Measurement of outcomes for patients with centralising versus non-centralising neck pain

摘要

Individuals with neck pain constitute the second largest outpatient population in physical therapy.1 Approximately 50–70% of the population has experienced neck pain in the past 6?months.2,3 Influencing factors of neck pain may include poor posture, muscle sprains, injuries resulting from sporting or occupational activities, or psychological factors such as anxiety or depression.4,5Neck pain commonly arises insidiously and is generally multifactorial in nature.6 Individuals experiencing radiating pain typically describe peripheral symptoms that are felt in the upper extremity. Cervical radiculopathy is the clinical description of pain and neurological symptoms of nerve root origin. Individuals who demonstrate cervical radiculopathy present with intermittent or constant peripheralisation of symptoms.Currently, a variety of treatments are used to decrease pain and increase function, but few studies demonstrate which interventions promote the best functional outcomes for individuals with neck pain.7–9 A common principle of treatment used by physical therapists for management of spinal pain is Mechanical Diagnosis and Therapy (MDT).7 According to the patient's response to repeated end range spinal loading movements, MDT classifies patients into three syndromes: dysfunction, derangement or postural syndrome.10 The most prevalent classification is the derangement syndrome, defined as an internal articular displacement that causes a disturbance in the joint and produces pain.11 Symptomatic and mechanical changes may occur with therapeutic loading strategies. Performance of movements that reduce the internal articular displacement can result in a decrease, abolition or centralisation (CEN) of symptoms as well as improvement in range of motion and function. Directional preference is the phenomenon of preference for postures and/or movements that decreases, abolishes or centralises symptoms and/or improves a limited motion.12 The patient's directional preference guides the prescription of specific exercises for treatment. Centralisation, a form of directional preference, is characterised by spinal pain and referred symptoms that are progressively abolished in a distal to proximal direction in response to therapeutic loading strategies.13 Additionally, patients can exhibit non-centralisation (NC) in which the symptoms remain at the distal segment and the symptoms do not move with therapeutic loading strategies. Improvement of function is assessed through the phenomenon of ‘CEN’ of symptoms as reported by the patient.7The hypothesis for this study was that the CEN as observed in patients would be associated with more favourable functional outcomes as compared to the outcomes of these patients who do not demonstrate centralisation (NC). Centralisation as seen in patients with low back pain (LBP) has been found to be an excellent predictor of a favourable outcome.12–18 Although Edmond et al. found individuals with neck pain who presented with CEN or a directional preference demonstrated improvements in functional outcomes,14 the research is limited. Therefore, the purpose of this study is to determine the relationship between CEN and outcome in people with neck pain and peripheral symptoms who are treated in physical therapy according to the MDT approach.