Factors Related to Pain and Disability Outcomes After an Internet-Delivered or Physiotherapist-Led Exercise Program for Individuals With Chronic Whiplash Symptoms: Secondary Analysis of a Randomized Controlled Study
Notice bibliographique
Résumé
Background: A neck-specific exercise program has shown sustained clinically important changes in pain and disability for approximately 50% of individuals with chronic whiplash-associated disorders (WAD). However, there is limited information about factors related to treatment response. Objective: The aim of this study is to identify factors related to changes in disability, neck pain, and physical function after a neck-specific exercise program delivered in 2 different ways for individuals with persistent WAD grade II or III, and to investigate whether any factors could predict those with clinically improved versus not improved disability, pain, and physical function. Methods: This was a planned secondary analysis of a multicenter prospective randomized controlled trial. Participants (n=140) with persistent (between 6 mo and 5 y from injury) WAD grade II or III were randomized into a 12-week, internet-based neck-specific exercise program (NSEIT) with 4 physiotherapy visits or the same exercise program supervised by a physiotherapist (NSE) twice per week for 12 weeks. Multivariate data analyses and orthogonal partial least squares (OPLS) models were used to investigate change in psychological and physiological factors (independent factors) related to change in the dependent factors: neck-related disability measured with the Neck Disability Index (NDI), neck pain intensity measured with a visual analogue scale, and physical function measured with the Patient-Specific Functional Scale (PSFS). Outcomes were measured at baseline and at 3-month and 15-month follow-up. OPLS discriminant analysis was used to investigate differences between the two groups (NSEIT and NSE) by studying the change scores of the dependent and independent factors. OPLS discriminant analysis was also used to investigate whether background variables and baseline measurements of the independent factors could predict clinically significant improvement in the dependent factors NDI, neck pain, and PSFS. Results: There were no significant differences between the groups. In both NSEIT and NSE, improvements in the following independent factors were related to improvements in NDI, pain, and PSFS at 3-month and 15-month follow-up: anxiety, depression, cognitive failures, pain catastrophizing, self-efficacy, fear avoidance beliefs, cervical range of motion, headache, and symptom satisfaction (R2=0.31-0.37; Q2=0.25-0.30; cross-validated ANOVA P<.001). No significant OPLS models could be built to distinguish clinically improved versus nonimproved patients as assessed by NDI, neck pain, or PSFS. Conclusions: Improvements in both psychological and physiological factors were related to improvements in disability, neck pain, and physical function after 12 weeks of NSEIT or NSE. The results indicate that these factors are interrelated and can be improved both with NSEIT and NSE. Known risk factors for poor outcomes of neck disability in WAD, such as low self-efficacy, fear avoidance beliefs, depressive symptoms, and catastrophizing, were improved, and we need to examine other factors not included in this study that can identify those who are not improved after NSEIT or NSE.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,009 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,005 | 0,007 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».