Abstract
Objectives
Development and internal validation of prognostic models for post-treatment and 1-year recovery in patients with neck pain in primary care.
Design
Prospective cohort study.
Setting
Primary care manual therapy practices.
Participants
Patients with non-specific neck pain of any duration (n = 1193).
Intervention
Usual care manual therapy.
Outcome measures
Recovery defined in terms of pain intensity, disability, and global perceived improvement directly post-treatment and at 1-year follow-up.
Results
All post-treatment models exhibited acceptable discriminative performance after derivation (AUC ≥ 0.7). The developed post-treatment disability model exhibited the best overall performance (R2 = 0.24; IQR, 0.22–0.26), discrimination (AUC = 0.75; 95% CI, 0.63–0.84), and calibration (slope 0.92; IQR, 0.91–0.93). After internal validation and penalization, this model retained acceptable discriminative performance (AUC = 0.74). The five other models, including those predicting 1-year recovery, did not reach acceptable discriminative performance after internal validation. Baseline pain duration, disability, and pain intensity were consistent predictors across models.
Conclusion
A post-treatment prognostic model for disability was successfully developed and internally validated. This model has potential to inform primary care clinicians about a patient’s individual prognosis after treatment, but external validation is required before clinical use can be recommended.