Fondazione Don Gnocchi, Scientific Institute, Firenze, Presidio Via Caccini, Via Caccini 18, 50141 Florence, Firenze FI, Italy.
Intern Emerg Med. 2011 Oct;6(5):413-21. doi: 10.1007/s11739-010-0499-x. Epub 2010 Dec 14.
The aim of this study was to describe the clinical course of patients with chronic, non-specific neck pain undergoing a public health covered, exercise-based rehabilitation program and to identify predictors of poor outcome. A prospective cohort study was carried out on patients with non-specific neck pain (6 months or longer), referred by their general practitioner to a 6-session program, including education and individually tailored exercise. The primary outcome measure for the course of neck pain was the Northwick neck pain questionnaire (NPQ) administered on baseline, discharge, and 1 year from discharge. Poor outcome was defined as NPQ score improving <30% (minimal clinically important difference-MCID-NPQ). The potential predictors included demographics, general health and psychological factors, neck pain history, and the clinical features described by NPQ. From January 2008 to June 2009, 212 patients were consecutively assessed for eligibility: 178 were enrolled and 162 completed follow-up (mean age = 65.3; 75% women). Baseline NPQ average score (40.7 + 17.1) improved by MCID on discharge (26.1 + 16.3) and at 1 year (28.5 + 17.3%). The poor outcome was reported by 45% patients on discharge and by 56% at follow-up. Pain-related medication intake independently predicted poor short- (OR 4.24; 95% CI 1.83-9.84; p = 0.001) and long-term (OR 2.69; 95% CI 1.19-6.06; p = 0.017) outcome, and catastrophizing (OR 2.91; 95% CI 1.31-6.48; p = 0.009) predicted poor outcome at 1 year. Our cohort of patients with chronic neck pain undergoing an exercise-based rehabilitation program reported improvement by or beyond MICD-NPQ in 55% cases on discharge and in 44% cases at 1 year. Poor outcome was predicted by pain-related medication intake in the short and long term, and by catastrophizing in the long term.
本研究旨在描述接受公共卫生覆盖的、基于运动的康复计划的慢性非特异性颈痛患者的临床过程，并确定不良预后的预测因素。对因非特异性颈痛（6 个月或更长时间）由全科医生转诊至 6 节课程的患者进行了前瞻性队列研究，包括教育和个体化定制的运动。颈痛病程的主要结局测量是在基线、出院时和出院后 1 年使用北威克颈痛问卷（NPQ）进行的。不良结局定义为 NPQ 评分改善<30%（最小临床重要差异-NPQ）。潜在的预测因素包括人口统计学、一般健康和心理因素、颈痛史以及 NPQ 描述的临床特征。从 2008 年 1 月至 2009 年 6 月，连续评估了 212 名符合条件的患者：178 名被纳入研究，162 名完成了随访（平均年龄=65.3；75%为女性）。基线 NPQ 平均评分（40.7+17.1）在出院时（26.1+16.3）和 1 年时（28.5+17.3）达到了最小临床重要差异。出院时报告不良结局的患者占 45%，随访时占 56%。疼痛相关药物的摄入独立预测了短期（OR 4.24；95%CI 1.83-9.84；p=0.001）和长期（OR 2.69；95%CI 1.19-6.06；p=0.017）结局不良，而灾难化（OR 2.91；95%CI 1.31-6.48；p=0.009）预测了 1 年时的不良结局。我们的慢性颈痛患者队列在出院时 55%的病例和 1 年后 44%的病例中报告了 NPQ 改善，达到或超过了最小临床重要差异。短期和长期疼痛相关药物摄入，以及长期的灾难化预测了不良结局。
