Less literature available on efficacy than effectiveness
Neck pain represents the fourth leading cause of disability worldwide, and its general prevalence in the U.S. is approximately 15%. Physical therapy is one of the numerous treatment options available for neck pain, and although studies have consistently found it to be efficacious in randomized-controlled trials (RCTs) with a carefully selected patient population, there is a dearth of literature on its real-world effectiveness in an uncontrolled setting. For this reason, a retrospective cohort study was conducted to determine the real-world effectiveness of physical therapy for common neck pain diagnoses and the significant factors for failure to improve.
Minimal clinically important difference used in analysis
Data was obtained from a national physical therapy chain that enrolled patients being treated for a neck pain-related diagnosis—except for spondylolisthesis—which led to 1,554 patients being included. Physical therapy consisted of typical manual techniques, exercise education, and modalities based on what the therapist deemed appropriate. To evaluate the real-world effectiveness of physical therapy, researchers used a threshold minimal clinically important difference (MCID) in the analysis for each of the following three outcome measures: neck disability index (NDI) and numeric pain rating scale (NPRS) at rest and during activity.
Physical therapy should remain recommended first-line treatment for neck pain
Results indicated that the proportion of patients achieving MCID was 40.5% for NDI, 50.6% for resting NPRS, and 52.1% for activity NPRS. Collectively, this equated to a real-world effectiveness of physical therapy for common neck pain diagnoses of approximately 50%. Worker's compensation status was found to be associated with increased odds to treatment failure across all three outcome measures, which is consistent with prior literature. To the authors' knowledge, although there is an abundance of literature on the efficacy of physical therapy in RCTs, this is the first study to report on its real-world effectiveness for neck pain, which is extremely valuable since it analyzes a more realistic representation of the population. While this roughly 50% effectiveness may seem low, the authors advise that physical therapy should still be regarded as the first-line treatment for most neck pain patients, and clinicians are therefore encouraged to refer presenting patients accordingly to help them achieve optimal outcomes in a timely manner.
-Summarized by Greg Gargiulo
-As reported in the November '18 issue of Clinical Spine Surgery