Physiotherapy | 2021
Development and internal validation of prognostic models for recovery in patients with non-specific neck pain presenting in primary care.
Abstract
OBJECTIVES\nDevelopment and internal validation of prognostic models for post-treatment and 1-year recovery in patients with neck pain in primary care.\n\n\nDESIGN\nProspective cohort study.\n\n\nSETTING\nPrimary care manual therapy practices.\n\n\nPARTICIPANTS\nPatients with non-specific neck pain of any duration (n=1193).\n\n\nINTERVENTION\nUsual care manual therapy.\n\n\nOUTCOME MEASURES\nRecovery defined in terms of pain intensity, disability, and global perceived improvement directly post-treatment and at 1-year follow-up.\n\n\nRESULTS\nAll 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.\n\n\nCONCLUSION\nA 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.