Rasmussen Hanne, Kent Peter, Kjaer Per, Kongsted Alice
The Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark.
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
BMC Musculoskelet Disord. 2015 Jun 16;16:150. doi: 10.1186/s12891-015-0609-z.
The component of the Quebec Task Force Classification System that subgroups patients based on the extent of their radiating pain and neurological signs has been demonstrated to have prognostic implications for patients with low back pain but has not been tested on patients with neck pain (NP). The main aim of this study was to examine the association between these subgroups, their baseline characteristics and outcome in chronic NP patients referred to an outpatient hospital department.
This was an observational study of longitudinal data extracted from systematically collected, routine clinical data. Patients were classified into Local NP only, NP + arm pain above the elbow, NP + arm pain below the elbow, and NP with signs of nerve root involvement (NP + NRI). Outcome was pain intensity and activity limitation. Associations were tested in longitudinal linear mixed models.
A total of 1,852 people were classified into subgroups (64 % females, mean age 49 years). Follow ups after 3, 6 and 12 months were available for 45 %, 32 % and 40 % of those invited to participate at each time point. A small improvement in pain was observed over time in all subgroups. There was a significant interaction between subgroups and time, but effect sizes were small. The local NP subgroup improved slightly less after 3 months as compared with all other groups, but continued to have the lowest level of pain. After 6 and 12 months, those with NP + pain above the elbow had improved the least and patients with NP + NRI had experienced the largest improvements in pain intensity. Similar results were obtained for activity limitation.
This study found baseline and outcome differences between neck pain subgroups classified using the Quebec Task Force Classification System. However, differences in outcome were typically small in size and mostly differentiated the local NP subgroup from the other subgroups. A caveat to these results is that they were obtained in a cohort of chronic neck pain patients who only displayed small improvements over time and the results may not apply to other cohorts, such as people at earlier stages of their clinical course and in other clinical settings.
魁北克工作组分类系统中根据放射痛程度和神经体征对患者进行亚组划分的部分，已被证明对腰痛患者具有预后意义，但尚未在颈痛（NP）患者中进行测试。本研究的主要目的是探讨这些亚组、其基线特征与转诊至门诊医院科室的慢性NP患者结局之间的关联。
这是一项对从系统收集的常规临床数据中提取的纵向数据进行的观察性研究。患者被分为仅局部NP、NP + 肘部以上手臂疼痛、NP + 肘部以下手臂疼痛以及有神经根受累体征的NP（NP + NRI）。结局指标为疼痛强度和活动受限情况。在纵向线性混合模型中测试关联。
共有1852人被分为亚组（64%为女性，平均年龄49岁）。在每个时间点受邀参与的患者中，分别有45%、32%和40%的人在3个月、6个月和12个月后接受了随访。所有亚组的疼痛随时间均有小幅改善。亚组与时间之间存在显著交互作用，但效应量较小。与所有其他组相比，局部NP亚组在3个月后的改善略少，但疼痛水平仍最低。在6个月和12个月后，NP + 肘部以上疼痛的患者改善最少，而NP + NRI的患者在疼痛强度方面改善最大。活动受限情况也得到了类似结果。
本研究发现，使用魁北克工作组分类系统划分的颈痛亚组在基线和结局方面存在差异。然而，结局差异通常较小，主要是将局部NP亚组与其他亚组区分开来。这些结果的一个注意事项是，它们是在一组慢性颈痛患者中获得的，这些患者随时间仅显示出小幅改善，结果可能不适用于其他队列，例如临床病程早期的人群和其他临床环境中的人群。
