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

Wingbermühle, RW; Heymans, MW; van Trijffel, E; Chiarotto, A; Koes, B; Verhagen, AP

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

Wingbermühle, RW Heymans, MW van Trijffel, E Chiarotto, A Koes, B Verhagen, AP

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Publisher:: Elsevier BV
Publication Type:: Journal Article
Citation:: Brazilian Journal of Physical Therapy, 2021
Issue Date:: 2021-07-01

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Field	Value	Language
dc.contributor.author	Wingbermühle, RW
dc.contributor.author	Heymans, MW
dc.contributor.author	van Trijffel, E
dc.contributor.author	Chiarotto, A
dc.contributor.author	Koes, B
dc.contributor.author	Verhagen, AP
dc.date.accessioned	2021-10-08T02:51:41Z
dc.date.available	2021-06-08
dc.date.available	2021-10-08T02:51:41Z
dc.date.issued	2021-07-01
dc.identifier.citation	Brazilian Journal of Physical Therapy, 2021
dc.identifier.issn	1413-3555
dc.identifier.issn	1809-9246
dc.identifier.uri	http://hdl.handle.net/10453/150928
dc.description.abstract	<h4>Background</h4>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.<h4>Objective</h4>The purpose of this study was to externally validate three promising models that predict neck pain recovery in primary care.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier BV
dc.relation.ispartof	Brazilian Journal of Physical Therapy
dc.relation.isbasedon	10.1016/j.bjpt.2021.06.001
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1117 Public Health and Health Services
dc.title	External validation of prognostic models for recovery in patients with neck pain
dc.type	Journal Article
utslib.location.activity	Brazil
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	open_access	*
dc.date.updated	2021-10-08T02:51:40Z
pubs.publication-status	Published

Abstract:

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.

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http://hdl.handle.net/10453/150928