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Objective: How interventions are reported can impact the ability to implement these intervention in clinical practice. Therefore, our aim is to assess the reporting of massage interventions in randomised controlled trials for patients with neck pain., Data Sources: This manuscript concerns a secondary analysis of trials evaluating massage for neck pain selected for a scoping review. An updated literature search was completed using four databases to 31 July 2023., Review Methods: Trials were selected that evaluate massage interventions. Two independent assessors extracted descriptive information, methodological quality (PEDro-scale) and assessed completeness of reporting of the intervention using the Template for Intervention Description and Replication (TIDier-checklist). We present frequencies of the extracted data., Results: We included 35 trials (2840 patients) with neck pain. Most trials (n = 23) included patients with chronic non-specific neck pain. We found a wide variety of massage interventions from Chinese massage, Swedish massage to myofascial release. In addition, the dose, number of sessions and the duration of the intervention varied widely. The methodological quality overall was fair to good (varied between 4-8/10), and we found a moderate completeness of reporting. All trials provided the name of the intervention, 30 (86%) provided a rationale and 26 (74%) trials described details of the massage intervention., Conclusion: The massage interventions were moderately described in trials in patients with neck pain, but provided enough information to guide the decision making for designing future Network Meta-analysis as to what trials need to be considered when grouping massage interventions in a clinically relevant way., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: A network meta-analysis aims to help clinicians make clinical decisions on the most effective treatment for a certain condition. Neck pain is multifactorial, with various classification systems and treatment options. Classifying patients and grouping interventions in clinically relevant treatment nodes for a NMA is essential, but this process is poorly defined., Objective: Our aim is to obtain consensus among experts on neck pain classifications and the grouping of interventions into nodes for a future network meta-analysis., Design: A Delphi consensus study involving neck pain experts worldwide., Methods: We invited authors of neck pain clinical practice guidelines published from 2014 onwards. The Delphi baseline questionnaire was developed based on the findings of a scoping review, including four items on classifications and 19 nodes. Participants were asked to record their level of agreement on a seven-point Likert scale or using Yes/No/Not sure answer options for the various statements. We used descriptive analysis to summarise the responses on each statement with content analysis of the free-text comments., Results: In total, 18/80 experts (22.5%) agreed to participate in one or more Delphi rounds. We needed three rounds to reach consensus for two classification of neck pain: one based on aetiology and one on duration. In addition, we also reached consensus on the grouping of interventions, including a definition of each node, with the number of nodes reduced to 17., Conclusion: With this consensus we clinically validated two neck pain classifications and grouped conservative treatments into 17 well-defined and clinically relevant nodes., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Our aim is to provide an overview of how neck pain is classified in the literature, define and group conservative interventions into 'nodes', and develop draft networks of interventions in preparation for a network meta-analysis (NMA)., Study Design and Settings: We performed a scoping review. For feasibility reasons, we searched for randomized clinical trials (RCTs) via neck pain clinical practice guidelines (CPGs) published from 2014. We used standardized data extraction forms to extract data about classification of neck pain and interventions evaluated in the included RCTs. We calculated frequencies of neck pain classifications and grouped interventions into nodes based on the definitions used in Cochrane reviews. Draft network graphs comparing interventions were constructed using the online Shiny R application CINEMA., Results: We included 242 RCTs from seven CPGs, evaluating 28,581 patients. We found three different classification systems of which The Neck Pain Task Force classification was used most often. We defined and grouped all interventions into 19 discrete potential nodes., Conclusion: We found a wide variation in neck pain classifications and conservative interventions. Grouping the interventions was challenging and needs further evaluation before conducting a final NMA., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of competing interest None.

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 (R 2 =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., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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., Competing Interests: Conflict of Interest The authors declare no conflicts of interest, (Copyright © 2021 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: In various countries, patients can visit a physiotherapist via self-referral. The aims of this study were to evaluate whether there are differences between individuals with nonspecific neck pain who consult a manual therapist via self-referral and those who do so via referral by a physician concerning patient characteristics, number of treatments, and recovery; and whether (self-)referral is associated with recovery., Methods: This study is part of a prospective cohort study with posttreatment and 12-month follow-up in a Dutch manual-therapy setting. Adult patients with nonspecific neck pain were eligible for participation. Baseline measurements included demographic data and data concerning neck pain. At follow-up, number of treatments, recovery, and satisfaction were assessed. To evaluate differences between the groups, we used the χ 2 test and the independent t test. A logistic regression analysis was used to evaluate the association between referral status and recovery., Results: In total, 272 manual therapists participated and 1311 patients were included. Of 831 patients whose referral data are available, about half patients consulted a manual therapist by self-referral. The mean number of treatments was 5.4, which did not differ between the 2 groups. We found no differences between the groups concerning age, sex, pain intensity at baseline, or recovery rate. Patients in the self-referral group experienced acute neck pain more frequently, had recurrent complaints more often, and reported less disability compared to the referred group. Referral status was not associated with recovery., Conclusion: We found several small differences between self-referred and referred patients., (Copyright © 2020. Published by Elsevier Inc.)

Objectives: The purpose of this study was to describe the design and baseline measurements of a prospective multicenter cohort study in patients with neck pain treated by Dutch manual therapists. Objectives of the study were to determine which patients seek help from a manual therapist, to describe usual care manual therapy in patients with neck pain, to examine the occurrence of nonserious adverse events after treatment, to describe predictors of adverse events, and to determine whether the occurrence of nonserious adverse events affect outcome after manual therapy care., Methods: During a 3-month inclusion period, consecutive patients aged between 18 and 80 years presenting with neck pain in manual therapy practices in The Netherlands were included in the study. Baseline questionnaires included the Numeric Rating Scale, Neck Disability Index (NDI), Neck Bournemouth Questionnaire, Fear Avoidance Beliefs Questionnaire (FABQ), and Patient Expectancy List. Within the treatment episode, manual therapist clinical reasoning and applied interventions were registered and patients reported on adverse events. At the end of the treatment episode and at 12-month follow-up, pain intensity (Numeric Rating Scale), functional outcomes (NDI, Neck Bournemouth Questionnaire), personal factors (FABQ), and global perceived effect were measured., Results: During the 3-month inclusion period, 263 participating manual therapists collected data on 1193 patients with neck pain. Most patients (69.4%) were female. The mean age was 44.7 (±13.7) years. The NDI showed overall mild disability (mean score 26%). Mean scores in pain intensity were moderate (4.8), and there was low risk of prolonged disability owing to personal factors (FABQ)., Conclusion: This study provides information on baseline characteristics of patients visiting manual therapists for neck pain. In The Netherlands, patients seeking care of manual therapists are comparable to patients in other countries regarding demographics and neck pain characteristics., (Copyright © 2019. Published by Elsevier Inc.)

Purpose: To describe the clinical course and develop prognostic models for poor recovery in patients with cervical radiculopathy who are managed conservatively., Methods: Sixty-one consecutive adults with cervical radiculopathy who were referred for conservative management were included in a prospective cohort study, with 6- and 12-month follow-up assessments. Exclusion criteria were the presence of known serious pathology or spinal surgery in the past. Outcome measures were perceived recovery, neck pain intensity and disability level. Multiple imputation analyses were performed for missing values. Prognostic models were developed using multivariable logistic regression analyses, with bootstrapping techniques for internal validation., Results: About 55% of participants reported to be recovered at 6 and 12 months. All multivariable models contained 2 baseline predictors. Longer symptoms duration increased the risk of poor perceived recovery, whereas the presence of paresthesia decreased this risk. A higher neck pain intensity and a longer duration of symptoms increased the risk of poor relief of neck pain. A higher disability score increased the risk of poor relief of disability, and larger active range of rotation toward the affected side decreased this risk. Following bootstrapping, the explained variance of the models varied between 0.22 and 0.30, and the median area under the curve varied between 0.75 and 0.79., Conclusions: The clinical course of cervical radiculopathy appears to be long, with most of the reduction in symptoms occurring within the first 6 months. All prognostic models showed an adequate predictive performance with modest diagnostic accuracy and explained variance. These slides can be retrieved under Electronic Supplementary Material.

The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of published systematic reviews.During the intake, the patient is screened for serious pathologies and corresponding patterns. Patients with cervical radiculopathy can be included or excluded through corresponding signs and symptoms and possibly diagnostic tests (Spurling test, traction/distraction test, and Upper Limb Tension Test). History taking is done to gather information about patients' limitations, course of pain, and prognostic factors (eg, coping style) and answers to health-related questions.In case of a normal recovery (treatment profile A), management should be hands-off, and patients should receive advice from the physical therapist and possibly some simple exercises to supplement "acting as usual."In case of a delayed/deviant recovery (treatment profile B), the physical therapist is advised to use, in addition to the recommendations for treatment profile A, forms of mobilization and/or manipulation in combination with exercise therapy. Other interventions may also be considered. The physical therapist is advised not to use dry needling, low-level laser, electrotherapy, ultrasound, traction, and/or a cervical collar.In case of a delayed/deviant recovery with clear and/or dominant psychosocial prognostic factors (treatment profile C), these factors should first be addressed by the physical therapist, when possible, or the patient should be referred to a specialist, when necessary.In case of neck pain grade III (treatment profile D), the therapy resembles that for profile B, but the use of a cervical collar for pain reduction may be considered. The advice is to use it sparingly: only for a short period per day and only for a few weeks.

Objective: To evaluate whether current Dutch primary care clinicians offer tailored treatment to patients with low back pain (LBP) or neck pain (NP) according to their risk stratification, based on the Keele STarT (Subgroup Targeted Treatment) Back-Screening Tool (SBT)., Design: Prospective cohort study with 3-month follow-up., Setting: Primary care., Participants: General practitioners (GPs) and physiotherapists included patients (N=284) with nonspecific LBP, NP, or both., Interventions: Patients completed a baseline questionnaire, including the Dutch SBT, for either LBP or NP. A follow-up measurement was conducted after 3 months to determine recovery (using Global Perceived Effect Scale), pain (using Numeric Pain Rating Scale), and function (using Roland Disability Questionnaire or Neck Disability Index). A questionnaire was sent to the GPs and physiotherapists to evaluate the provided treatment., Main Outcome Measures: Prevalence of patients' risk profile and clinicians' applied care, and the percentage of patients with persisting disability at follow-up. A distinction was made between patients receiving the recommended treatment and those receiving the nonrecommended treatment., Results: In total, 12 GPs and 33 physiotherapists included patients. After 3 months, we analyzed 184 patients with LBP and 100 patients with NP. In the LBP group, 52.2% of the patients were at low risk for persisting disability, 38.0% were at medium risk, and 9.8% were at high risk. Overall, 24.5% of the patients with LBP received a low-risk treatment approach, 73.5% a medium-risk, and 2.0% a high-risk treatment approach. The specific agreement between the risk profile and the received treatment for patients with LBP was poor for the low-risk and high-risk patients (21.1% and 10.0%, respectively), and fair for medium-risk patients (51.4%). In the NP group, 58.0% of the patients were at low risk for persisting disability, 37.0% were at medium risk, and 5.0% were at high risk. Only 6.1% of the patients with NP received the low-risk treatment approach. The medium-risk treatment approach was offered the most (90.8%), and the high-risk approach was applied in only 3.1% of the patients. The specific agreement between the risk profile and received treatment for patients with NP was poor for low-risk and medium-risk patients (6.3% and 48.0%, respectively); agreement for high-risk patients could not be calculated., Conclusions: Current Dutch primary care for patients with nonspecific LBP, NP, or both does not correspond to the recommended stratified-care approach based on the SBT, as most patients receive medium-risk treatment. Most low-risk patients are overtreated, and most high-risk patients are undertreated. Although the stratified-care approach has not yet been validated in Dutch primary care, these results indicate there may be substantial room for improvement., (Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

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]., (Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Objective: To evaluate the reliability and validity of the Dutch version of the STarT Back screening Tool (SBT), for patients with neck pain., Methods: We modified the SBT to fit patients with neck pain. General practitioners and physiotherapists included patients who completed both a baseline and a follow-up questionnaire at 3 days and 3 months, respectively. The construct validity was assessed using Pearson's correlation between the SBT and the reference questionnaires. The reproducibility was assessed in the first week using the quadratic weighted kappa and the specific agreement. Predictive validity was assessed using a relative-risk ratio (RR) for, amongst others, persisting disability at 3 months. Content validity was analysed using both floor and ceiling effects., Results: In total, 100 patients were included; 58% were categorised as being at "low risk" for persisting disability, 37% at "medium risk" and 5% at "high risk". As expected for the construct validity, we found a moderate to high correlation for all questions except for activity question 3. The reproducibility had a quadratic-weighted kappa of 0.58, and a specific agreement of 90.9% for "low-risk" and 66.7% for "medium-risk" patients. The RRs for persisting disability for "medium-risk" against "low-risk" patients were 1.5 (95% C.I. 0.9-2.4) and 1.5 (95% C.I. 0.5-4.1) for pain. The sample size for high-risk patients was low., Conclusion: The original SBT is modified to fit patients with neck pain in Dutch primary care. The psychometric analysis indicates sufficiently reliable outcomes, although the predictive validity showed statistically insignificant results., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objectives: The aim of this systematic review is to assess the effectiveness of conservative treatments for patients with cervical radiculopathy, a term used to describe neck pain associated with pain radiating into the arm. Little is known about the effectiveness of conservative treatment for patients with cervical radiculopathy., Methods: We electronically searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, and CINAHL for randomized clinical trials. Conservative therapies consisted of physiotherapy, collar, traction etc. Two authors independently assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group and extracted the data. If studies were clinically homogenous, a meta-analysis was performed. The overall quality of the body of evidence was evaluated using the GRADE method., Results: Fifteen articles were included that corresponded to 11 studies. Two studies scored low risk of bias. There is low-level evidence that a collar is no more effective than physiotherapy at short-term follow-up and very low-level evidence that a collar is no more effective than traction. There is low-level evidence that traction is no more effective than placebo traction and very low level-evidence that intermittent traction is no more effective than continuous traction., Discussion: On the basis of low-level to very low-level evidence, no 1 intervention seems to be superior or consistently more effective than other interventions. Regardless of the intervention assignment, patients seem to improve over time, indicating a favorable natural course. Use of a collar and physiotherapy show promising results at short-term follow-up.

Objective: General practitioners refer patients with continued neck pain that do not respond well to conservative care frequently to secondary care for further assessment. Are surgical interventions to the cervical spine effective when compared to conservative care for patients with neck pain?, Design: Systematic review., Method: The search strategy outlined by the Cochrane Back Review Group (CBRG) was followed. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to June 2011. Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of adults with neck pain, which evaluated at least one clinically relevant primary outcome measure (e.g. pain, functional status, recovery), were included. In addition, treatments had to include surgery and conservative care. Two authors independently assessed risk of bias using the criteria recommended by the CBRG and extracted the data. The quality of the evidence was rated using the GRADE method., Results: Patients included had neck pain with or without radiculopathy or myelopathy. In total, three RCTs and six CCTs were identified comparing different surgical interventions with conservative care, of which one had a low risk of bias. Overall there is very low quality of evidence available on the effectiveness of surgery compared to conservative care in neck pain patients showing overall no differences., Conclusion: Most studies on surgical techniques comparing these to conservative care showed a high risk of bias. The benefit of surgery over conservative care is not clearly demonstrated.

We aimed to assess the effects of additional fusion on surgical interventions to the cervical spine for patients with neck pain with or without radiculopathy or myelopathy by performing a systematic review. The search strategy outlined by the Cochrane Back Review Group (CBRG) was followed. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL and PEDro up to June 2011. Only randomised, controlled trials of adults with neck pain that evaluated at least one clinically relevant primary outcome measure (pain, functional status, recovery) were included. Two authors independently assessed the risk of bias by using the criteria recommended by the CBRG and extracted the data. Data were pooled using a random effects model. The quality of the evidence was rated using the GRADE method. In total, 10 randomised, controlled trials were identified comparing additional fusion upon anterior decompression techniques, including 2 studies with a low risk of bias. Results revealed no clinically relevant differences in recovery: the pooled risk difference in the short-term follow-up was -0.06 (95% confidence interval -0.22 to 0.10) and -0.07 (95% confidence interval -0.14 to 0.00) in the long-term follow-up. Pooled risk differences for pain and return to work all demonstrated no differences. There is no additional benefit of fusion techniques applied within an anterior discectomy procedure on pain, recovery and return to work., (Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

Purpose: To critically appraise and compare the measurement properties of the original versions of neck-specific questionnaires., Methods: Bibliographic databases were searched for articles concerning the development or evaluation of the measurement properties of an original version of a self-reported questionnaire, evaluating pain and/or disability, which was specifically developed or adapted for patients with neck pain. The methodological quality of the selected studies and the results of the measurement properties were critically appraised and rated using a checklist, specifically designed for evaluating studies on measurement properties., Results: The search strategy resulted in a total of 3,641 unique hits, of which 25 articles, evaluating 8 different questionnaires, were included in our study. The Neck Disability Index is the most frequently evaluated questionnaire and shows positive results for internal consistency, content validity, structural validity, hypothesis testing, and responsiveness, but a negative result for reliability. The other questionnaires show positive results, but the evidence for each measurement property is mostly limited, and at least 50% of the information on measurement properties per questionnaire is lacking., Conclusions: Our findings imply that studies of high methodological quality are needed to properly assess the measurement properties of the currently available questionnaires. Until high quality studies are available, we recommend using these questionnaires with caution. There is no need for the development of new neck-specific questionnaires until the current questionnaires have been adequately assessed.

We evaluated whether patients with self-reported whiplash differed in perceived pain, functional limitation and prognosis from patients with other painful neck complaints. Data from three Dutch trials and an English trial were used all evaluating conservative treatment in neck pain patients in primary care. All patients had non-specific neck pain. Information on any trauma or injury came from self-report at baseline. We compared frequencies of baseline variables and outcome at short-term and long term for whiplash and non-trauma neck pain patients separately. The total study population consisted of 804 neck pain patients. Of these patients 133 reported (16.5%) that an injury was the cause of their neck pain. In all trials there were 17-18% more male patients in the whiplash group. At follow-up pain decreased between 12 and 28%, function 10%, and 25-50% of patients recovered in all trials. Post-treatment improvements in pain, function and recovery were comparable between whiplash and non-trauma patients. We also found no different prognostic factors between whiplash and non-trauma patients. Overall we found in a population with mild to moderate pain no clinically relevant differences between patients with self-reported whiplash and patients with other painful neck complaints. The findings suggest that whiplash patients with mild to moderate pain should not be considered a specific subgroup of patients with non-specific neck pain., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Several disease-specific questionnaires to measure pain and disability in patients with neck pain have been translated. However, a simple translation of the original version doesn't guarantee similar measurement properties. The objective of this study is to critically appraise the quality of the translation process, cross-cultural validation and the measurement properties of translated versions of neck-specific questionnaires., Methods: Bibliographic databases were searched for articles concerning the translation or evaluation of the measurement properties of a translated version of a neck-specific questionnaire. The methodological quality of the selected studies and the results of the measurement properties were critically appraised and rated using the COSMIN checklist and criteria for measurement properties., Results: The search strategy resulted in a total of 3641 unique hits, of which 27 articles, evaluating 6 different questionnaires in 15 different languages, were included in this study. Generally the methodological quality of the translation process is poor and none of the included studies performed a cross-cultural adaptation. A substantial amount of information regarding the measurement properties of translated versions of the different neck-specific questionnaires is lacking. Moreover, the evidence for the quality of measurement properties of the translated versions is mostly limited or assessed in studies of poor methodological quality., Conclusions: Until results from high quality studies are available, we advise to use the Catalan, Dutch, English, Iranian, Korean, Spanish and Turkish version of the NDI, the Chinese version of the NPQ, and the Finnish, German and Italian version of the NPDS. The Greek NDI needs cross-cultural validation and there is no methodologically sound information for the Swedish NDI. For all other languages we advise to translate the original version of the NDI.

Objective: The aim of this study was to obtain an overview of the methodological quality of studies on the measurement properties of neck pain and disability questionnaires and to describe how well various aspects of the design and statistical analyses of studies on measurement properties are performed., Methods: A systematic review was performed of published studies on the measurement properties of neck pain and disability questionnaires. Two reviewers independently rated the quality of the studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. This checklist was developed in an international Delphi consensus study., Results: A total of 47 articles were included on the measurement properties of 8 different questionnaires. The methodological quality of the included studies was adequate on some aspects (often, adequate statistical analyses are used for assessing reliability, measurement error, and construct validity) but can be improved on other aspects. The most important methodological aspects that need to be improved are as follows: assessing unidimensionality in internal consistency analysis, stable patients and similar test conditions in studies on reliability and measurement error, and more emphasis on the relevance and comprehensiveness of the items in content validity studies. Furthermore, it is recommended that studies on construct validity and responsiveness should be based on predefined hypotheses and that better statistical methods should be used in responsiveness studies., Conclusion: Considering the importance of adequate measurement properties, it is concluded that, in the field of measuring neck pain and disability, there is room for improvement in the methodological quality of studies measurement properties., (Copyright © 2011 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Objective: To conduct a systematic review and meta-analysis on the prognosis of acute idiopathic neck pain and disability., Data Sources: EMBASE, CINAHL, Medline, AMED, PEDro, and CENTRAL were searched from inception to July 2009, limited to human studies. Reference lists of relevant systematic reviews were searched by hand. Search terms included: neck pain, prognosis, inception, cohort, longitudinal, observational, or prospective study and randomized controlled trial., Study Selection: Eligible studies were longitudinal cohort studies and randomized controlled trials with a no treatment or minimal treatment arm that recruited an inception cohort of acute idiopathic neck pain and reported pain or disability outcomes. Eligibility was determined by 2 authors independently. Seven of 20,085 references were included., Data Extraction: Pain and disability data were extracted independently by 2 authors. Risk of bias was assessed independently by 2 authors., Data Synthesis: Statistical pooling showed a weighted mean pain score (0-100) of 64 (95% confidence interval [CI], 61-67) at onset and 35 (95% CI, 32-38) at 6.5 weeks. At 12 months, neck pain severity remained high at 42 (95% CI, 39-45). Disability reduced from a pooled weighted mean score (0-100) at onset of 30 (95% CI, 28-32) to 17 (95% CI, 15-19) by 6.5 weeks, without further improvement at 12 months. Studies varied in length of follow-up, design, and sample size., Conclusions: This review provides Level I evidence that the prognosis of acute idiopathic neck pain is worse than currently recognized. This evidence can guide primary care clinicians when providing prognostic information to patients. Further research to identify prognostic factors and long-term outcomes from inception cohorts would be valuable., (Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To describe sickness absence in patients with arm, neck and/or shoulder complaints and to evaluate determinants of sickness absence during 6 months follow-up., Methods: A prospective cohort study in physical therapy practice with follow-up measurements at 3 and 6 months. The main outcome measure was the occurrence of sickness absence due to arm, neck and shoulder complaints during 6 months follow-up. Determinants were tested in univariate and multivariate GEE (Generalized Estimating Equations) analysis., Results: At baseline 161 patients (33%) reported absence from work. The multivariate analysis showed that self-reported work-relatedness of complaints, previous musculoskeletal trauma, higher severity of complaints at baseline, more somatization and low decision authority at work were associated with sickness absence during the follow-up period., Conclusion: In physical therapy practice, social and psychological factors (at work) influence the occurrence of sickness absence in patients with arm, neck and/or shoulder complaints. These factors can be taken into account when developing and evaluating interventions to reduce sickness absence among these patients., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Study Design: Reanalysis of data from 3 randomized controlled trials., Objective: Development and validation of a prediction rule that estimates the probability of complaints persisting for at least 6 months in patients presenting with nonspecific neck pain in primary care., Summary of Background Data: A substantial proportion of the neck pain patients will develop chronic neck pain. An important question is whether we can identify patients at risk of persistent complaints at the first consultation with the physician, based on their personal characteristics? A prediction model that quantifies prognosis in patients with nonspecific neck pain is not available., Methods: The study population consisted of a sample (n = 468) from the adult primary care population (18-70 years) in The Netherlands presenting with nonspecific neck pain. The primary outcome measure was global perceived recovery measured at 6 months of follow-up. Seventeen baseline characteristics of the patients were included in the analysis. Significant predictors were identified by multivariable backward stepwise logistic regression analysis. A score chart was constructed by using the regression coefficient estimates. The score chart was externally validated in a cohort of patients with nonspecific neck pain (n = 315), who participated in a randomized controlled trial in the United Kingdom (PANTHER-trial)., Results: The multivariable analysis resulted in a set of 9 predictors. The score chart has a discriminative ability of 0.66. External validation of the score chart showed a discriminative ability of 0.65, an adequate calibration, a good fit, and a low explained variation., Conclusion: We developed a score chart, estimating the probability of persistent complaints at 6 months follow-up for patients with nonspecific neck pain. This chart performed well in the study population and external validation population. The prediction which patients are more likely to develop persistent complaints is significantly improved by the score chart.

Objective: To evaluate whether different categorization strategies for introducing continuous variables in multivariable logistic regression analysis results in prognostic models that differ in content and performance., Study Design and Setting: Backward multivariable logistic regression (P<0.05 and P<0.157) was performed with possible predictors for persistent complaints in patients with nonspecific neck pain. The continuous variables were introduced in the analysis in three separate ways: (1) continuous, (2) split into multiple categories, and (3) dichotomized. The different models were compared with regard to model content, goodness of fit, explained variation, and discriminative ability. We also compared the effect on performance of categorization before and after the selection procedure., Results: For P<0.05, the final model with continuous variables, containing five predictors, disagreed on three predictors with both categorization strategies. For P<0.157, the model with continuous variables, containing six predictors, disagreed on three predictors with the model containing stratified continuous variables and on six predictors compared with the model with dichotomized variables. The models in which the variables were kept continuous performed best. There was no clear difference in performance between categorization before and after the selection procedure., Conclusion: Categorization of continuous variables resulted in a different content and poorer performance of the final model.

Chronic neck pain is a common complaint in the Netherlands with a point prevalence of 14.3%. Patients with chronic neck pain are often referred to physiotherapy and, nowadays, are mostly treated with exercise therapy. It is, however, unclear which type of exercise therapy is to be preferred. Therefore, this study evaluates the effectiveness of behaviour graded activity (BGA) compared with conventional exercise (CE) for patients with chronic neck pain. Eligible patients with non-specific chronic neck were randomly allocated to either BGA or CE. Primary treatment outcome is the patient's global perceived effect concerning recovery from complaint and daily functioning. Outcome assessment was performed at baseline, and at 4, 9, 26, and 52 weeks after randomization. Effectiveness was examined with general estimating equations analyses. Baseline demographics and patient characteristics were well balanced between the two groups. Mean age was 45.7 (SD 12.4) years and the median duration of complaints was 60 months. The mean number of treatments was 6.6 (SD 3.0) in BGA and 11.2 (SD 4.1) in CE. No significant differences between treatments were found in their effectiveness of managing patients with chronic neck pain. In both BGA and CE some patients reported recovery from complaints and daily function but the proportion of recovered patients did not exceed 50% during the 12-month follow-up period. Both groups showed clinically relevant improvements in physical secondary outcomes. International Standard Randomised Controlled Trial Number: ISRCTN88733332.

Physiotherapists' treatment approach might influence their behaviour during practice and, consequently, patients' treatment outcome; however, an explicit description of the treatment approach is often missing in trials. The purpose of this prospective exploratory study was to evaluate whether the treatment approach differs between therapists who favour a behavioural graded activity (BGA) program, conservative exercise (CE) or manual therapy, and whether BGA training has influence on the treatment approach. Forty-two therapists participated. BGA therapists received a 2-day training. Treatment approach was measured at baseline and at 3-month follow-up, using the Pain Attitude and Beliefs Scale for Physiotherapists (PABS-PTs). By this method data on the adoption of biomedical or biopsychosocial approaches were generated. Differences were examined with analysis of variance (ANOVA) and independent Student's t-test. Influence of the BGA training was examined with linear regression. At baseline, there were no significant differences between BGA, CE or manual therapists use of biomedical or biopsychosocial approaches, but there was a trend for BGA therapists to score higher on the biopsychosocial approach. At follow-up, their biopsychosocial score remained higher and their biomedical score was lower compared to CE therapists. Corrected regression analysis showed a 4.4 points (95%CI -7.9; -0.8) higher decrease for therapists who followed the BGA training compared to therapists who did not. Our results indicate no significant differences in treatment approach at baseline, and that BGA training might influence therapists' treatment approach since the scores on the biomedical approach decreased.

Objective: The aim of this study was to investigate the use of the Acute Low Back Pain Screening Questionnaire (ALBPSQ) in patients with acute neck pain in general practice. The ALBPSQ is a biopsychosocial screening questionnaire containing 20 items concerning mainly psychosocial variables. Although originally developed for patients with low back pain, it may also be applicable for patients with neck pain. We evaluated its reliability and determined an optimal cutoff point for predicting future sick leave., Methods: A prospective study was conducted on consecutive patients with acute neck pain in general practice with a follow-up period of 1 year. Reliability was determined by means of a test-retest procedure with a 1-week interval. The total number of days on sick leave was added up based on self-reported questionnaires., Results: One hundred eighty-seven patients were included in the study, of which 180 patients were included in the analysis. Almost half of the patients were better or much improved within the first week. Test-retest reliability was high (intraclass correlation coefficient, 0.85; 95% confidence interval, 0.73-0.92). Almost 40% of the patients reported sick leave because of neck pain during the follow-up period. An optimal cutoff score of 72 was calculated for predicting future sick leave, with a sensitivity of 77% and a specificity of 62%. The area under the curve of the receiver operator characteristics curve was regarded doubtful (0.66; 95% confidence interval, 0.56-0.76)., Conclusion: The ALBPSQ has shown to be a reliable instrument and potentially useful in a screening procedure for future sick leave in patients with acute neck pain in general practice.

The objective of this study is to identify subgroups of patients with non-specific neck pain who are more likely to benefit from either physiotherapy, spinal manipulation therapy, or usual care, on the short- and long-term. Data of three recently finished randomised controlled trials, with similar design and setting, were combined. The combined study population consisted of 329 patients with non-specific neck pain in an adult (18-70years) primary care population in the Netherlands. The primary outcome measure was global perceived recovery and was measured at the end of the treatment period and after 52 weeks of follow-up. Fourteen candidate variables were selected for the analysis. Predictors were identified by multivariable logistic regression analysis and were tested for interaction with treatment. Based on the multivariable models with interaction terms a decision model for treatment choice was developed. The analysis revealed three predictors for recovery of which the effect is modified by treatment: pain intensity (0-10 scale) in the short-term model, age and (no) accompanying low back pain in the long-term model. With these predictors a clinically relevant improvement in recovery rate (up to 25% improvement) can be established in patients receiving a tailored instead of a non-advised treatment. In conclusion we identified three characteristics that facilitate a deliberate treatment choice, to optimise benefit of treatment in patients with non-specific neck pain: age, pain intensity, and (no) accompanying low back pain.

Background: High levels of continuous neck pain after a motor vehicle accident (MVA) are reported in cross-sectional studies. Knowledge of this association in general practice is limited., Aim: To compare the differences in perceived pain and disability in patients with acute neck pain due to an MVA versus other self-reported causes. The secondary aim was to identify prognostic factors for continuous neck pain., Design of Study: Prospective cohort study with 1-year follow-up., Setting: General practices in Rotterdam and its suburban region., Method: Patients with non-specific acute neck pain were invited to participate. Questionnaires were collected at baseline and after 6, 12, 26, and 52 weeks. The numerical pain-rating scale (NRS) and the neck disability index (NDI) were measured. Regression analysis was used to identify prognostic factors for continuous neck pain., Results: A total of 187 patients were included. The MVA subgroup (n = 42) was significantly younger (P = 0.007), reported more sick leave (P = 0.037), higher levels of headache (P<0.001) and higher NDI scores at baseline (P = 0.018) but lower scores for previous neck pain (P = 0.015) compared to the remaining cohort. At follow-up the MVA subgroup had higher scores for continuous neck pain (63% versus 40%) and at the NDI (11.0 versus 7.1). After multivariate analysis 'pain in the upper part of the neck' (odds ratio [OR] = 1.6), 'duration of complaints at baseline longer than 2 weeks' (OR = 5.3), and an 'MVA' (OR = 5.3) were significantly correlated with outcome., Conclusion: Individuals exposed to MVAs constitute a relevant subgroup of patients with neck pain. An MVA and a longer duration of complaints are prognostic factors for continuous neck pain.

Objective: To describe the natural course of patients with acute neck pain presenting in general practice and to identify prognostic factors for recovery and sick leave., Design: We conducted a prospective cohort study with a 1-year follow-up in general practice. Questionnaires were collected at baseline and after 6, 12, 26, and 52 weeks. Days of sick leave were dichotomized into two groups: below and above 7 days of sick leave. Logistic regression was used to identify prognostic factors for recovery and sick leave., Patients: Consecutive patients with nonspecific neck pain lasting no longer than 6 weeks were invited to participate., Results: One hundred eighty-seven patients were included and 138 (74%) provided follow-up data. After 1 year, 76% of the patients stated to be fully recovered or much improved, although 47% reported to have ongoing neck pain. Almost half of the patients on sick leave at baseline returned to work within 7 days. Multivariate analysis showed that the highest association with recovery was the advice of the general practitioner (GP) "to wait and see" (odds ratio [OR] 6.7, 95% confidence interval [CI] 1.6-31.8). For sick leave, referral by the GP, for physical therapy or to a medical specialist, showed the highest association (OR 2.8, 95% CI 1.0-8.4)., Conclusion: Acute neck pain had a good prognosis for the majority of patients, but still a relatively high proportion of patients reported neck pain after 1-year follow-up. The advice given by the GP "to wait and see" was associated with recovery, and "referral" was associated with prolonged sick leave.

Background: Research on neck pain in primary care is sparse. The role of GPs in taking care of patients with neck pain has not been described so far. This study focused on interested in the interaction between patients and GPs in their first contact on a new episode of neck pain., Aim: To describe GPs' management of acute neck pain in patients and to detail the diagnostic and therapeutic procedures undertaken by GPs and self-care by patients., Design of Study: A prospective cohort study with 1-year follow up., Setting: General practice in The Netherlands., Method: Patients consulting their GP for non-specific acute neck pain lasting no longer than 6 weeks were invited to participate. Questionnaires were collected from patients at baseline and after 6, 12, 26, and 52 weeks. Patients rated their recovery on a 7-point ordinal scale., Results: In total 187 patients were included. At baseline GPs prescribed medication for 42% of patients, mostly non-steroidal anti-inflammatory drugs (56%) or muscle relaxation medication (20%); 51% were referred to a physiotherapist. Seventy-four per cent of referred patients reported recovery at the end of the follow-up year, whereas 79% of non-referred patients reported recovery. Frequently-given advice by the GP was to 'wait and see' (23%), 'improve posture' and 'stay active' (22%) or to 'take a rest' (18%). Self-care by patients included different sources of heat application (79%) and exercises (57%). Complementary medicine was used in 12% of cases and 39% of patients visited their GP again during follow up. Consultation of a medical specialist and ordering of X-rays rarely occurred., Conclusion: Management by GPs included a strategy to 'wait and see' for an expected favourable natural course supported by medication, or referral to a physiotherapist.

A prospective cohort study with a 1 week follow-up. To examine the reliability and responsiveness of the Dutch version of the Neck Disability Index (NDI) in patients with acute neck pain in general practice. An increasing number of studies on treatment options is published in which the NDI is used. Reports of the ability of the NDI to detect change over time, often called responsiveness, however have not yet been published. At baseline 187 patients (119 women, 68 men) were included. They completed a questionnaire on demographic variables, self-reported cause of their complaints and the NDI. After 1 week, 86 patients were sent the NDI again together with the perceived recovery scale which was used as our external criterion. The scale ranged from 1 (complete recovery) to 7 (complaints are worse than ever). Response rate was 93%. Test-retest scores on reliability were good (ICC = 0.90). A Bland and Altman plot and a graph of total sum score differences showed no visible tendency towards unequal spreading of the data. For patients that reported on the perceived recovery scale that they were "stable" we found a responsiveness ratio of 1.82. The standard error of measurement (SEM) was 0.60 what resulted in a minimal detectable change (MDC) of 1.66. The NDI has shown to be a reliable and responsive instrument in patients with acute neck pain in general practice.

Objective: The primary aim of this study was to assess the reproducibility of tests for the active and passive range of motion used in the physical examination for patients with neck pain. The secondary aim was to determine whether the history of the patients influences the reproducibility and the prevalence of positive findings., Methods: Sixty-nine participants were recruited in 3 physical therapy practices. Two examiners independently performed a physical examination on all participants. The examiners were blinded for patient characteristics (neck pain/no neck pain) and each other's findings. History findings were available for only half the patients with neck pain. Cohen's kappa was used to express reproducibility., Results: The reproducibility for active and passive range of motion was moderate (kappa = 0.52 and 0.54, respectively), but a wide range in kappa scores was found. Extension of the neck showed good reproducibility for both active and passive movements (kappa = 0.88 and 0.85), whereas lateral flexion showed poor reproducibility (kappa = 0.35 and 0.33). Knowledge of history had no influence on the reproducibility and prevalence of positive findings., Conclusion: The reproducibility for active and passive range of motion is moderate. Knowledge of the patient's history did not influence the reproducibility and prevalence of positive findings.

The objective of our prospective inception cohort study was to identify prognostic factors for poor recovery in patients with whiplash-associated disorders grade 1 or 2 who still had neck pain and accompanying complaints 2 weeks after the accident. The study was carried out in a primary health care setting in The Netherlands and included 125 patients. The primary outcome measure was functional recovery defined in terms of neck pain intensity or work disability without medication use. The secondary outcome measures included neck pain intensity, work disability and sick leave. The outcomes were assessed at 4, 12 and 52 weeks after the accident. Prognostic factors were identified by logistic regression analyses. One year after the injury, 64% of the patients were recovered. Factors related to poor recovery were female gender, a low level of education, high initial neck pain, more severe disability, higher levels of somatisation and sleep difficulties. Neck pain intensity and work disability proved to be the most consistent predictors for poor recovery. The accuracy of the predictions of the prognostic models was high, meaning that the models adequately distinguished patients with poor recovery from those regarded as recovered. These findings add to the growing body of evidence, indicating that socio-demographic, physical and psychological factors affect short- and long-term outcome after whiplash injury. Our findings also indicate that care providers can easily identify patients at risk for poor recovery with a visual analogue scale for initial pain intensity and work-related activities.

Background: Chronic neck pain is a common complaint in the Netherlands with a point prevalence of 14.3%. Patients with chronic neck pain are often referred to a physiotherapist and, although many treatments are available, it remains unclear which type of treatment is to be preferred. The objective of this article is to present the design of a randomised clinical trial, Ephysion, which examines the clinical and cost effectiveness of behavioural graded activity compared with a physiotherapy treatment for patients with chronic non-specific neck pain., Methods: Eligible patients with non-specific neck pain persisting longer than 3 months will be randomly allocated to either the behavioural graded activity programme or to the physiotherapy treatment. The graded activity programme is based on an operant approach, which uses a time-contingent method to increase the patient's activity level. This treatment is compared with physiotherapy treatment using a pain-contingent method. Primary treatment outcome is the patient's global perceived effect concerning recovery from the complaint. Global perceived effect on daily functioning is also explored as primary outcome to establish the impact of treatment on daily activity. Direct and indirect costs will also be assessed. Secondary outcomes include the patient's main complaints, pain intensity, medical consumption, functional status, quality of life, and psychological variables. Recruitment of patients will take place up to the end of the year 2004 and follow-up measurement will continue until end 2005.

To compare prevalence rates of serious and non-serious adverse events after manipulation and mobilization and to identify risk factors of serious and non-serious adverse events following 4 types of manual therapy treatment in patients with neck pain. A prospective cohort study in primary care manual therapy practice. Patients with neck pain (N=686) provided data on adverse events after 1014 manipulation treatments, 829 mobilization treatments, 437 combined manipulation and mobilization treatments, and 891 treatments consisting of "other treatment modality". Usual care manual therapy. A chi-square test was performed to explore differences in prevalence rates. Logistic regression analysis was performed within the 4 treatment groups. A priori we defined associations between patient-characteristics and adverse events of odds ratio (OR)>2 or OR<0.5 as clinically relevant. No serious adverse events, such as cervical artery dissection or stroke, were reported. With regard to non-serious adverse events, we found that these are common after manual therapy treatment: prevalence rates are ranging from 0.3% to 64.7%. We found a statistically significant difference between the 4 types of treatments, detrimental to mobilization treatment. Logistic regression analysis resulted in 3 main predictors related to non-serious adverse events after manual therapy treatment: smoking (OR ranges from 2.10 [95% confidence interval [CI] 1.37-3.11] to 3.33 [95% CI 1.83-5.93]), the presence of comorbidity (OR ranges from 2.32 [95% CI 1.22-4.44] to 3.88 [95% CI 1.62-9.26]), and female sex (OR ranges from 0.22 [95% CI 0.11-0.46] to 0.49 [95% CI 0.28-0.86]). There is a significant difference in the occurrence of non-serious adverse events after mobilization compared with manipulation or a combination of manipulation and mobilization. Non-serious adverse events in manual therapy practice are common and are associated with smoking and the presence of comorbidity. In addition, women are more likely to report non-serious adverse events. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate whether the predictive validity of the Dutch version of the STarT Back Tool (SBT) can be improved by (1) using other cut-off values, (2) changing the items, or (3) adding prognostic factors to the SBT. Design: This was a secondary analysis of a prospective cohort study (PRINS study: Prevalence of Risk groups in Neck- and back pain patients according to the STarT back screening tool) in patients with low back or neck pain. Methods: The predictive validity was calculated with a relative risk ratio and a Spearman correlation. The new cut-off values were calculated with receiver operating characteristic curves. Replacing items of the SBT and adding new items were assessed with logistic regression analyses. Results: A total of 150 patients were included; 51% were categorized as having low risk, 39% as moderate risk, and 11% as high risk. Changing the cut-off total score to ≤2 and the subscore to ≥5 led to an improvement of the Spearman correlation and RR. Adding the item "duration of the complaints" improved the RR for moderate risk (3.6) (95% CI = 1.6–7.9) and for high risk (9.0) (95% CI = 4.2–19.1) compared with low risk. The new Spearman correlation was improved to rs = 0.37. Conclusion: The predictive validity was improved by adding the item "duration of the complaints" and changing the cut-off values. [ABSTRACT FROM AUTHOR]

The article assesses the diagnostic accuracy of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) framework for evaluating vascular complications in patients seeking physiotherapy care for neck pain and/or headache, finding poor accuracy.