRefPubMed

48.

Ailliet L, Rubinstein SM, Hoekstra T, van Tulder MW, de Vet HCW. Long-term trajectories of patients with neck pain and low back pain presenting to chiropractic care: A latent class growth analysis. Eur J Pain. 2018;22(1):103–13. https://doi.org/10.1002/ejp.1094.CrossRefPubMed

49.

Pico-Espinosa OJ, Cote P, Hogg-Johnson S, Jensen I, Axen I, Holm LW, et al. Trajectories of pain intensity over 1 year in adults with disabling subacute or chronic neck pain. Clin J Pain. 2019;35(8):678–85. https://doi.org/10.1097/AJP.0000000000000727.CrossRefPubMedPubMedCentral

50.

Irgens P, Kongsted A, Myhrvold BL, Waagan K, Engebretsen KB, Natvig B, et al. Neck pain patterns and subgrouping based on weekly SMS-derived trajectories. BMC Musculoskelet Disord. 2020;21(1):678. https://doi.org/10.1186/s12891-020-03660-0.CrossRefPubMedPubMedCentral

51.

Hush JM, Refshauge K, Sullivan G, De Souza L, Maher CG, McAuley JH. Recovery: what does this mean to patients with low back pain? Arthritis Rheum. 2009;61(1):124–31. https://doi.org/10.1002/art.24162.CrossRefPubMed

52.

Hush JM, Refshauge KM, Sullivan G, De Souza L, McAuley JH. Do Numerical Rating Scales and the Roland-Morris Disability Questionnaire capture changes that are meaningful to patients with persistent back pain? Clin Rehabil. 2010;24(7):648–57. https://doi.org/10.1177/0269215510367975.CrossRefPubMed

53.

Robinson-Papp J, George MC, Dorfman D, Simpson DM. Barriers to chronic pain measurement: A qualitative study of patient perspectives. Pain Med. 2015;16(7):1256–64. https://doi.org/10.1111/pme.12717.CrossRefPubMed

54.

Grotle M, Vollestad NK, Brox JI. Screening for yellow flags in first-time acute low back pain: reliability and validity of a Norwegian version of the Acute Low Back Pain Screening Questionnaire. Clin J Pain. 2006;22(5):458–67. https://doi.org/10.1097/01.ajp.0000208243.33498.cb.CrossRefPubMed

55.

Linton SJ, Nicholas M, MacDonald S. Development of a short form of the Orebro Musculoskeletal Pain Screening Questionnaire. Spine. 2011;36(22):1891–5. https://doi.org/10.1097/BRS.0b013e3181f8f775.CrossRefPubMed

56.

Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974;19(1):1–15. https://doi.org/10.1002/bs.3830190102.CrossRefPubMed

Title: The association between different outcome measures and prognostic factors in patients with neck pain: a cohort study
Authors: Birgitte Lawaetz Myhrvold
Alice Kongsted
Pernille Irgens
Hilde Stendal Robinson
Nina K Vøllestad
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Neck Pain
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-022-05558-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The association between different outcome measures and prognostic factors in patients with neck pain: a cohort study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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