Development of a clinical prediction rule to identify patients with neck pain who are likely to benefit from home-based mechanical cervical traction

Abstract

The objective of the study was to identify the population of patients with neck pain who improved with home-based mechanical cervical traction (HMCT). A prospective cohort study was conducted in a physical therapy clinic at a local hospital. Patients with neck pain referred to the clinic for physical therapy were included in the study. A HMCT program was given to participants for 2 weeks. The patient's demographic data, Numerical Pain Scale (NPS) score, Neck Disability Index (NDI) and Fear-Avoidance Beliefs Questionnaire score were collected, and standard physical examination of the cervical spine was conducted before intervention. The NPS score, NDI and a global rating of perceived improvement were collected after the intervention was completed. A total of 103 patients participated in the study and 47 had a positive response to HMCT. A clinical prediction rule with four variables (Fear-Avoidance Beliefs Work Subscale score < 13, pre-intervention pain intensity ≥ 7/10, positive cervical distraction test and pain below shoulder) was identified. With satisfaction of at least three out of four variables (positive likelihood ratio = 4.77), the intervention's success rate increased from 45.6% to over 80%. It appears that patients with neck pain who are likely to respond to HMCT may be identified.

Figures

Fig. 1

The patient generates force on his/her own by pulling the pulley string: a traction force generator, b patient self-force generating pulley string, c force meter and d harness

Fig. 2

The patient is having the traction treatment: a traction force generator, b patient self-force generating pulley string, c force meter and d harness

Fig. 3

Flow chart for judging responders by Numerical Pain Scale

Fig. 4

Flow chart for judging responders by global rating of perceived improvement

Fig. 5

Flow chart for judging responders by Neck Disability Index