Prognostic factors for the improvement of pain and disability following multidisciplinary rehabilitation in patients with chronic neck pain.

BACKGROUND: Recent clinical studies have demonstrated the effectiveness of specific, multidisciplinary, bio-psychosocial, rehabilitation programmes for chronic neck pain. However, prognostic factors for the improvement of pain and disability are mostly unknown. Therefore, the aim of this study was to explore prognostic factors associated with improvements in chronic neck pain following participation in a three-week, multidisciplinary, bio-psychosocial, rehabilitation programme. METHODS: In this observational, prospective cohort study, a total of 112 patients were assessed at the beginning, end, and 6 months following the completion of a multidisciplinary, bio-psychosocial, rehabilitation programme. Inclusion for participation in the rehabilitation programme depended upon an interdisciplinary pain assessment. The primary outcome was neck pain and disability, which was measured using the Northern American Spine Society questionnaire for pain+disability and was quantified with effect sizes (ES). Multivariable linear regression analyses were used to explore potential prognostic factors associated with improvements in pain and disability scores at discharge and at the 6-month follow-up period. RESULTS: The mean age of the patients was 59.7 years (standard deviation = 10.8), and 70.5% were female. Patients showed improvement in pain+disability at discharge (ES = 0.56; p < 0.001), which was sustained at the 6-month follow-up (ES = 0.56; p < 0.001). Prognostic factors associated with improvement in pain+disability scores at discharge included poor pain+disability baseline scores (partial, adjusted correlation r = 0.414, p < 0.001), older age (r = 0.223, p = 0.024), a good baseline cervical active range-of-motion (ROM) (r = 0.210, p < 0.033), and improvements in the Short-form 36 mental health scale (r = 0.197; p = 0.047) and cervical ROMs (r = 0.195, p = 0.048) from baseline values. Prognostic factors associated with improvements in pain+disability at the 6-month follow-up were similar and included poor pain+disability baseline scores (partial, adjusted correlation r = 0.364, p < 0.001), improvements in the Short-form 36 mental health scale (r = 0.232; p = 0.002), cervical ROMs (r = 0.247, p = 0.011), and better cervical ROM baseline scores. However, older age was not a factor (r = 0.134, p = 0.172). CONCLUSIONS: Future prognostic models for treatment outcomes in chronic neck pain patients should consider cervical ROM and mental health status. Knowledge of prognostic factors may help in the adoption of individualized treatment for patients who are less likely to respond to multidisciplinary rehabilitation.

Multidisciplinary biopsychosocial rehabilitation in chronic neck pain: a naturalistic prospective cohort study with intraindividual control of effects and 12-month follow-up.

BACKGROUND: In contrast to the large evidence of the effectiveness of multidisciplinary biopsychosocial rehabilitation (MBR) in chronic low back pain, little is known about the effects of MBR in chronic neck pain (CNP). AIM: To quantify short-term and 12-month effects of a 3-week CNP-specific MBR program. DESIGN: Naturalistic prospective observational cohort study with intraindividual control of effects. SETTING: Outpatient clinic at a tertiary physical medicine and rehabilitation center. POPULATION: Consecutive patients with CNP (N.=81) who participated in a CNP-specific MBR. METHODS: The intervention was a MBR outpatient clinic program. Primary Outcome was the North American Spine Society (NASS) questionnaire pain/function scale. Secondary outcomes included the NASS scale neurogenic symptoms, Short-Form 36 Health Survey (SF-36) and numerical rating scales (NRS) for maximum and average pain. Short-term changes of health were quantified using effect sizes (ES), which were corrected by the change during waiting time before MBR. RESULTS: At the end of treatment, the NASS pain/function scale showed significant improvement (P<0.001) by a moderate corrected ES (ES=0.59). Moderate significant improvements were also found for the NASS scale neurogenic symptoms (ES=0.65), the SF-36 scales bodily pain (ES=0.56) and mental health (ES=0.54), and the NRS maximum pain (ES=0.59). Significant small corrected ES were found for the SF-36 scales physical functioning (ES=0.32), physical role (ES=0.41), vitality (ES=0.42), social functioning (ES=0.41), emotional role (ES=0.41) and the NRS average pain (ES=0.48). The improvement on the SF-36 scale general health was not significant (ES=0.19). At the follow-up after 12 months, the NASS pain/function scale remained its moderate ES (ES=0.52, P value <0.001). Also, the NASS Scale neurogenic symptoms, the SF-36 scales bodily pain, general health, social functioning and mental health and both NRS pain scales showed significant benefits. CONCLUSIONS: This study showed that MBR may be effective in patients with CNP. Maintenance of moderate benefits in pain and function seems possible for at least 12 months. CLINICAL REHABILITATION IMPACT: The findings support the concept of CNP-specific MBR.