Wingbermühle Roel W, Chiarotto Alessandro, van Trijffel Emiel, Stenneberg Martijn S, Kan Ronald, Koes Bart W, Heymans Martijn W
SOMT University of Physiotherapy, Amersfoort, The Netherlands; Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
J Physiother. 2023 Apr;69(2):100-107. doi: 10.1016/j.jphys.2023.02.002. Epub 2023 Mar 21.
Can existing post-treatment prognostic models for predicting neck pain recovery (primarily in terms of disability and secondarily in terms of pain intensity and perceived improvement) be externally validated and updated at the end of the treatment period and at 6 and 12 weeks of follow-up in a new Dutch cohort of people with neck pain treated with guideline-based usual care physiotherapy?
External validation and model updating in a new prospective cohort of three previously developed prognostic models.
People with (sub)acute neck pain and registered for primary care physiotherapy treatment.
Recovery of disability, pain intensity, and perceived recovery at 6 and 12 weeks and at the end of the treatment period.
Discriminative performance (c-statistic) of the disability model at 6 weeks was 0.73 (95% CI 0.69 to 0.77) and reasonably well calibrated after intercept recalibration. The disability model at 12 weeks and at the end of the treatment period showed discriminative c-statistic performance values of 0.69 (95% CI 0.64 to 0.73) and 0.68 (95% CI 0.63 to 0.72), respectively, and was well calibrated. Pain models and perceived recovery models did not reach acceptable performance. Cervical mobility added value to the disability models and pain catastrophising to the disability and pain models at 6 weeks.
Broad external validation of the disability model was successful in people with (sub)acute neck pain and clinicians may use this model in clinical practice with reasonable accuracy. Further research is required to assess the disability model's clinical impact and generalisability, and to identify additional valuable model predictors.
现有的用于预测颈部疼痛恢复情况（主要依据残疾程度，其次依据疼痛强度和感知到的改善情况）的治疗后预后模型，能否在接受基于指南的常规护理物理治疗的荷兰颈部疼痛新队列中，在治疗期结束时以及随访的6周和12周进行外部验证和更新？
对三个先前开发的预后模型在新的前瞻性队列中进行外部验证和模型更新。
患有（亚）急性颈部疼痛并登记接受初级护理物理治疗的患者。
在6周、12周以及治疗期结束时残疾程度、疼痛强度和感知恢复情况。
残疾模型在6周时的判别性能（c统计量）为0.73（95%可信区间0.69至0.77），在校正截距后校准良好。残疾模型在12周和治疗期结束时的判别c统计量性能值分别为0.69（95%可信区间0.64至0.73）和0.68（95%可信区间0.63至0.72），且校准良好。疼痛模型和感知恢复模型未达到可接受的性能。颈椎活动度在6周时为残疾模型增加了价值，疼痛灾难化思维为残疾和疼痛模型增加了价值。
残疾模型在患有（亚）急性颈部疼痛的人群中进行广泛的外部验证是成功的，临床医生可在临床实践中以合理的准确性使用该模型。需要进一步研究以评估残疾模型的临床影响和普遍性，并确定其他有价值的模型预测因素。
