Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands.
Spine (Phila Pa 1976). 2010 Aug 1;35(17):E827-35. doi: 10.1097/BRS.0b013e3181d85ad5.
Reanalysis of data from 3 randomized controlled trials.
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.
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.
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).
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.
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.
对 3 项随机对照试验数据的重新分析。
制定并验证一种预测规则，用于评估在初级保健中出现非特异性颈痛的患者中，至少持续 6 个月的抱怨持续存在的可能性。
相当一部分颈痛患者会发展为慢性颈痛。一个重要的问题是，我们是否可以根据患者的个人特征，在首次就诊时识别出有持续抱怨风险的患者？目前还没有可用于评估非特异性颈痛患者预后的预测模型。
研究人群由荷兰初级保健人群（18-70 岁）中出现非特异性颈痛的样本（n=468）组成。主要结局测量指标是 6 个月随访时的整体感知恢复情况。分析中纳入了患者的 17 项基线特征。通过多变量向后逐步逻辑回归分析确定显著预测因素。使用回归系数估计值构建评分图表。在英国参加一项随机对照试验（PANTHER 试验）的非特异性颈痛患者队列（n=315）中对评分图表进行了外部验证。
多变量分析产生了一组 9 个预测因素。评分图表具有 0.66 的区分能力。评分图表的外部验证显示出 0.65 的区分能力、适当的校准、良好的拟合度和较低的变异解释度。
我们开发了一种评分图表，用于估计非特异性颈痛患者在 6 个月随访时持续抱怨的概率。该图表在研究人群和外部验证人群中的表现良好。该评分图表显著提高了预测患者更有可能出现持续抱怨的能力。
