Prognostic Factors for Recurrences in Neck Pain Patients Up to 1 Year After Chiropractic Care
SOURCE: J Manipulative Physiol Ther. 2015 (Sep 15 ~ FULL TEXT
Anke Langenfeld, MS, B. Kim Humphreys, DC, PhD,
Jaap Swanenburg, PhD, Cynthia K. Peterson, RN, DC, MMedEd, PhD
CAPHRI School of Public Health and Primary Care,
Department of Epidemiology,
Maastricht, The Netherlands
OBJECTIVE: Information about recurrence and prognostic factors is important for patients and practitioners to set realistic expectations about the chances of full recovery and to reduce patient anxiety and uncertainty. Therefore, the purpose of this study was to assess recurrence and prognostic factors for neck pain in a chiropractic patient population at 1 year from the start of the current episode.
METHODS: Within a prospective cohort study, 642 neck pain patients were recruited by chiropractors in Switzerland. After a course of chiropractic therapy, patients were followed up for 1 year regarding recurrence of neck pain. A logistic regression analysis was used to assess prognostic factors for recurrent neck pain. The independent variables age, pain medication usage, sex, work status, duration of complaint, previous episodes of neck pain and trauma onset, numerical rating scale, and Bournemouth questionnaire for neck pain were analyzed. Prognostic factors that have been identified in previous studies to influence recovery of neck pain are psychologic distress, poor general health at baseline, and a previous history of pain elsewhere.
RESULTS: Five hundred forty five patients (341 females), with a mean age of 42.1 years (SD, 13.1) completed the 1-year follow-up period. Fifty-four participants (11%) were identified as “recurrent.” Prognostic factors associated with recurrent neck pain were previous episodes of neck pain and increasing age.
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CONCLUSION: The results of this study suggest that recurrence of neck pain within 1 year after chiropractic intervention in Swiss chiropractic patients presenting from varied onsets is low. This study found preliminary findings that older age and a previous episode of neck may be useful predictors of neck pain recurrence within 1 year.
Neck pain is a common reason for patients seeking health care.  Most people will see a medical practitioner or another health care provider at least once in their lifetime due to neck pain.  Those who have experienced an episode of neck pain are likely to have another onset within the next 1 to 5 years.  Consequently, The Neck Pain Task Force has described neck pain as an episodic occurrence over one’s lifetime with variable degrees of recovery between episodes.  Hush et al  reported that a new episode of neck pain appears to recover during the acute phase. Nevertheless, the prognosis for a complete recovery is quite poor.  In an observational study, it was shown that patients with a new episode of neck pain in primary care setting typically have high pain scores that improve rapidly during the 3 months after treatment. However, those who do not recover within the 3 months after the intervention have reported relatively low residual pain and disability.