Few promising multivariable prognostic models exist for recovery of people with non-specific neck pain in musculoskeletal primary care: a systematic review

© 2017 Australian Physiotherapy Association Question Which multivariable prognostic model(s) for recovery in people with neck pain can be used in primary care? Design Systematic review of studies evaluating multivariable prognostic models. Participants People with non-specific neck pain presenting at primary care. Determinants Baseline characteristics of the participants. Outcome measures Recovery measured as pain reduction, reduced disability, or perceived recovery at short-term and long-term follow-up. Results Fifty-three publications were included, of which 46 were derivation studies, four were validation studies, and three concerned combined studies. The derivation studies presented 99 multivariate models, all of which were at high risk of bias. Three externally validated models generated usable models in low risk of bias studies. One predicted recovery in non-specific neck pain, while two concerned participants with whiplash-associated disorders (WAD). Discriminative ability of the non-specific neck pain model was area under the curve (AUC) 0.65 (95% CI 0.59 to 0.71). For the first WAD model, discriminative ability was AUC 0.85 (95% CI 0.79 to 0.91). For the second WAD model, specificity was 99% (95% CI 93 to 100) and sensitivity was 44% (95% CI 23 to 65) for prediction of non-recovery, and 86% (95% CI 73 to 94) and 55% (95% CI 41 to 69) for prediction of recovery, respectively. Initial Neck Disability Index scores and age were identified as consistent prognostic factors in these three models. Conclusion Three externally validated models were found to be usable and to have low risk of bias, of which two showed acceptable discriminative properties for predicting recovery in people with neck pain. These three models need further validation and evaluation of their clinical impact before their broad clinical use can be advocated. Registration PROSPERO CRD42016042204. [Wingbermühle RW, van Trijffel E, Nelissen PM, Koes B, Verhagen AP (2018) Few promising multivariable prognostic models exist for recovery of people with non-specific neck pain in musculoskeletal primary care: a systematic review. Journal of Physiotherapy 64: 16–23

External validation of prognostic models for recovery in patients with neck pain

BackgroundNeck pain is one of the leading causes of disability in most countries and it is likely to increase further. Numerous prognostic models for people with neck pain have been developed, few have been validated. In a recent systematic review, external validation of three promising models was advised before they can be used in clinical practice.ObjectiveThe purpose of this study was to externally validate three promising models that predict neck pain recovery in primary care.MethodsThis validation cohort consisted of 1311 patients with neck pain of any duration who were prospectively recruited and treated by 345 manual therapists in the Netherlands. Outcome measures were disability (Neck Disability Index) and recovery (Global Perceived Effect Scale) post-treatment and at 1-year follow-up. The assessed models were an Australian Whiplash-Associated Disorders (WAD) model (Amodel), a multicenter WAD model (Mmodel), and a Dutch non-specific neck pain model (Dmodel). Models' discrimination and calibration were evaluated.ResultsThe Dmodel and Amodel discriminative performance (AUC ConclusionsExternal validation of promising prognostic models for neck pain recovery was not successful and their clinical use cannot be recommended. We advise clinicians to underpin their current clinical reasoning process with evidence-based individual prognostic factors for recovery. Further research on finding new prognostic factors and developing and validating models with up-to-date methodology is needed for recovery in patients with neck pain in primary care

Strategic Alliances Of Small And Medium Entrepreneurs A Challenge For The Colective Modernization Of Transport In The City Of Bogota

The public collective transportation of the city of Bogotá is facing a new reality, caused by a significant advance in the urban development, as well as, making progress of the mobility which expressed by the implementation of in a new system of massive transport for the city called TRANSMILENIO. In response to the challenge that this new urban dynamics has generated, the entrepreneurs of the collective transport of the city of Bogotá have made them aware of the urgent need to modernize their sector, in order to, succeed in being competitive within the new concept of public transport. This complex process of modernization of the collective transport has raised the need to create new paradigms of business management which include the construction of strategic alliances of small and medium entrepreneurs of the collective transportation of the city. This process has relied on the participation of the academy, local authorities and the support of programs that Inter American Development Bank has been implementing in the area of managerial partnership. The article on consideration shows the process of modernization that is given inside the collective companies of transports in the city of Bogotá, taking as a main referring the experience of “ Alliance Tránsfer” which considers the construction of new paradigms of business management, quality of the service, social managerial responsibility and the construction of citizenship. The principles on which the “Alliance Tránsfer” is getting built are based on a new conception of the urban collective public transport of passengers. “ALIANZA TRANSFER” not only includes the implementation of high standards of planning, operation, management, and quality in the service, but also the commitment in rebuilding values and the managerial social responsibility. At the same time, “Alliance Tránsfer” attempts to contribute trough the development of the collective public service of transport in the process of the social inclusion using it as a tool to fortify processes of construction and formation of the civilian population. Finally, “Alliance Tránsfer” seeks to agglutinate entrepreneurs through the sum of synergies of the transporters of the collective public sector to constitute themselves in to authentic agents of the social and economic development.Institute of Transport and Logistics Studies. Faculty of Economics and Business. The University of Sydne

Development and internal validation of prognostic models for recovery in patients with non-specific neck pain presenting in primary care

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

Clinimetric evaluation of active range of motion measures in patients with non-specific neck pain: a systematic review

The study is to provide a critical analysis of the research literature on clinimetric properties of instruments that can be used in daily practice to measure active cervical range of motion (ACROM) in patients with non-specific neck pain. A computerized literature search was performed in Medline, Cinahl and Embase from 1982 to January 2007. Two reviewers independently assessed the clinimetric properties of identified instruments using a criteria list. The search identified a total of 33 studies, investigating three different types of measurement instruments to determine ACROM. These instruments were: (1) different types of goniometers/inclinometers, (2) visual estimation, and (3) tape measurements. Intra- and inter-observer reliability was demonstrated for the cervical range of motion instrument (CROM), Cybex electronic digital instrument (EDI-320) and a single inclinometer. The presence of agreement was assessed for the EDI-320 and a single inclinometer. The CROM received a positive rating for construct validity. When clinical acceptability is taken into account both the CROM and the single inclinometer can be considered appropriate instruments for measuring the active range of motion in patients with non-specific neck pain in daily practice. Reliability is the aspect most frequently evaluated. Agreement, validity and responsiveness are documented less frequently

Role and reliability of passive joint motion assessment: Towards multivariable diagnostics and decision-making in manual therapy

Manual therapists strongly rely on passive intervertebral motion (PIVM) assessment for making decisions about spinal joint mobilisation and thrust manipulation in patients with neck or low-back pain. However, uncertainty exists about the use and the value of this physical examination procedure within clinical diagnostics and decision-making in manual therapy. The two main objectives of the research reported in this thesis were: (1) to evaluate the inter-examiner reliability of passive joint motion assessment of the spine and the extremities and (2) to examine the role and position of PIVM assessment within the process of clinical reasoning and decision-making in clinical practice in manual therapy in patients with spine-related disorders. From three systematic reviews, we concluded that the inter-examiner reliability of the tactile and visual judgements by therapists during passive motion assessment of joints of the spine and the extremities is unacceptably low. Two further studies showed that Dutch manual therapists are highly consistent in reporting their use, interpretation, and related perceptions regarding PIVM assessment and we found that PIVM assessment is positioned, albeit more or less routinely, as an ‘add-on’ test after history taking, visual inspection, and active and regional passive motion examination. Our research supports a multivariable, biopsychosocial, hypothesis-oriented approach to evaluating clinical diagnostics and decision-making in manual therapy as opposed to continuing investigating the value of single tests. We propose methods to incorporate such an approach into reliability studies and randomised controlled trials with the aim to, eventually, better identify those patients responding (or not) to spinal manual therapy