scholarly journals Prognostic factors for the improvement of pain and disability following multidisciplinary rehabilitation in patients with chronic neck pain

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Martin Weigl ◽  
Josefine Letzel ◽  
Felix Angst
Keyword(s):  
Mental Health ◽  
Prognostic Factors ◽  
Neck Pain ◽  
Short Form ◽  
Psychosocial Rehabilitation ◽  
Chronic Neck Pain ◽  
Rehabilitation Programme ◽  
Factors Associated ◽  
Pain Disability

Abstract Background Recent clinical studies have demonstrated the effectiveness of specific, multidisciplinary, bio-psychosocial, rehabilitation programmes for chronic neck pain. However, prognostic factors for the improvement of pain and disability are mostly unknown. Therefore, the aim of this study was to explore prognostic factors associated with improvements in chronic neck pain following participation in a three-week, multidisciplinary, bio-psychosocial, rehabilitation programme. Methods In this observational, prospective cohort study, a total of 112 patients were assessed at the beginning, end, and 6 months following the completion of a multidisciplinary, bio-psychosocial, rehabilitation programme. Inclusion for participation in the rehabilitation programme depended upon an interdisciplinary pain assessment. The primary outcome was neck pain and disability, which was measured using the Northern American Spine Society questionnaire for pain+disability and was quantified with effect sizes (ES). Multivariable linear regression analyses were used to explore potential prognostic factors associated with improvements in pain and disability scores at discharge and at the 6-month follow-up period. Results The mean age of the patients was 59.7 years (standard deviation = 10.8), and 70.5% were female. Patients showed improvement in pain+disability at discharge (ES = 0.56; p < 0.001), which was sustained at the 6-month follow-up (ES = 0.56; p < 0.001). Prognostic factors associated with improvement in pain+disability scores at discharge included poor pain+disability baseline scores (partial, adjusted correlation r = 0.414, p < 0.001), older age (r = 0.223, p = 0.024), a good baseline cervical active range-of-motion (ROM) (r = 0.210, p < 0.033), and improvements in the Short-form 36 mental health scale (r = 0.197; p = 0.047) and cervical ROMs (r = 0.195, p = 0.048) from baseline values. Prognostic factors associated with improvements in pain+disability at the 6-month follow-up were similar and included poor pain+disability baseline scores (partial, adjusted correlation r = 0.364, p < 0.001), improvements in the Short-form 36 mental health scale (r = 0.232; p = 0.002), cervical ROMs (r = 0.247, p = 0.011), and better cervical ROM baseline scores. However, older age was not a factor (r = 0.134, p = 0.172). Conclusions Future prognostic models for treatment outcomes in chronic neck pain patients should consider cervical ROM and mental health status. Knowledge of prognostic factors may help in the adoption of individualized treatment for patients who are less likely to respond to multidisciplinary rehabilitation.

scholarly journals Prognostic Factors for Improvement in Pain and Disability after Multidisciplinary Rehabilitation in Patients with Chronic Neck Pain

2020 ◽  
Author(s):  
Martin Weigl ◽  
Josefine Letzel ◽  
Felix Angst
Keyword(s):  
Mental Health ◽  
Prognostic Factors ◽  
Neck Pain ◽  
Range Of Motion ◽  
Psychological Treatment ◽  
Short Form ◽  
Chronic Neck Pain ◽  
Rehabilitation Programme ◽  
Cervical Range Of Motion ◽  
Pain Disability

Abstract Background: Recent clinical studies support the effectiveness of chronic neck pain specific multidisciplinary biopsychosocial rehabilitation programmes, but prognostic factors for improvement in pain and disability are unknown. The aim of this study was to identify predictors of improvement in patients with chronic neck pain after participation in a three-week multidisciplinary biopsychosocial rehabilitation programme. Methods: In this observational prospective cohort study patients were assessed at the beginning and the end of a multidisciplinary biopsychosocial rehabilitation programme. Inclusion for participation in the rehabilitation programme depended upon an interdisciplinary pain assessment. Consecutive patients who fulfilled the inclusion criteria were invited to participate in the study. A total of 112 patients participated. The primary outcomes, pain and disability, were measured by the Northern American Spine Society questionnaire (NASS), quantified by effect sizes (ES), and modelled with various co-factors. Secondary outcomes were mental health measured by the Short-Form 36 and total cervical active range of motion measured by a reliable, validated cervical range of motion instrument.Results: Patients’ mean age was 59.7 years (standard deviation=10.8); 70.5% were female. Patients improved significantly (p<0.001) in pain+disability (ES=0.56), mental health (ES=0.45) and cervical range of motion (ES=0.39). Prognostic factors for improvement in pain+disability were worse baseline scores (partial, adjusted correlation r=0.41, p<0.001), higher age (r=0.22, p=0.024), higher improvement in cervical range of motion (r=0.21, p=0.033) and higher improvement in mental health scale (r=0.20; p=0.047). Conclusions: Better outcomes for patients with improvement in neck range of motion, improvement of mental health, and higher age support the use of multidisciplinary biopsychosocial rehabilitation that combines physical and psychological treatment components. Furthermore, the results suggest that older patients may improve more compared to younger patients.

scholarly journals The effect of osteopathic medicine on pain in musicians with nonspecific chronic neck pain: a randomized controlled trial

2020 ◽  
Vol 12 ◽  
pp. 1759720X2097985
Author(s):  
Gabriele Rotter ◽  
Isabel Fernholz ◽  
Sylvia Binting ◽  
Theresa Keller ◽  
Stephanie Roll ◽  
...  
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Chronic Neck Pain ◽  
Trial Registration ◽  
Analysis Of Covariance ◽  
Control Group ◽  
Osteopathic Medicine ◽  
Randomized Controlled ◽  
Pain Disability

Background: Nonspecific chronic neck pain (cNP) is common in adult violinists and violists and is often treated with osteopathic medicine (OM), although the effectiveness of this treatment has not been determined to date. This study aimed to evaluate the effectiveness and safety of OM in adult violinists and violists with cNP. Methods: In a two-armed randomized controlled single-center open trial, adult violinists and violists, including music students, with cNP (⩾12 weeks) were randomized to either five individualized OM sessions (OM group) or to no intervention (control group, CG) in the outpatient clinic for integrative medicine, Charité - Universitätsmedizin Berlin, Germany. All patients received a musicians’ medicine consultation and paracetamol on demand. The primary outcome parameter was the neck pain intensity on a visual analog scale (VAS, 0–100 mm, 0 = no pain, 100 = worst imaginable pain) after 12 weeks. Secondary outcomes included neck pain disability (Neck Disability Index, NDI, 0–100%) after 12 weeks. The last follow-up visit was after 52 weeks. Statistical analysis included analysis of covariance adjusted for respective baseline value. Results: Altogether, 62 outpatients were included [OM group ( n = 28), CG ( n = 34); 81% female; mean age, 41.6 ± 11.1 years; mean baseline neck pain, 55.9 ± 11.6 mm]. After 12 weeks, OM was associated with an improvement in the OM group versus the CG in neck pain on the VAS [14.6 mm (95% confidence interval 8.0; 21.2) versus 40.8 mm (34.7; 46.9), p < 0.001, Cohen’s d = 1.4], and neck pain disability as determined by the NDI [8.8% (6.7; 10.8) versus 17.2% (15.3; 19.1), p < 0.001]. Some improvements were maintained until 52 weeks of follow-up. No serious adverse events were observed. Conclusions: The results of this study suggest that OM might be effective in reducing pain intensity in adult violinists and violists with nonspecific cNP. Further studies should investigate the efficacy of OM in comparison with a sham procedure and with other effective therapy methods in high-quality multicenter trials. Trial registration: WHO Trial Registration https://apps.who.int/trialsearch/NoAccess.aspx?aspxerrorpath=/trialsearch/Trial2.aspx by German Clinical Trials Register DRKS00009258, Universal Trial Number (UTN): U1111-1173-5943.

scholarly journals Factors associated with non-initiation of mental healthcare after detection of poor mental health at a scheduled health check: a cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037731
Author(s):  
Christine Geyti ◽  
Kaj Sparle Christensen ◽  
Else-Marie Dalsgaard ◽  
Bodil Hammer Bech ◽  
Jane Gunn ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Short Form ◽  
Mental Component Summary Score ◽  
Mental Healthcare ◽  
Poor Mental Health ◽  
Health Check ◽  
Health Concern ◽  
Factors Associated

IntroductionPoor mental health is an important public health concern, but mental health problems are often under-recognised. Providing feedback to general practitioners (GPs) on their patients’ mental health status may improve the identification of cases in need of mental healthcare.ObjectivesTo investigate the extent of initiation of mental healthcare after identification of poor mental health and to identify factors associated with non-initiation.DesignProspective cohort study with 1-year follow-up.SettingIn a population-based health preventive programme, Check Your Health, we conducted a combined mental and physical health check in Randers Municipality, Denmark, in 2012–2015 in collaboration with local GPs.ParticipantsParticipants were 350 individuals aged 30–49 years old with screen-detected poor mental health who had not received mental healthcare within the past year. The cohort was derived from 14 167 randomly selected individuals of whom 52% (n=7348) participated. Mental health was assessed by the mental component summary score of the 12-item Short-Form Health Survey.OutcomeThe outcome was initiation of mental healthcare. Mental healthcare included psychometric testing by GP, talk therapy by GP, contact with a psychologist, contact with a psychiatrist and psychotropic medication.ResultsWithin 1 year, 22% (95% CI 18 to 27) of individuals with screen-detected poor mental health initiated mental healthcare. Among individuals who initiated mental healthcare within follow-up, one in six had visited their GP once or less in the preceding year. Male sex (OR: 0.49 (95% CI 0.28 to 0.86)) and less impaired mental health (OR: 0.93 (95% CI 0.89 to 0.98)) were associated with non-initiation of mental healthcare. We found no overall association between socioeconomic factors and initiating mental healthcare.ConclusionSystematic provision of mental health test results to GPs may improve the identification of cases in need of mental healthcare, but does not translate into initiation of mental healthcare. Further research should focus on methods to improve initiation of mental healthcare, especially among men.Trial registration numberNCT02028195.

scholarly journals Efficacy of Manual Therapy and Transcutaneous Electrical Nerve Stimulation in Cervical Mobility and Endurance in Subacute and Chronic Neck Pain: A Randomized Clinical Trial

2021 ◽  
Vol 10 (15) ◽  
pp. 3245
Author(s):  
Belén Díaz-Pulido ◽  
Yolanda Pérez-Martín ◽  
Daniel Pecos-Martín ◽  
Isabel Rodríguez-Costa ◽  
Milagros Pérez-Muñoz ◽  
...  
Keyword(s):  
Primary Care ◽  
Neck Pain ◽  
Manual Therapy ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Sagittal Plane ◽  
Chronic Neck Pain ◽  
Post Intervention ◽  
Electrical Nerve Stimulation

Neck pain is a frequent health problem. Manual therapy (MT) and transcutaneous electrical nerve stimulation (TENS) are recommended techniques for treatment of mechanical neck disorders (MND) in Spanish Public Primary Care Physiotherapy Services. The aim of this study was to compare the efficacy of MT versus TENS in active mobility and endurance in cervical subacute or chronic neck pain. Ninety patients with MND were randomly allocated to receive ten 30-min sessions of either MT or TENS, in a multi-centered study through 12 Primary Care Physiotherapy Units in the Madrid community. Active cervical range of motion (CD-ROM) and endurance (Palmer and Epler test) were evaluated pre- and post-intervention and at 6-month follow-up. A generalized linear model of repeated measures was constructed for the analysis of differences. Post-intervention MT yielded a significant improvement in active mobility and endurance in patients with subacute or chronic MND, and at 6-month follow-up the differences were only significant in endurance and in sagittal plane active mobility. In the TENS group, no significant improvement was detected. With regard to other variables, MT improved mobility and endurance more effectively than TENS at post-intervention and at 6-month follow-up in the sagittal plane. Only MT generated significant improvements in cervical mobility and endurance in the three movement planes.

scholarly journals Alexander Technique vs. Targeted Exercise for Neck Pain—A Preliminary Comparison

2021 ◽  
Vol 11 (10) ◽  
pp. 4640
Author(s):  
Jordan J. Becker ◽  
Tara L. McIsaac ◽  
Shawn L. Copeland ◽  
Rajal G. Cohen
Keyword(s):  
Neck Pain ◽  
Video Game ◽  
Cost Effective ◽  
Standard Of Care ◽  
Chronic Neck Pain ◽  
Exercise Group ◽  
Alexander Technique ◽  
Private Lessons ◽  
Pain Disability ◽  
Exercise Class

Background: Alexander technique private lessons have been shown to reduce chronic neck pain and are thought to work by different mechanisms than exercise. Group classes may also be effective and would be cost-effective. Design: A two-group pre-test/post-test design. Participants were assigned to either a general Alexander technique class or an exercise class designed to target neck pain. Both groups met over 5 weeks for two 60 min sessions/week. Participants: A total of 16 participants with chronic neck pain (aged 50+/−16 years) completed this study. Interventions: The Alexander class used awareness-building methods to teach participants to reduce habitual tension during everyday activities. The exercise class was based on physical therapy standard of care to strengthen neck and back muscles thought to be important for posture. Measures: We assessed neck pain/disability, pain self-efficacy, activation of the sternocleidomastoid muscles during the cranio-cervical flexion test, and posture while participants played a video game. Results: Both groups reported decreased neck pain/disability after the interventions. Sternocleidomastoid activation decreased only in the Alexander group. Conclusion: In this small preliminary study, Alexander classes were at least as effective as exercise classes in reducing neck pain and seemed to work via a different mechanism. Larger, multi-site studies are justified.

scholarly journals FRI0248 PROGNOSTIC FACTORS FOR STEROID-FREE REMISSION IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES: IMPORTANCE OF ANTHROPOMETRIC MEASUREMENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 708.1-708
Author(s):  
J. S. Lee ◽  
S. H. Nam ◽  
S. J. Choi ◽  
W. J. Seo ◽  
S. Hong ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Cox Regression ◽  
Idiopathic Inflammatory Myopathies ◽  
Inflammatory Myopathies ◽  
Immunosuppressant Therapy ◽  
Muscle Enzymes ◽  
Cox Regression Analysis ◽  
Factors Associated ◽  
Early Use

Background:Several studies have been conducted on factors associated with mortality in idiopathic inflammatory myopathies (IIM), but few studies have assessed prognostic factors for steroid-free remission in IIM.Objectives:We investigated the various clinical factors, including body measurements, that affect IIM treatment outcomes.Methods:Patients who were newly diagnosed with IIM between 2000 and 2018 were included. Steroid-free remission was defined as at least three months of normalisation of muscle enzymes and no detectable clinical disease activity. The factors associated with steroid-free remission were evaluated by a Cox regression analysis.Results:Of the 106 IIM patients, 35 displayed steroid-free remission during follow-up periods. In the multivariable Cox regression analyses, immunosuppressants’ early use within one month after diagnosis [hazard ratio (HR) 6.21, 95% confidence interval (CI) 2.61–14.74, p < 0.001] and sex-specific height quartiles (second and third quartiles versus first quartile, HR 3.65, 95% CI 1.40–9.51, p = 0.008 and HR 2.88, 95% CI 1.13–7.32, p = 0.027, respectively) were positively associated with steroid-free remission. Polymyositis versus dermatomyositis (HR 0.21, 95% CI 0.09–0.53, p = 0.001), presence of dysphagia (HR 0.15, CI 0.05–0.50, p = 0.002) and highest versus lowest quartile of waist circumference (WC) (HR 0.24, 95% CI 0.07–0.85, p = 0.027) were negatively associated with steroid-free remission.Conclusion:The early initiation of immunosuppressant therapy, type of myositis and presence of dysphagia are strong predictors of steroid-free remission in IIM; moreover, height and WC measurements at baseline may provide additional important prognostic value.Disclosure of Interests:None declared

scholarly journals Prognosis and Course of Disability in Patients With Chronic Nonspecific Low Back Pain: A 5- and 12-Month Follow-up Cohort Study

2013 ◽  
Vol 93 (12) ◽  
pp. 1603-1614 ◽  
Author(s):  
Karin Verkerk ◽  
Pim A.J. Luijsterburg ◽  
Martijn W. Heymans ◽  
Inge Ronchetti ◽  
Annelies L. Pool-Goudzwaard ◽  
...  
Keyword(s):  
Cohort Study ◽  
Low Back Pain ◽  
Prognostic Factors ◽  
Back Pain ◽  
Short Form ◽  
Low Back ◽  
Multidisciplinary Therapy ◽  
Patient Reported ◽  
Specific Disability

Background Few data are available on the course of and predictors for disability in patients with chronic nonspecific low back pain (CNSLBP). Objective The purpose of this study was to describe the course of disability and identify clinically important prognostic factors of low-back-pain–specific disability in patients with CNSLBP receiving multidisciplinary therapy. Design A prospective cohort study was conducted. Methods A total of 1,760 patients with CNSLBP who received multidisciplinary therapy were evaluated for their course of disability and prognostic factors at baseline and at 2-, 5-, and 12-month follow-ups. Recovery was defined as 30% reduction in low back pain–specific disability at follow-up compared with baseline and as absolute recovery if the score on the Quebec Back Pain Disability Scale (QBPDS) was ≤20 points at follow-up. Potential prognostic factors were identified using multivariable logistic regression analysis. Results Mean patient-reported disability scores on the QBPDS ranged from 51.7 (SD=15.6) at baseline to 31.7 (SD=15.2), 31.1 (SD=18.2), and 29.1 (SD=20.0) at 2, 5, and 12 months, respectively. The prognostic factors identified for recovery at 5 and 12 months were younger age and high scores on disability and on the 36-Item Short-Form Health Survey (SF-36) (Physical and Mental Component Summaries) at baseline. In addition, at 5-month follow-up, a shorter duration of complaints was a positive predictor, and having no comorbidity and less pain at baseline were additional predictors at 12-month follow-up. Limitations Missing values at 5- and 12-month follow-ups were 11.1% and 45.2%, respectively. Conclusion After multidisciplinary treatment, the course of disability in patients with CNSLBP continued to decline over a 12-month period. At 5- and 12-month follow-ups, prognostic factors were identified for a clinically relevant decrease in disability scores on the QBPDS.

Abstract 14344: Prognostic Factors of Atrial Fibrillation Patients With Coronary Artery Disease: The Fushimi Af Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nobutoyo Masunaga ◽  
Hisashi Ogawa ◽  
Yuya Aono ◽  
Syuhei Ikeda ◽  
KOSUKE DOI ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Prognostic Factors ◽  
Major Bleeding ◽  
Cardiac Death ◽  
Cardiovascular Events ◽  
Factors Associated ◽  
Artery Disease

Background: Atrial fibrillation (AF) patients are likely to have concomitant coronary artery disease (CAD). A new strategy of antithrombotic therapy in AF patients with stable CAD was demonstrated in recent randomized clinical trials. Now that antithrombotic therapy for AF patients with CAD has reached a major turning point, it is important to know the prognostic factors in those patients. Purpose: In this study, we investigated clinical characteristics, cardiovascular events and prognostic factors in AF patients with CAD. Methods: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients who visited the participating medical institutions in Fushimi-ku, Kyoto, Japan. Follow up data including prescription status were available in 4,441 patients from March 2011 to November 2019. Of 4,441 patients, 645 patients had a history of CAD at enrollment. Results: The mean age was 76.4±8.6 and 65.9% were male. Averages of CHA 2 DS 2 -VASc score and HAS-BLED score were 4.41 and 2.35, respectively. Oral anticoagulant (OAC) was prescribed in 52.9% of those patients and antiplatelet drug (APD) was prescribed in 70.4%. The combination of OAC and APD was prescribed in 36.0%. During follow-up period (median 1,495 days), cardiac death occurred in 51 patients, composite of cardiac death, myocardial infarction (MI) and stroke in 136, and major bleeding in 77 (1.8, 5.1 and 2.9 per 100 person-years, respectively). In multivariate analysis, factors associated with composite of cardiac death, MI and stroke in AF patients with CAD were low body weight (<=50kg) (hazard ratio [95% confidence interval]; 1.62 [1.07-2.47]), previous stroke (1.69 [1.13-2.52]), heart failure (1.47 [1.02-2.11]), hypertension (0.60 [0.41-0.87]) and diabetes mellitus (1.62 [1.13-2.32]). Furthermore, factors associated with major bleeding in AF patients with CAD were anemia (male: hemoglobin<12 g/dl, female: hemoglobin<11 g/dl) (1.82 [1.09-3.04]) and thrombocytopenia (<150,000 /μL) (3.02 [1.29-7.03]). Conclusion: In Japanese AF patients with CAD, low body weight, previous stroke, heart failure, hypertension and diabetes mellitus were associated with cardiovascular events, and anemia and thrombocytopenia were associated with major bleeding.

scholarly journals PROGNOSTIC FACTORS OF LUMBAR DISCECTOMY RECOVERY.A PROSPECTIVE ANALYSIS

2017 ◽  
Vol 16 (4) ◽  
pp. 283-287
Author(s):  
Thiago Kolachinski Brandão ◽  
André Nunes Machado ◽  
Bruno Vieira Moter ◽  
Adriano Masayuki Yonezaki ◽  
Fabrício Hidetoshi Ueno ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Short Form ◽  
Lumbar Discectomy ◽  
Social Aspect ◽  
Prospective Analysis ◽  
Domain Functional ◽  
One Year ◽  
Short Form Health

ABSTRACT Objective: To perform a prospective analysis of the quality of life prognostic factors in patients undergoing lumbar discectomy after two years of the procedure, relating the tools Short Form Health Survey, Roland Morris, Oswestry Disability Index, and VAS. Methods: Seventy-two patients were evaluated through the questionnaires in the preoperative, and one month, six months, one year and two years in the postoperative period, being performed lumbar discectomy after failure of conservative treatment. Results: We observed an improvement in comparative analysis during follow-up regarding baseline values. Conclusion: The domains social aspect, pain, general state, emotional aspect, mental health and vitality presented an improvement from the first month after the surgery; however, the domain functional capacity only showed significant improvement after 6 months and the physical aspects only after one year. Roland-Morris and VAS scales improved after one month after surgery, but Oswestry scale showed that for the measured aspects there was only improvement after six months of surgery.

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