Jasper Mattijs Schellingerhout

Measurement properties of disease-specific questionnaires in patients with neck pain: a systematic review

PurposeTo critically appraise and compare the measurement properties of the original versions of neck-specific questionnaires.MethodsBibliographic databases were searched for articles concerning the development or evaluation of the measurement properties of an original version of a self-reported questionnaire, evaluating pain and/or disability, which was specifically developed or adapted for patients with neck pain. The methodological quality of the selected studies and the results of the measurement properties were critically appraised and rated using a checklist, specifically designed for evaluating studies on measurement properties.ResultsThe search strategy resulted in a total of 3,641 unique hits, of which 25 articles, evaluating 8 different questionnaires, were included in our study. The Neck Disability Index is the most frequently evaluated questionnaire and shows positive results for internal consistency, content validity, structural validity, hypothesis testing, and responsiveness, but a negative result for reliability. The other questionnaires show positive results, but the evidence for each measurement property is mostly limited, and at least 50% of the information on measurement properties per questionnaire is lacking.ConclusionsOur findings imply that studies of high methodological quality are needed to properly assess the measurement properties of the currently available questionnaires. Until high quality studies are available, we recommend using these questionnaires with caution. There is no need for the development of new neck-specific questionnaires until the current questionnaires have been adequately assessed.

Methodological Quality of Studies on the Measurement Properties of Neck Pain and Disability Questionnaires: A Systematic Review

OBJECTIVE The aim of this study was to obtain an overview of the methodological quality of studies on the measurement properties of neck pain and disability questionnaires and to describe how well various aspects of the design and statistical analyses of studies on measurement properties are performed. METHODS A systematic review was performed of published studies on the measurement properties of neck pain and disability questionnaires. Two reviewers independently rated the quality of the studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. This checklist was developed in an international Delphi consensus study. RESULTS A total of 47 articles were included on the measurement properties of 8 different questionnaires. The methodological quality of the included studies was adequate on some aspects (often, adequate statistical analyses are used for assessing reliability, measurement error, and construct validity) but can be improved on other aspects. The most important methodological aspects that need to be improved are as follows: assessing unidimensionality in internal consistency analysis, stable patients and similar test conditions in studies on reliability and measurement error, and more emphasis on the relevance and comprehensiveness of the items in content validity studies. Furthermore, it is recommended that studies on construct validity and responsiveness should be based on predefined hypotheses and that better statistical methods should be used in responsiveness studies. CONCLUSION Considering the importance of adequate measurement properties, it is concluded that, in the field of measuring neck pain and disability, there is room for improvement in the methodological quality of studies measurement properties.

Prognosis of patients with nonspecific neck pain: development and external validation of a prediction rule for persistence of complaints.

Study Design. Reanalysis of data from 3 randomized controlled trials. Objective. Development and validation of a prediction rule that estimates the probability of complaints persisting for at least 6 months in patients presenting with nonspecific neck pain in primary care. Summary of Background Data. A substantial proportion of the neck pain patients will develop chronic neck pain. An important question is whether we can identify patients at risk of persistent complaints at the first consultation with the physician, based on their personal characteristics? A prediction model that quantifies prognosis in patients with nonspecific neck pain is not available. Methods. The study population consisted of a sample (n = 468) from the adult primary care population (18–70 years) in The Netherlands presenting with nonspecific neck pain. The primary outcome measure was global perceived recovery measured at 6 months of follow-up. Seventeen baseline characteristics of the patients were included in the analysis. Significant predictors were identified by multivariable backward stepwise logistic regression analysis. A score chart was constructed by using the regression coefficient estimates. The score chart was externally validated in a cohort of patients with nonspecific neck pain (n = 315), who participated in a randomized controlled trial in the United Kingdom (PANTHER-trial). Results. The multivariable analysis resulted in a set of 9 predictors. The score chart has a discriminative ability of 0.66. External validation of the score chart showed a discriminative ability of 0.65, an adequate calibration, a good fit, and a low explained variation. Conclusion. We developed a score chart, estimating the probability of persistent complaints at 6 months follow-up for patients with nonspecific neck pain. This chart performed well in the study population and external validation population. The prediction which patients are more likely to develop persistent complaints is significantly improved by the score chart.

Categorizing continuous variables resulted in different predictors in a prognostic model for nonspecific neck pain

OBJECTIVE To evaluate whether different categorization strategies for introducing continuous variables in multivariable logistic regression analysis results in prognostic models that differ in content and performance. STUDY DESIGN AND SETTING Backward multivariable logistic regression (P<0.05 and P<0.157) was performed with possible predictors for persistent complaints in patients with nonspecific neck pain. The continuous variables were introduced in the analysis in three separate ways: (1) continuous, (2) split into multiple categories, and (3) dichotomized. The different models were compared with regard to model content, goodness of fit, explained variation, and discriminative ability. We also compared the effect on performance of categorization before and after the selection procedure. RESULTS For P<0.05, the final model with continuous variables, containing five predictors, disagreed on three predictors with both categorization strategies. For P<0.157, the model with continuous variables, containing six predictors, disagreed on three predictors with the model containing stratified continuous variables and on six predictors compared with the model with dichotomized variables. The models in which the variables were kept continuous performed best. There was no clear difference in performance between categorization before and after the selection procedure. CONCLUSION Categorization of continuous variables resulted in a different content and poorer performance of the final model.

Do whiplash patients differ from other patients with non-specific neck pain regarding pain, function or prognosis?

We evaluated whether patients with self-reported whiplash differed in perceived pain, functional limitation and prognosis from patients with other painful neck complaints. Data from three Dutch trials and an English trial were used all evaluating conservative treatment in neck pain patients in primary care. All patients had non-specific neck pain. Information on any trauma or injury came from self-report at baseline. We compared frequencies of baseline variables and outcome at short-term and long term for whiplash and non-trauma neck pain patients separately. The total study population consisted of 804 neck pain patients. Of these patients 133 reported (16.5%) that an injury was the cause of their neck pain. In all trials there were 17-18% more male patients in the whiplash group. At follow-up pain decreased between 12 and 28%, function 10%, and 25-50% of patients recovered in all trials. Post-treatment improvements in pain, function and recovery were comparable between whiplash and non-trauma patients. We also found no different prognostic factors between whiplash and non-trauma patients. Overall we found in a population with mild to moderate pain no clinically relevant differences between patients with self-reported whiplash and patients with other painful neck complaints. The findings suggest that whiplash patients with mild to moderate pain should not be considered a specific subgroup of patients with non-specific neck pain.

Pain severity and catastrophising modify treatment success in neck pain patients in primary care

The objective of this study was to evaluate whether clinical factors at baseline in patients with non-specific neck pain are related to recovery after treatment with manual therapy versus physiotherapy. Participating physiotherapists recruited new consulters with complaints of the neck and/or upper extremity. For this study we selected patients from this cohort with non-specific neck complaints. Participants filled in questionnaires at baseline, 3 and 6 months. The main outcome measure was recovery at 6 months follow-up. Possible predictors like complaint-specific factors, physical factors, social and psychological factors were evaluated for interaction with treatment. Of the 396 participants in this study, 97 (24.5%) received manual therapy, all others received physiotherapy, consisting of exercises, massage or physical applications. In the multivariable model four variables were significantly related to recovery: duration of complaint, catastrophising, distress and somatisation. Severity of main complaint and catastrophising appeared to show interaction with treatment. It appeared that every point increase in severity or catastrophising resulted in a lower chance to recover from physiotherapy compared to manual therapy. In conclusion, severity of main complaint and catastrophising seem to modify treatment success. Increased pain severity or catastrophising at baseline increased the chance of treatment success after manual therapy compared to physiotherapy.

Evaluation of measurement properties of self-administered PROMs aimed at patients with non-specific shoulder pain and "activity limitations": a systematic review.

ObjectiveTo critically appraise and compare the measurement properties of self-administered patient-reported outcome measures (PROMs) focussing on the shoulder, assessing “activity limitations.”Study designSystematic review. The study population had to consist of patients with shoulder pain. We excluded postoperative patients or patients with generic diseases. The methodological quality of the selected studies and the results of the measurement properties were critically appraised and rated using the COSMIN checklist.ResultsOut of a total of 3427 unique hits, 31 articles, evaluating 7 different questionnaires, were included. The SPADI is the most frequently evaluated PROM and its measurement properties seem adequate apart from a lack of information regarding its measurement error and content validity.ConclusionFor English, Norwegian and Turkish users, we recommend to use the SPADI. Dutch users could use either the SDQ or the SST. In German, we recommend the DASH. In Tamil, Slovene, Spanish and the Danish languages, the evaluated PROMs were not yet of acceptable validity. None of these PROMs showed strong positive evidence for all measurement properties. We propose to develop a new shoulder PROM focused on activity limitations, taking new knowledge and techniques into account.

Een beslismodel voor aspecifieke nekpijn

SamenvattingSchellingerhout JM, Verhagen AP, Heymans MW, Pool JM, Vonk F, Koes BW, De Vet HCW. Een beslismodel voor aspecifieke nekpijn. Huisarts Wet 2009;52(8):384-90.Doel Het ontwikkelen van een beslismodel dat aangeeft welke subgroepen van patiënten met aspecifieke nekpijn het meest gebaat zijn bij fysiotherapie, manuele therapie of een afwachtend beleid.Methode We combineerden gegevens van drie recente Nederlandse gerandomiseerde onderzoeken met een overeenkomstige opzet, die zijn uitgevoerd in de eerste lijn. In totaal betrof het 329 volwassenen (18 tot 70 jaar) die voor aspecifieke nekpijn de huisarts bezochten. De uitkomstmaat was door de patiënt gerapporteerd ervaren herstel. Deze bepaalden we aan het eind van de behandeling en na 52 weken follow-up. We identificeerden tien prognostische variabelen met behulp van een multivariabele logistische regressieanalyse en testten deze op interactie met behandeling. Op grond van de gegevens van deze analyse maakten we een beslismodel voor behandelkeuze.Resultaten We identificeerden drie factoren die gerelateerd zijn aan herstel en die interactie toonden met behandeling: pijnintensiteit op de korte termijn, leeftijd en aan-/afwezigheid van lage rugpijn op de lange termijn. Als men rekening houdt met deze prognostische factoren kan men een tot 25% grotere kans op herstel realiseren.Conclusie Wij identificeerden drie prognostische factoren die een gerichte behandelingskeuze bij patiënten met aspecifieke nekpijn mogelijk maken en daarmee de kans op herstel vergroten: pijnintensiteit, leeftijd en aan-/afwezigheid van lage rugpijn.

Beslisregels bij klachten bewegingsapparaat

Beslisregels voor patiënten met aandoeningen van het bewegingsapparaat nemen toe in populariteit. Australisch onderzoek laat echter zien dat we voorzichtig moeten zijn bij het toepassen ervan.