Nyirö Luana, Peterson Cynthia K, Humphreys B Kim
Department of Chiropractic Medicine, Orthopaedic University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland.
University of Zurich, Rämistrasse 71, 8006 Zürich, Switzerland.
Chiropr Man Therap. 2017 Aug 16;25:24. doi: 10.1186/s12998-017-0154-y. eCollection 2017.
Neck pain is a common complaint in chiropractic patients. Amongst other baseline variables, numerous studies identify duration of symptoms as a strong predictor of outcome in neck pain patients. The usual time frame used for 'acute' onset of pain is between 0 and 4 weeks. However, the appropriateness of this time frame has been challenged for chiropractic low back pain patients. Therefore, the purpose of this study was to compare outcomes in neck pain patients with 0-2 vs 2-4 and 4-12 weeks of symptoms undergoing chiropractic treatment.
This is a prospective cohort observational study with 1 year follow-up including 495 patients whose data was collected between October 2009 and March 2015. Patients were divided into high-acute (0-2 weeks), mid-acute (2-4 weeks) and subacute (4-12 weeks) corresponding to duration of their symptoms at initial treatment. Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire for neck pain (BQN) at baseline. At follow-up time points of 1 week, 1 month, 3 months, 6 months and 1 year the NRS and BQN were completed along with the Patient Global Impression of Change (PGIC) scale. The PGIC responses were dichotomized into 'improved' and 'not improved' patients and compared between the 3 subgroups. The Chi-square test was used to compare improved patients between the 3 subgroups and the unpaired Student's t-test was used for the NRS and BQN change scores.
The proportion of patients 'improved' was only significantly higher for patients with symptoms of 0-2 weeks compared to 2-4 weeks at the 1 week outcome time point ( = 0.015). The NRS changes scores were significantly greater for patients with 2-4 weeks of symptoms compared to 4-12 weeks of symptoms only at 1 week ( = 0.035).
The time period of 0-4 weeks of symptoms as the definition of "acute" neck pain should be maintained. Independent of the exact duration of symptoms, medium-term and long-term outcome is favourable for acute as well as subacute neck pain patients.
Not applicable for prospective cohort studies. Ethics approval prior to study EK 19/2009.
颈部疼痛是脊椎按摩治疗患者的常见主诉。在其他基线变量中，众多研究表明症状持续时间是颈部疼痛患者预后的有力预测指标。通常将疼痛“急性”发作的时间范围定义为0至4周。然而，这一时间范围对脊椎按摩治疗的下背部疼痛患者的适用性受到了质疑。因此，本研究的目的是比较接受脊椎按摩治疗、症状持续时间为0至2周、2至4周和4至12周的颈部疼痛患者的预后情况。
这是一项前瞻性队列观察研究，随访期为1年，纳入了495例患者，其数据收集于2009年10月至2015年3月之间。根据初始治疗时症状的持续时间，患者被分为高急性组（0至2周）、中急性组（2至4周）和亚急性组（4至12周）。患者在基线时完成数字疼痛评分量表（NRS）和颈部疼痛的伯恩茅斯问卷（BQN）。在1周、1个月、3个月、6个月和1年的随访时间点，患者要完成NRS、BQN以及患者整体印象变化量表（PGIC）。PGIC的回答被分为“改善”和“未改善”两组患者，并在3个亚组之间进行比较。采用卡方检验比较3个亚组中病情改善的患者，采用非配对学生t检验分析NRS和BQN的变化分数。
在1周的预后时间点，与症状持续2至4周的患者相比（P = 0.015），症状持续0至2周的患者中“病情改善”的比例仅显著更高。仅在1周时，症状持续2至4周的患者的NRS变化分数显著高于症状持续4至12周的患者（P = 0.035）。
应维持将症状持续0至4周定义为“急性”颈部疼痛的时间标准。无论症状的确切持续时间如何，急性和亚急性颈部疼痛患者的中期和长期预后都较好。
前瞻性队列研究不适用。研究前经伦理批准EK 19/2009。
