In 2007, a study conducted by Hill, et. al., aimed to identify predictors of poor outcome in patients undergoing physical therapy for neck pain. The researchers also compared these findings with the subjective perceptions of physical therapy practitioners regarding predictors of treatment outcome. Understanding these predictors is crucial for optimizing treatment approaches and improving patient care.

The study involved a secondary analysis of data obtained from a randomized controlled trial that assessed the efficacy of physical therapy treatments for neck pain. The trial included a total of 346 participants. At the beginning of the trial, participants completed a baseline questionnaire, which collected data on various potential risk factors associated with poor treatment outcomes. Follow-up assessments were conducted via postal questionnaires at 6 weeks and 6 months after the start of treatment. Outcome measures were evaluated using perceived global change and minimal clinically important differences in the Northwick Park Neck Pain Questionnaire (MCID-NPQ). In addition, physical therapy practitioners’ perceptions of predictors for treatment outcome were captured using a separate questionnaire, and their ratings were compared with the data derived from the trial.

The analysis revealed that baseline characteristics accounted for a significantly higher proportion of the explained variance in global change compared to MCID-NPQ at the 6-month follow-up. Independent factors influencing treatment outcome included manual social class, catastrophizing (exaggerated negative thinking), anxiety and depression levels, low treatment expectations, severity of baseline neck pain and disability, presence of comorbid back pain, and older age. Interestingly, the perceptions of physical therapy practitioners regarding predictors of treatment outcome were highly consistent with the ranks derived from the trial data.

This study identified several significant predictors of treatment outcome, particularly at the 6-month mark, encompassing psychosocial, functional, and demographic indicators. The findings suggest that physical therapists have a collective awareness of the relative importance of physical and psychosocial factors in predicting clinical outcomes for patients with neck pain. However, despite these advances, a substantial amount of variability in treatment outcomes remained unexplained. Therefore, further exploration of underlying factors is necessary to enhance clinical decision-making and optimize patient care.

Reference: Hill, J. C., Lewis, M., Sim, J., Hay, E. M., & Dziedzic, K. (2007). Predictors of poor outcome in patients with neck pain treated by physical therapy. The Clinical journal of pain, 23(8), 683-690.