Self-Management for Persistent Neck Pain: 9-year Follow-up
In the United States, clinicians have been forced away from providing group services due to the current payment model based on a fee schedule. I do have some issues with this study: patients weren't risk adjusted. We all know that some individuals will have poorer results than others due to certain factors that affect outcomes. If I ignore the lack of risk adjustment, my brain then settles on the NDI and its properties. The minimal detectable change for the NDI (0-50) is 10.5 points. This study used NDI (0-100). There really isn't a clinical difference between the two groups of patients with regard to functional ability. The Numerical Rating Scale (0-10) for pain has a minimal detectable change of 4.3 points. Again, there isn't a clinical difference between the groups.
The relevance of this study is that clinicians can treat these individuals in a group setting with a focus on self-efficacy and group discussions or clinicians can provide individualized physical therapy sessions. Studies like this open the door changing delivery models of care. Before the fee for service model becomes extinct, clinicians need to plan out new delivery models of care that can be implemented.
Here's a quick view of the abstract.
A 9-year follow-up of a self-management group intervention for persistent neck pain in primary healthcare: a randomized controlled trial.
In previous short-term and 2-year follow-ups, a pain and stress self-management group intervention (PASS) had better effect on pain-related disability, self-efficacy, catastrophizing, and perceived pain control than individually administered physiotherapy (IAPT) for patients with persistent tension-type neck pain. Studies that have evaluated long-term effects of self-management approaches toward persistent neck pain are sparse. The objective of this study was to compare pain-related disability, self-efficacy for activities of daily living (ADL), catastrophizing, pain, pain control, use of analgesics, and healthcare utilization in people with persistent tension-type neck pain 9 years after they received the PASS or IAPT.
MATERIALS AND METHODS:
Of 156 people (PASS, n = 77; IAPT, n = 79) originally included in a randomized controlled trial, 129 people (PASS, n = 63; IAPT, n = 66) were eligible and were approached for the 9-year follow-up. They were sent a self-assessment questionnaire, comprising the Neck Disability Index, the Self-Efficacy Scale, the Coping Strategies Questionnaire, and questions regarding pain, analgesics, and healthcare utilization. Mixed linear models for repeated measures analysis or generalized estimating equations were used to evaluate the differences between groups and within groups over time (baseline, previous follow-ups, and 9-year follow-up) and the interaction effect of "time by group".
Ninety-four participants (73%) responded (PASS, n = 48; IAPT, n = 46). At 9 years, PASS participants reported less pain-related disability, pain at worst, and analgesics usage, and a trend toward better self-efficacy compared to IAPT participants. There was a difference between groups in terms of change over time for disability, self-efficacy for ADL, catastrophizing, perceived pain control, and healthcare visits in favor of PASS. Analyses of simple main effects at 9 years showed that the PASS group had less disability (p = 0.006) and a trend toward better self-efficacy (p = 0.059) than the IAPT group.
The favorable effects on pain-related disability of PASS were sustained 9 years after the intervention.
J Pain Res. 2016 Dec 30;10:53-64. doi: 10.2147/JPR.S125074. eCollection 2017.