Directional preference constructs for patients’ neck pain in the absence of centralization

ABSTRACT

Objectives: We conducted a secondary analysis of a prospective, observational cohort study to (1) report the prevalence of Directional Preference (DP) constructs at first examination for patients with cervical spine challenges, and (2) determine the association between DP constructs and clinical outcomes at discharge from physical therapy.

Methods: We analyzed data collected from 718 consecutive patients who presented to outpatient, private practice clinics with primary complaints of non-specific neck pain; 200 patients met the inclusion criteria and completed first examination and discharge data. Statistical analysis determined the association between DP constructs at first examination and clinical outcomes at discharge.

Results: The findings in this investigation were that (1) the most prevalent DP constructs at first examination were related to ROM and pain intensity including Patient Reported Improvement in ROM (79.5%), Increase in Spine ROM (32.5%), and Pain Intensity Change (15.0%), (2) all DP groups improved and met the MCID for disability and pain intensity change at discharge except for the group that did not exhibit Increase in Spine ROM for pain intensity, (3) no clinically significant differences in pain intensity or disability existed between DP groups at discharge, and (4) 28.5% and 6.5% of patients exhibited a relative increase in cervical spine extension and flexion ROM, respectively, post-repeated movement testing on the first examination.

Discussion: The most prevalent DP constructs at first examination were related to ROM and pain intensity, and each was associated with a comparable clinical trajectory in terms of pain and disability outcomes at discharge. The findings of this study help Mechanical Diagnosis and Therapy (MDT) providers understand the common DP constructs encountered in routine clinical practice and their relation to pain and disability outcomes for patients with cervical spine challenges.

Level of Evidence: 2b

KEYWORDS:

• Cervical spine
• neck pain
• directional preference
• McKenzie
• centralization
• practice-based evidence
• orthopedic
• musculoskeletal

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Richard Yarznbowicz

Richard Yarznbowicz obtained his doctor of physical therapy from the University of the Sciences in Philadelphia in 2010 before earning his diploma in Mechanical Diagnosis and Therapy in 2013. He is also a board certified Orthopedic Clinical Specialist. He has authored and co-authored several publications regarding the assessment and treatment of patients with musculoskeletal disorders.

Minjing Tao

Minjing Tao is an Assistant Professor of Statistics at The Florida State University. She earned her Ph.D. in Statistics from UW-Madison in 2013. Her research interests have included high dimensional data analysis, financial time series, and statistical inference for high-frequency financial data.