Hanney William J, Kolber Morey J, George Steven Z, Young Ian, Patel Chetan K, Cleland Joshua A
University of Central Florida, Orlando, FL, USA.
Nova Southeastern University, Fort Lauderdale, FL, USA.
Int J Sports Phys Ther. 2013 Dec;8(6):756-76.
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.
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.
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 < 18/50, presence of shoulder protraction during static postural assessment, patient does not bicycle for exercise, cervical side bending < 32°, and Fear Avoidance Belief Questionnaire-Physical Activity Score < 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.
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.
2b.
颈部疼痛是一个重要问题，且存在多种治疗选择。虽然一些研究表明运动对非特异性颈部疼痛患者有益，但临床医生在决策过程中几乎没有辅助工具。因此，本研究的目的是推导一个初步的临床预测规则（CPR），用于识别可能对基于运动的治疗方案有反应的颈部疼痛（NP）患者。基于运动的干预措施已在NP患者中显示出积极效果，然而尚不清楚哪些患者更有可能对这种治疗方法产生反应。
招募以非特异性NP为主要报告且伴有或不伴有手臂疼痛的连续患者。所有患者都参与了一个标准化运动项目，然后在6周时被分类为有成功或不成功的结果。将潜在的预测变量纳入逐步回归分析。保留在回归模型中的变量用于制定一个多变量CPR，可用于对可能从基于运动的治疗中获益的NP患者进行分类。对患者进行6个月的随访以评估长期效果。
91名患者纳入研究，其中50名有成功结果。确定了一个包含5个变量的CPR（颈部残疾指数评分<18/50、静态姿势评估时存在肩部前伸、患者不骑自行车锻炼、颈椎侧屈<32°、恐惧回避信念问卷 - 身体活动评分<15）。如果5个变量中有4个存在，成功结果的概率从56%变为78%（+似然比2.97）。在6个月时，根据该规则被认为成功结果为阳性的患者和阴性的患者之间，自我报告的结果没有显著差异。
所提出的CPR可能识别出短期内可能从基于运动的治疗中获益的NP患者。然而，长期随访显示两组之间没有显著差异。
2b。
