Background

Neck 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.

Objective

The purpose of this study was to externally validate three promising models that predict neck pain recovery in primary care.

Methods

This 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.

Results

The Dmodel and Amodel discriminative performance (AUC < 0.70) and calibration measures (slope largely different from 1) were poor. The Mmodel could not be evaluated since several variables nor their proxies were available.

Conclusions

External 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.

中文翻译：

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颈部疼痛患者康复预后模型的外部验证

背景

在大多数国家，颈部疼痛是导致残疾的主要原因之一，并且可能会进一步增加。已经开发了许多针对颈部疼痛患者的预后模型，但很少有人得到验证。在最近的一项系统评价中，建议在将三种有前途的模型用于临床实践之前对其进行外部验证。

客观的

本研究的目的是从外部验证三个有前途的模型，这些模型可以预测初级保健中的颈部疼痛恢复。

方法

该验证队列由 1311 名患有任何持续时间的颈部疼痛的患者组成，这些患者被荷兰的 345 名手动治疗师前瞻性招募和治疗。结果衡量指标是治疗后和 1 年随访时的残疾（颈部残疾指数）和恢复（全球感知效应量表）。评估的模型是澳大利亚鞭打相关疾病 (WAD) 模型 (Amodel)、多中心 WAD 模型 (Mmodel) 和荷兰非特异性颈部疼痛模型 (Dmodel)。评估模型的辨别和校准。

结果

Dmodel 和 Amodel 判别性能（AUC < 0.70）和校准测量（斜率与 1 相差很大）很差。无法评估 Mmodel，因为有几个变量或其代理可用。

结论

有希望的颈部疼痛恢复预后模型的外部验证不成功，不推荐其临床应用。我们建议临床医生使用基于证据的个体预后因素来支持他们当前的临床推理过程以促进康复。需要进一步研究寻找新的预后因素以及使用最新方法开发和验证模型，以便初级保健中颈部疼痛患者的康复。