Treatment based classification systems for patients with non-specific neck pain:A systematic review

Objective: We aimed to identify published classification systems with a targeted treatment approach (treatment-based classification systems (TBCSs)) for patients with non-specific neck pain, and assess their quality and effectiveness. Design: Systematic review. Data sources: MEDLINE, CINAHL, EMBASE, PEDro and the grey literature were systematically searched from inception to December 2019. Study appraisal and synthesis: The main selection criterium was a TBCS for patients with non-specific neck pain with physiotherapeutic interventions. For data extraction of descriptive data and quality assessment we used the framework developed by Buchbinder et al. We considered as score of ≤3 as low quality, a score between 3 and 5 as moderate quality and a score ≥5 as good quality. To assess the risk of bias of studies concerning the effectiveness of TBCSs (only randomized clinical trials (RCTs) were included) we used the PEDro scale. We considered a score of ≥ six points on this scale as low risk of bias. Results: Out of 7664 initial references we included 13 studies. The overall quality of the TBCSs ranged from low to moderate. We found two RCTs, both with low risk of bias, evaluating the effectiveness of two TBCSs compared to alternative treatments. The results showed that both TBCSs were not superior to alternative treatments. Conclusion: Existing TBCSs are, at best, of moderate quality. In addition, TBCSs were not shown to be more effective than alternatives. Therefore using these TBCSs in daily practice is not recommended

An Exploratory Practice-Oriented Pilot Study into Matched Treatments in Patients with Non-Specific Neck Pain

Background: Even though physiotherapists attempt to match care to the patient’s needs, there is little knowledge about which treatments are applied in daily practice and which treatments have the most potential to improve ROM in patients with non-specific neck pain with a limited ROM. The objective of this study was 1) to establish the measurement error of the Sensamove cervical training accelerometer (SCT); 2) to describe the applied treatments for patients with non-specific neck pain with an identified restriction in cervical Range of Motion (ROM) in primary care physiotherapy clinics; 3) to explore if the cervical ROM, pain, (perceived) disability and motor control improved after one manual therapy treatment. Methods: The standard error of measurement (SEM) and the smallest detectable difference (SDD) were calculated based on a test-retest study. Second, an explorative, longitudinal study design (follow-up one week) was performed. Inclusion criterion: nonspecific neck pain with an identified restriction in cervical ROM. Measurements: pre- (T0) and post-treatment (T1), and one-week post-treatment (T2). Outcomes: ROM, motor control movement task, Numerical Pain Rating Scale (NPRS), and Patient Specific Function Scale (PSFS). Results: The SEM varied from 1.62° (lateral flexion right) to 3.46° (extension). The SDD varied from 4.49° (lateral flexion right) to 9.58° (extension). Four physiotherapists included 24 patients and used eight different treatments. The T0-T2 improvement in cervical ROM ranged from 2.95° (SD 6.09) (right lateral flexion) to 11.00° (SD11.87) (left rotation). The movement task was performed 3.96 (SD 4.24) seconds faster. The NPRS decreased by 3.08 (SD 1.82) points, and PSFS improved by 7.71 (SD 5.34) points. Conclusion: The measurement error has been established. Moreover, this study illustrates that matched treatments, as applied in daily practice, have the potential to induce short-term improvements

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Illness perceptions and activity limitations in osteoarthritis of the knee: a case report in intervention study

This case report describes the process and outcome of an intervention where illness perceptions (IPs) were targeted in order to reduce limitations in daily activities. The patient was a 45-year-old woman diagnosed with posttraumatic secondary osteoarthritis of the lateral patella-femoral cartilage of the right knee. At baseline, the patient reported maladaptive IPs on the Brief Illness Perception Questionnaire Dutch Language Version and limitations in walking stairs, cycling and walking. Fewer limitations in daily activities are hypothesized by changing maladaptive IPs into more favourable IPs. In this case report, discussing maladaptive IPs with the patient was the main intervention. A participatory decision making model was used as a design by which the maladaptive IP were discussed. Six out of eight maladaptive IPs changed favourably and there was a clinically relevant decrease in limitations of daily activities. The Global Perceived Effect was rated as much improve

Illness perceptions; exploring mediators and/or moderators in disabling persistent low back pain: Multiple baseline single-case experimental design

Introduction: Illness Perceptions (IPs) may play a role in the management of persistent low back pain. The mediation and/or moderation effect of IPs on primary outcomes in physiotherapy treatment is unknown. Methods: A multiple single-case experimental design, using a matched care physiotherapy intervention, with three phases (phases A-B-A’) was used including a 3 month follow up (phase A’). Primary outcomes: pain intensity, physical functioning and pain interference in daily life. Analyzes: linear mixed models, adjusted for fear of movement, catastrophizing, avoidance, sombreness and sleep. Results: Nine patients were included by six different primary care physiotherapists. Repeated measures on 196 data points showed that IPs Consequences, Personal control, Identity, Concern and Emotional response had a mediation effect on all three primary outcomes. The IP Personal control acted as a moderator for all primary outcomes, with clinically relevant improvements at 3 month follow up. Conclusion: Our study might indicate that some IPs have a mediating or a moderating effect on the outcome of a matched care physiotherapy treatment. Assessing Personal control at baseline, as a relevant moderator for the outcome prognosis of successful physiotherapy management of persistent low back pain, should be further eplored

Prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: a systematic review

Background: Prognosis of acute idiopathic neck pain is poor. An overview of modifiable and non-modifiable prognostic factors for the development of chronic musculoskeletal neck pain after an episode of idiopathic, non-traumatic neck pain is needed. Objective: Identify prognostic factors for pain intensity and perceived non-recovery at three, six and 12 months after a first episode of idiopathic, non-traumatic neck pain. Study design: Systematic review METHODS: Systematic literature search up to October 21, 2017 for prospective prognostic studies with main outcomes perceived non-recovery and pain intensity. The QUIPS was used for quality assessment. Results: Out of 2737 screened articles six prospective studies with high-risk-of-bias were identified, analyzing 47 and 43 factors for the outcome variables 'pain intensity' and 'perceived non-recovery', respectively. Based on univariate- and multivariate analyses we found moderate evidence for 'age> 40 years' and 'concomitant back pain' to be prognostic for 'pain intensity'. For the outcome 'perceived non-recovery' at 12 months, we found moderate evidence for both 'a previous period of neck pain' and 'accompanying headache' as prognostic variables for persistent pain, based on univariate analysis. No prognostic factor was found which was retained in more than one multivariate analysis for the outcome variable 'perceived non-recovery'. However, the quality of the evidence for these prognostic factors was low to very low. Conclusion: This review identifies prognostic factors for neck pain, of which only a few are modifiable. Further research is needed before drawing definite conclusions about the prognostic value of these factors

Treatment based classification systems for patients with non-specific neck pain: A systematic review

Objective: We aimed to identify published classification systems with a targeted treatment approach (treatment-based classification systems (TBCSs)) for patients with non-specific neck pain, and assess their quality and effectiveness. Design: Systematic review. Data sources: MEDLINE, CINAHL, EMBASE, PEDro and the grey literature were systematically searched from inception to December 2019. Study appraisal and synthesis: The main selection criterium was a TBCS for patients with non-specific neck pain with physiotherapeutic interventions. For data extraction of descriptive data and quality assessment we used the framework developed by Buchbinder et al. We considered as score of ≤3 as low quality, a score between 3 and 5 as moderate quality and a score ≥5 as good quality. To assess the risk of bias of studies concerning the effectiveness of TBCSs (only randomized clinical trials (RCTs) were included) we used the PEDro scale. We considered a score of ≥ six points on this scale as low risk of bias. Results: Out of 7664 initial references we included 13 studies. The overall quality of the TBCSs ranged from low to moderate. We found two RCTs, both with low risk of bias, evaluating the effectiveness of two TBCSs compared to alternative treatments. The results showed that both TBCSs were not superior to alternative treatments. Conclusion: Existing TBCSs are, at best, of moderate quality. In addition, TBCSs were not shown to be more effective than alternatives. Therefore using these TBCSs in daily practice is not recommended

The Association of Illness Perceptions and Prognosis for Pain and Physical Function in Patients with Non-Cancer Musculoskeletal Pain: A Systematic Literature Review

In the literature, illness perceptions have been reported to be important psychological factors associated with pain intensity and physical function in individuals with musculoskeletal pain. The objective of this study was to assess the relationship of illness perceptions with pain intensity and physical function in individuals with noncancer musculoskeletal pain. In this systematic review, relevant literature databases, including PubMed, Embase, PsycINFO, CINAHL, and SPORTDiscus, were searched from inception through December 12, 2017. Two authors (E.D.R. and H.W.) independently performed the search procedures, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the A MeaSurement Tool to Assess systematic Reviews guidelines, and the risk-of-bias assessment, using the QUality In Prognosis Studies tool. A qualitative best-evidence synthesis was performed. A total of 26 articles were included in the review. There were 11 cross-sectional studies concerning associations of illness perceptions with pain intensity and 11 cross-sectional studies of associations of illness perceptions with physical function. For the prognosis of pain intensity by illness perceptions, the authors found 4 longitudinal studies, and for the prognosis of physical function by illness perceptions, the authors found 12 longitudinal studies. All studies except 1 had high risk of bias. Across 15 cross-sectional studies on 9 different musculoskeletal conditions, the researchers found limited to moderate evidence for a consistent direction of the relationship of illness perceptions with pain intensity and physical function. Higher maladaptive illness perceptions imply stronger pain intensity and more limitation in physical function. Evidence in longitudinal studies is lacking, especially on pain

The clinical reasoning process in randomized clinical trials with patients with non-specific neck pain is incomplete: A systematic review

OBJECTIVE: Primarily to evaluate the completeness of the description of the clinical reasoning process in RCTs with patients with non-specific neck pain with an argued or diagnosed cause i.e. an impairment or activity limitation. Secondly, to determine the association between the completeness of the clinical reasoning process and the degree of risk of bias. DATA SOURCES: Pubmed, Cinahl and PEDro were systematically searched from inception to July 2016. STUDY SELECTION: RCTs (n = 122) with patients with non-specific neck pain receiving physiotherapy treatment published in English were included. DATA EXTRACTION: Data extraction included study characteristics and important features of the clinical reasoning process based on the Hypothesis-Oriented Algorithm for Clinicians II (HOAC II)]. DATA SYNTHESIS: Thirty-seven studies (30%) had a complete clinical reasoning process of which 8 (6%) had a 'diagnosed cause' and 29 (24%) had an 'argued cause'. The Spearmans rho association between the extent of the clinical reasoning process and the risk of bias was -0.2. CONCLUSIONS: In the majority of studies (70%) the described clinical reasoning process was incomplete. A very small proportion (6%) had a 'diagnosed cause'. Therefore, a better methodological quality does not necessarily imply a better described clinical reasoning process