Development of a Preliminary Clinical Prediction Rule to Identify Patients with Neck Pain That May Benefit from a Standardized Program of Stretching and Muscle Performance Exercise: A Prospective Cohort Study

BACKGROUND AND PURPOSE: Neck pain is a significant problem and many treatment options exist. While some studies suggest exercise is beneficial for individuals with non-specific neck pain clinicians have few tools to assist in the decision making process. Therefore, the purpose of this study was to derive a preliminary clinical prediction rule (CPR) for identifying patients with neck pain (NP) who may respond to an exercise-based treatment program. Exercise-based interventions have demonstrated positive outcomes in patients with NP, however it is unclear which patients are more likely to respond to this treatment approach. METHODS: Consecutive patients with a primary report of nonspecific NP with or without arm pain were recruited. All patients participated in a standardized exercise program and then were classified as having a successful or non-successful outcome at 6 weeks. Potential predictor variables were entered into a stepwise regression analysis. Variables retained in the regression model were used to develop a multivariate CPR that can be used to classify patients with NP that may benefit from exercise-based treatment. A 6-month follow up of the patients was used to evaluate the long-term effects. RESULTS: Ninety-one patients were enrolled in the study of which 50 had a successful outcome. A CPR with 5 variables was identified (Neck Disability Index score \u3c 18/50, presence of shoulder protraction during static postural assessment, patient does not bicycle for exercise, cervical side bending \u3c 32°, and Fear Avoidance Belief Questionnaire-Physical Activity Score \u3c 15). If 4 of the 5 variables were present, the probability of a successful outcome shifted from 56% to 78% (+LR 2.97). At 6 months no significant difference existed in self-reported outcomes between those considered positive on the rule for a successful outcome and those negative on the rule for a successful outcome. CONCLUSIONS: The proposed CPR may identify patients with NP likely to benefit from exercise-based treatment in the short term. However, long-term follow up did not demonstrate a significant difference between groups. LEVEL OF EVIDENCE: 2b