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