Baseline characteristics of patients with nerve-related neck and arm pain predict the likely response to neural tissue management

Nee, Robert J., Vicenzino, Bill, Jull, Gwendolen A., Cleland, Joshua A. and Coppieters, Michel W. (2013) Baseline characteristics of patients with nerve-related neck and arm pain predict the likely response to neural tissue management. Journal of Orthopaedic and Sports Physical Therapy, 43 6: 379-391. doi:10.2519/jospt.2013.4490


Author Nee, Robert J.
Vicenzino, Bill
Jull, Gwendolen A.
Cleland, Joshua A.
Coppieters, Michel W.
Title Baseline characteristics of patients with nerve-related neck and arm pain predict the likely response to neural tissue management
Journal name Journal of Orthopaedic and Sports Physical Therapy   Check publisher's open access policy
ISSN 0190-6011
1938-1344
Publication date 2013-06
Year available 2013
Sub-type Article (original research)
DOI 10.2519/jospt.2013.4490
Volume 43
Issue 6
Start page 379
End page 391
Total pages 13
Place of publication Alexandria, VA United States
Publisher American Physical Therapy Association, Orthopedic Section
Collection year 2014
Language eng
Formatted abstract
Study Design Planned secondary analysis of a randomized controlled trial comparing neural tissue management (NTM) to advice to remain active.

Objective To develop a model that predicts the likelihood of patient-reported improvement following NTM.

Background
Matching patients to an intervention they are likely to benefit from potentially improves outcomes. However, baseline characteristics that predict patients' responses to NTM are unknown.

Methods Data came from 60 consecutive adults who had nontraumatic, nerve-related neck and unilateral arm pain for at least 4 weeks. Participants were assigned to a group that received NTM (n = 40), which involved brief education, manual therapy, and nerve gliding exercises for 4 treatments over 2 weeks, or to a group that was given advice to remain active (n = 20), which involved instruction to continue their usual activities. The participants' global rating of change at a 3- to 4-week follow-up defined improvement. Penalized regression of NTM data identified the best prediction model. A medical nomogram was created for prediction model scoring. Post hoc analysis determined whether the model predicted a specific response to NTM.

Results Absence of neuropathic pain qualities, older age, and smaller deficits in median nerve neurodynamic test range of motion predicted improvement. Prediction model cutoffs increased the likelihood of improvement from 53% to 90% (95% confidence interval: 56%, 98%) or decreased the likelihood of improvement to 9% (95% confidence interval: 1%, 42%). The model did not predict the outcomes of the advice to remain active group.

Conclusion Baseline characteristics of patients with nerve-related neck and arm pain predicted the likelihood of improvement with NTM. Model performance needs to be validated in a new sample using different comparison interventions and longer follow-up. Australian New Zealand Clinical Trials Registry




Keyword Cervical radicular pain
Clinical prediction rule
Medical nomogram
Neurodynamic treatment
Penalized regression
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Health and Rehabilitation Sciences Publications
 
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