Predictors of Poor Outcome in Patients With Neck Pain Treated by Physical Therapy Assessment of a traditional acupuncture therapy for chronic neck pain: a pilot randomised controlled study. Comparison of the effectiveness of a behavioural graded activity program and manual therapy in patients with sub-acute neck pain: design of a randomized clinical trial. Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: Design of a randomised controlled trial Testing the feasibility of a knowledge translation intervention designed to improve chiropractic care for adults with neck pain disorders: study protocol for a pilot cluster-randomized controlled trial The ability to change of three questionnaires for neck pain. Subjective Health Measure Used on Chinese Patients With Neck Pain in Hong Kong Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain? A randomised control trial with a 4-month follow up. Efficacy of a Patient-Educational Booklet for Neck-Pain Patients With Workers' Compensation: A Randomized Controlled Trial Sensitivity to Change and Internal Consistency of the Northwick Park Neck Pain Questionnaire and Derivation of a Minimal Clinically Important Difference Is a Behavioral Graded Activity Program More Effective Than Manual Therapy in Patients With Subacute Neck Pain?: Results of a Randomized Clinical Trial Comparative effectiveness of manipulation, mobilisation and the Activator instrument in treatment of non-specific neck pain: a systematic review Clinical Pressure Pain Threshold Testing in Neck Pain: Comparing Protocols, Responsiveness, and Association With Psychological Variables Perceived value of spinal manipulative therapy and exercise among seniors with chronic neck pain: a mixed methods study. Accurately measuring the quality and effectiveness of cervical spine surgery in registry efforts: determining the most valid and responsive instruments. Reliability of 3 Assessment Tools Used to Evaluate Randomized Controlled Trials for Treatment of Neck Pain Validity of five common manual neck pain provoking tests.
Objectives This study evaluated predictors of poor outcome in patients with neck pain treated by physical therapy  , and sought to compare the findings of empirical data with physical therapy practitioners ' subjective perceptions about predictors of outcome . Methods This study was a secondary analysis of data from a r and omized controlled trial assessing physical therapy treatments for neck pain ( n=346 ) . A baseline question naire provided data on a number of potential risk factors of poor outcome at follow-up . Follow-up was conducted at 6 weeks and 6 months by postal question naire with outcome defined separately by perceived ( global ) change and minimal clinical ly important differences in the Northwick Park Neck Pain Question naire ( MCID-NPQ ) . Therapists ' perceptions of predictors for treatment outcome were captured using a separate question naire , and the ratings compared with ranks derived from the 6-month trial data . Results Baseline characteristics accounted for a much greater proportion of explained variance for global change compared with MCID-NPQ at 6 months . Independent biopsychosocial characteristics included manual social class , catastrophizing , anxiety and depression , low treatment expectations , severity of baseline neck pain/disability , presence of comorbid back pain , and older age . Physical therapist ranks correlated highly with those derived from the trial data . Conclusions Significant predictors of outcome were identified , particularly at 6 months , including psychosocial , functional , and demographic indicators . Our findings suggest that physical therapists are collectively aware of the relative importance of physical and psychosocial factors in predicting clinical outcome . However , a significant amount of variability in outcomes in our prognostic models remained largely unexplained , indicating that we need to explore further underlying factors to inform clinical decision-making OBJECTIVE This study is aim ed to assess the efficacy of traditional acupuncture for chronic neck pain in patients by comparing the differences in symptoms , dysfunctions and quality of life . METHODS The study used a two-arm , single-blinded , r and omised controlled design . The patients were r and omised to the study group and control group , who respectively received traditional acupuncture and placebo treatment . The Northwick Park Neck Pain Question naire ( NPQ ) , visual analogue scale ( VAS ) , Short Form ( 36 ) Health Survey ( SF-36 ) and doctor 's judgement were applied for measuring effectiveness . The patients ' effectiveness outcome was assessed , respectively , before the intervention , immediately after the intervention , at the end of the first month of follow-up and at the end of the third month of follow-up . The statistical analysis was done on Statistical Package for Social Sciences ( SPSS ) v13 , which included comparison of demographic and clinical homogeneity , the repeated measures approach based on the general linear model ( GLM ) for effectiveness assessment and the sum rank test for doctors ' subjective efficacy judgement . RESULTS Totally , 190 patients were recruited and 178 patients ( 88 in the study group and 90 in the control group ) completed the intervention and follow-up assessment . The scores of NPQ , VAS and SF-36 were improved after the intervention and during follow-up ( P<0.01 vs. before the intervention ) . The patients in the study group had better effectiveness outcome in NPQ , VAS and in the VT , SF and MH domains of SF-36 ( P<0.05 ) . CONCLUSION Traditional acupuncture can relieve pain intensity and improve the quality of daily life with a relative long-term clinical efficacy in patients with chronic neck pain The objective is to present the design of a r and omized clinical trial ( RCT ) on the effectiveness and cost effectiveness of a behavioural grade d activity programme compared with manual therapy in patients with sub-acute neck pain . Sub-acute is defined as pain existing for 4 - 12 weeks . The behavioural grade d activity programme is a time-contingent increase in activities from baseline towards pre-determined goals . Manual therapy consists mainly of specific spinal mobilization techniques and exercises . The primary outcomes are global perceived effect and functional status . Secondary outcomes are kinesiophobia , distress , coping , depression and somatization . The intensity and persistence of the pain and its interference with activities are also assessed . Direct and indirect costs are measured by means of cost diaries . Measurements take place at baseline and 6 and 12 weeks after r and omization . To assess the long-term effect , measurements will also take place after 6 and 12 months . Finally some challenges are discussed concerning the use of a behavioural grade d activity programme , manual therapy and outcomes Background Many patients suffer from chronic neck pain following a whiplash injury . A combination of cognitive , behavioural therapy with physiotherapy interventions has been indicated to be effective in the management of patients with chronic whiplash-associated disorders . The objective is to present the design of a r and omised controlled trial ( RCT ) aim ed at evaluating the effectiveness of a combined individual physical and cognitive behavioural- grade d activity program on self-reported general physical function , in addition to neck function , pain , disability and quality of life in patients with chronic neck pain following whiplash injury compared with a matched control group measured at baseline and 4 and 12 months after baseline . Methods / Design The design is a two-centre , RCT - study with a parallel group design . Included are whiplash patients with chronic neck pain for more than 6 months , recruited from physiotherapy clinics and an out-patient hospital department in Denmark . Patients will be r and omised to either a pain management ( control ) group or a combined pain management and training (intervention)group . The control group will receive four educational sessions on pain management , whereas the intervention group will receive the same educational sessions on pain management plus 8 individual training sessions for 4 months , including guidance in specific neck exercises and an aerobic training programme . Patients and physiotherapists are aware of the allocation and the treatment , while outcome assessors and data analysts are blinded . The primary outcome measures will be Medical Outcomes Study Short Form 36 ( SF36 ) , Physical Component Summary ( PCS ) . Secondary outcomes will be Global Perceived Effect ( -5 to + 5 ) , Neck Disability Index ( 0 - 50 ) , Patient Specific Functioning Scale ( 0 - 10 ) , numeric rating scale for pain bothersomeness ( 0 - 10 ) , SF-36 Mental Component Summary ( MCS ) , TAMPA scale of Kinesiophobia ( 17 - 68 ) , Impact of Event Scale ( 0 - 45 ) , EuroQol ( 0 - 1 ) , craniocervical flexion test ( 22 mmHg - 30 mmHg ) , joint position error test and cervical range of movement . The SF36 scales are scored using norm-based methods with PCS and MCS having a mean score of 50 with a st and ard deviation of 10 . Discussion The perspectives of this study are discussed , in addition to the strengths and weaknesses . Trial registration The study is registered in http://www . Clinical Trials.gov identifier NCT01431261 Background Neck pain in adults is common and a leading cause of physical disability . Recently , a guideline was developed for the management of non-specific neck pain ( NSNP ) with an aim to improve the quality of the delivery of chiropractic care . One key guideline recommendation is to undertake multimodal care for patients with NSNP . The aim of this pilot study is to determine the feasibility of implementing a multifaceted knowledge translation intervention by promoting the use of multimodal care by chiropractors managing patients with NSNP . Methods / design The design is a cluster-r and omized controlled pilot and feasibility trial . Chiropractors in private practice in Canada will be approached to participate in the study . Thirty consenting chiropractors will be r and omized to receive either a theory-based educational intervention in the experimental group or simply a printed copy of the guideline in the control group .  Each chiropractor will recruit five neck pain patients ( a total of 150 patients ) into the study . Development of the multifaceted intervention was informed by the results of a related qualitative study based on the Theoretical Domains Framework and consists of a series of three webinars , two online case scenarios , a self-management video on Brief Action Planning , and a printed copy of the practice guideline . Primary feasibility outcomes for both chiropractors and patients include rates of ( 1 ) recruitment , ( 2 ) retention , and ( 3 ) adherence to the intervention . A checklist of proxy measures embedded within patient encounter forms will be used to assess chiropractors ’ compliance with guideline recommendations ( e.g. exercise and self-care prescriptions ) at study onset and at 3 months . Secondary outcomes include scores of behavioural constructs ( level of knowledge and self-efficacy ) for recommended multimodal care . Clinical outcomes include pain intensity and neck pain-specific disability . Analyses from this study will focus on generating point estimates and corresponding 95 % confidence intervals for parameters of a priori interest ( recruitment , retention , adherence , pain intensity , Neck Disability Index ) . Discussion Results of this study will inform the design of a larger cluster-r and omized controlled trial aim ed at evaluating the effectiveness of the theory-based tailored intervention and increasing the use of multimodal care by chiropractors managing patients with NSNP.Trial registration https:// clinical trials.gov/ , OBJECTIVE To assess the sensitivity to change of three algofunctional scales for neck pain . METHODS Observational , prospect i ve study . Patients with neck disorders were included .  Pain and patients ' perceived h and icap assessed on visual analogue scales ( VAS Pain , VAS H and icap ) , and functional disability measures ( Neck Disability Index , Neck Pain and Disability Scale , Northwick Park Neck Pain Question naire  )  were recorded twice , at baseline and at an 11-month follow-up assessment . Sensitivity to change was assessed using the effect size ( ES ) and the st and ardised response mean ( SRM ) , and the non-parametric Spearman 's rank correlation coefficient ( r ) was used to assess the correlation between quantitative variable changes and patients ' overall opinion . Analysis of variance ( ANOVA ) followed by a Tukey-test was performed to determine if the scales distinguished improved , stable , and deteriorated patients . RESULTS Seventy-one patients ( 43 women , mean age 49 years ) were included and evaluated twice at an interval of 11 + /- 2 months . The three scales showed good sensitivity to change . The ANOVA showed a group effect , and individual changes in the scales scores were statistically different in two-by-two comparisons ( improved , stable or deteriorated patients ) . Changes in NPDS scores had the highest correlation with patient 's overall assessment ( r = 0.592 ) . CONCLUSION The three scales can detect changes in patients with neck disorders . Changes in NPDS score had the best correlation with patients ' overall opinion concerning their neck disorder and this question naire should be given preference in clinical trials Study Design . A prospect i ve observational study was conducted on the use of the Chinese version of the Northwick Park Neck Pain Question naire . Objective . To examine the reliability , validity , and responsiveness of the Chinese version of the Northwick Park Neck Pain Question naire in Chinese patients with neck pain in Hong Kong . Summary of Background Data . There is increasing recognition that patient perspectives are essential both in making medical decisions and in judging the treatment outcomes . A valid Chinese version of a neck disability index question naire is urgently needed for effective and reliable evaluation of the treatment outcomes for patients with neck pain . Methods . Two sample s with 532 consecutive adult patients with neck pain from seven physiotherapy outpatient departments in Hong Kong who completed the Northwick Park Neck Pain Question naire  were observed and measured at different intervals : at the beginning of physiotherapy , at 7 days , at 3 weeks , and 6 weeks after physiotherapy . Results . The question naire had good content validity , very good test – retest reliability , and internal consistency ( intraclass correlation coefficient , 0.95 ; Cronbach ’s alpha , 0.87 ) . It also had good validity ( Spearman correlation coefficient of 0.59 when the score was correlated with that of a generic 42-item Chinese health question naire ) and good responsiveness ( effect size of 1.11 at week 6 after treatment began ) . Conclusions . The Chinese version of the Northwick Park Neck Pain Question naire has been shown to demonstrate very good content validity , a high degree of test – retest reliability , and internal consistency . It also exhibited good construct validity and high sensitivity to changes in severity over time AIM To investigate the effect of combining pain education , specific exercises and grade d physical activity training ( exercise ) compared with pain education alone ( control ) on physical health-related quality of life ( HR-QoL ) in chronic neck pain patients . METHODS A multicentre r and omised controlled trial of 200 neck pain patients receiving pain education .  The exercise group received additional exercises for neck/shoulder , balance and oculomotor function , plus grade d physical activity training .  Patient-reported outcome measures ( Short Form-36 Physical and Mental component summary scores , EuroQol-5D , Beck Depression Inventory-II , Neck Disability Index , Pain Bothersomeness , Patient-Specific Functioning Scale , Tampa Scale of Kinesiophobia , Global Perceived Effect ) and clinical tests ( Aastr and Physical Fitness , cervical Range of Motion , Pressure Pain Threshold at infraspinatus , tibialis anterior and cervical spine , Cranio-cervical Flexion , Cervical Extension muscle function , and oculomotion ) were recorded at baseline and after 4 months . RESULTS The exercise group showed statistically significant improvement in physical HR-QoL , mental HR-QoL , depression , cervical pressure pain threshold , cervical extension movement , muscle function , and oculomotion . Per protocol analyses confirmed these results with additional significant improvements in the exercise group compared with controls . CONCLUSIONS This multimodal intervention may be an effective intervention for chronic neck pain patients . TRIAL REGISTRATION The trial was registered on www . Clinical Trials.govNCT01431261 and at the Regional Scientific Ethics Committee of Southern Denmark S-20100069 Study Design . A r and omized controlled trial of an educational booklet for patients with first-time neck pain . Objective . To assess the clinical impact of a novel educational book on patients ' functional outcomes and beliefs about neck pain . Summary of Background Data . Previous research has shown that a novel education booklet ( The Back Book ) had a positive impact on patients with low back pain ' beliefs and clinical outcomes . The current study sought to evaluate the efficacy of a similar education booklet ( The Neck Book ) for neck-pain patients . Methods . Workers ' compensation patients were given either the experimental booklet , a traditional booklet or no booklet . The primary outcome measures , collected at 2-weeks , 3-months , and 6-months after baseline , were The Fear Avoidance Beliefs Question naire and The Neck Pain and Disability Scale . Health-related functional measures were also collected at these intervals . Results . Only 34 % ( N = 187 ) of an original cohort of patients ( N = 522 ) had data for all of the follow-up periods . For these 187 patients , repeated- measures analyses of covariance , using the baseline measure as the covariate , revealed no significant differences among the 3 groups on any of the outcome measures at any of the follow-up periods . For example , at 6-months , the experimental booklet , traditional booklet , and no-booklet groups reported The Neck Pain and Disability Scale mean scores ( SDs ) of 31.3 ( 15.5 ) , 35.3 ( 17.0 ) , and 31.8 ( 15.6 ) , respectively . Similarly , there were no significant effects for The Fear Avoidance Beliefs Question naire scores—35.9 ( 21.5 ) , 40.3 ( 22.1 ) , and 38.0 ( 23.4 ) , respectively . Conclusion . This study demonstrates that the educational booklets studied were not associated with improved outcomes in patients with neck pain receiving workers ' compensation . Whether these results would apply to a nonworkers ' compensation population requires further study . The loss of many patients to follow-up also makes any other firm conclusions more difficult to determine Objectives To estimate the sensitivity to change and internal consistency of the Northwick Park Neck Pain Question naire ( NPQ ) and derive its minimal clinical ly important difference ( MCID ) . Methods Data on 311 participants in a r and omized controlled trial of physical therapy for neck pain were analyzed , between baseline and 6-month follow-up . Cronbach α was used to estimate internal consistency . Three methods of evaluating the NPQ 's sensitivity to change were used ; Cohen 's effect size , st and ardized response mean , and Guyatt 's responsiveness statistic . The smallest change on the NPQ that can be construed as clinical ly important ( the MCID ) was obtained by ( 1 ) comparing values derived from different methods that account for the measurement error of the question naire with improvements in other neck pain-specific measures , and then ( 2 ) examining the impact of the addition of an independent measure ( “ anchor ” ) relating to participants ' subjective rating of improvement . Results Cronbach α was 0.79 for the whole scale . Using all participants , Cohen 's d was 0.78 , st and ardized response mean was 0.71 , and Guyatt 's responsiveness statistic was 0.93 . Using only participants who stated they had improved , the estimates were 1.35 , 1.27 , 1.45 , respectively . The MCID for the NPQ was determined as a 25 % reduction in score from baseline together with a patient 's global rating of their neck pain of at least “ better . ” Conclusions These results show high internal consistency and sensitivity to change for the NPQ , and provide an MCID that allows participants with varying levels of severity to demonstrate improvement Study Design . A r and omized clinical trial . Objective . To compare the effectiveness of a behavioral grade d activity program with manual therapy in patients with subacute ( 4–12 weeks ) nonspecific neck pain . Summary of Background Data . Neck pain is a common complaint , for which many conservative therapies are available in primary care . There is strong evidence for manual therapy in combination with exercises . Psychosocial factors are also believed to play a role in chronic pain . The evidence of the effectiveness of a program focused on these factors is still unknown . Methods . A r and omized clinical trial was conducted , involving 146 patients with subacute nonspecific neck pain .  The BGA program can be described as a time-contingent increase in activities from baseline toward predetermined goals . Manual therapy consists of specific spinal mobilization techniques and exercises . Primary outcomes were global perceived effect , the Numerical Rating Scale for pain and the Neck Disability Index . Secondary outcomes were the Tampa Scale for Kinesiophobia , the 4 Dimensional Symptom Question naire , and the Pain Coping and Cognition List . Measurements were carried out at baseline and 6 , 13 , 26 , and 52 weeks after r and omization . Data are analyzed according to the intention-to-treat principle , using multilevel analysis . Results . The success rates at 52 weeks , based on the GPE were 89.4 % for the BGA program and 86.5 % for MT . This difference was not statistically significant . For pain and disability , a difference was found in favor of the BGA program ; mean difference for pain = 0.99 ( 95 % CI 0.15–1.83 ) and mean difference for NDI = 2.42 ( 95 % CI 0.52–4.32 ) . All other differences between the interventions in the primary and secondary outcomes were not statistically significant . Conclusion . Based on this trial it can be concluded that there are only marginal , but not clinical ly relevant , differences between a BGA program and MT Background Neck pain is a common problem and different forms of manual therapy are used in its treatment . The purpose of this systematic review was to critically appraise the literature that directly compared manipulation , mobilisation and the Activator instrument for non-specific neck pain . Methods Electronic data bases ( MEDLINE , MANTIS and CINAHL ) were search ed from their inception to October 2005 for all English language r and omised clinical trials that directly compared manipulation , mobilisation and the Activator instrument . Inclusion and exclusion criteria were applied to select the studies and these studies were then evaluated using vali date d criteria . Results Five such studies were identified . The method ological quality was mostly poor . Findings from the studies were mixed and no one therapy was shown to be more effective than the others . Conclusion Further high quality research has to be done before a recommendation can be made as to the most effective manual method for non-specific neck pain Background Quantitative sensory testing , including  pressure pain threshold ( PPT ) , is seeing increased use in clinical practice . In order to facilitate clinical utility , knowledge of the properties of the tool and interpretation of results are required . Objectives This observational study used a clinical sample of people with mechanical neck pain to determine : ( 1 ) the influence of number of testing repetitions on measurement properties , ( 2 ) reliability and minimum clinical ly important difference , and ( 3 ) associations between PPT and key psychological constructs . Design This study was observational with both cross-sectional and prospect i ve elements . Methods Experienced clinicians measured  PPT  in patients with mechanical neck pain following a st and ardized protocol . Subcohorts also provided repeated measures and completed scales of key psychological constructs . Results The total sample was 206 participants , but not all participants provided data for all analyses . Interrater and 1-week test-retest reliability were excellent ( intraclass correlation coefficients [2,1]=.75–.95 ) . Potentially important differences in reliability and PPT scores were found when using only 1 or 2 repeated measures compared with all 3 . The PPT over a distal location ( tibialis anterior muscle ) was not adequately responsive in this sample , but the local site ( upper trapezius muscle ) was responsive and may be useful as part of a protocol to evaluate clinical change . Sensitivity values ( range=0.08–0.50 ) and specificity values ( range=0.82–0.97 ) for a range of change scores are presented . Depression , catastrophizing , and kinesiophobia were able to explain small but statistically significant variance in local PPT ( 3.9%–5.9 % ) , but only catastrophizing and kinesiophobia explained significant variance in the distal PPT ( 3.6 % and 2.9 % , respectively ) . Limitations Limitations of the study include multiple raters , unknown recruitment rates , and unknown measurement properties at sites other than those tested here . Conclusions The results suggest that PPT is adequately reliable and that 3 measurements should be taken to maximize measurement properties . The variance explained by the psychological variables was small but significant for 3 constructs related to catastrophizing , depression , and fear of movement . Clinical implication s for application and interpretation of PPT are discussed OBJECTIVE To explore perceptions of spinal manipulative therapy and exercise among adults aged 65 years and older with chronic neck pain . DESIGN Mixed methods study embedded within a r and omized clinical trial . SUBJECTS/ PATIENTS Interviews were conducted with 222 of 241 r and omized clinical trial participants . They had a mean age of 72.2 years and they had neck pain of moderate severity and of 6 years mean duration . METHODS Semi-structured interviews were conducted at the completion of the 12 week intervention phase , during which participants received spinal manipulative therapy and exercise interventions . Interviews explored determinants of satisfaction with care , whether or not therapy was worthwhile , and what was liked and disliked about treatment . Interviews were recorded and transcribed ; content analysis was used to identify themes within responses . RESULTS Participants placed high value on their relationships with health care team members , supervision , individualized care , and the exercises and information provided as treatment . Change in symptoms did not figure as prominently as social and process-related themes . Percpetions of age , activities , and co-morbities influenced some seniors ' expectations of treatment results , and comorbidities impacted perceptions of their ability to participate in active care . CONCLUSION Relationship dynamics should be leveraged in clinical encounters to enhance patient satisfaction and perceived value of care BACKGROUND CONTEXT There is a growing dem and to measure the real-world effectiveness and value of care across all specialties and disease states . Prospect i ve registries have emerged as a feasible way to capture real-world care across large patient population s. However , the proven validity of more robust and cumbersome patient-reported outcome instruments ( PROi ) must be balanced with what is feasible to apply in large-scale registry efforts . Hence , commercial registry efforts that measure quality and effectiveness of care in an attempt to guide quality improvement , pay for performance , or value-based purchasing should incorporate measures that most accurately represent patient-centered improvement . PURPOSE We set out to establish the relative validity and responsiveness of common PROi in accurately determining effectiveness of cervical surgery for neck and arm pain in registry efforts . STUDY DESIGN Prospect i ve cohort study . PATIENT SAMPLE Eighty-eight patients undergoing primary anterior cervical discectomy and fusion ( ACDF ) for neck and arm pain . OUTCOME MEASURES Patient-reported outcome measures for pain ( numeric rating scale for neck pain [ NRS-NP ] and arm pain [ NRS-AP ] ) , disability ( neck disability index [ NDI ] ) , general health ( short-form 12-item survey physical component summary [ SF-12 PCS ] and mental component summary [ SF-12 MCS ] ) , and quality of life ( Euro-Qol-5D [ EQ-5D ] ) were assessed . METHODS Eighty-eight patients undergoing primary ACDF for neck and arm pain were entered into a Web-based prospect i ve registry . Baseline and 12-month patient-reported outcomes ( NRS-NP , NRS-AP , NDI , SF-12 PCS , SF-12 MCS , and EQ-5D ) were assessed . Patients were also asked whether they experienced a level of improvement after ACDF that met their expectation ( meaningful improvement ) . To assess the validity of NRS-NP , NRS-AP , and NDI ( measures of pain and disability ) to discriminate between meaningful and nonmeaningful improvement and the validity of SF-12 PCS , SF-12 MCS , and EQ-5D ( measures of general health and quality of life ) to discriminate between meaningful and nonmeaningful improvement , receiver-operating characteristic curves were generated for each outcome instrument . The greater the area under the curve ( AUC ) , the more valid the discriminator . The difference between st and ardized response means ( SRMs ) in patients reporting meaningful improvement versus not was calculated to determine the relative responsiveness of each outcome instrument to changes in  pain and QOL after surgery . RESULTS For pain and disability , both NDI ( AUC=0.75 ) and NRS-AP ( AUC=0.74 ) were valid discriminators of meaningful improvement . Numeric rating scale for neck pain ( AUC=0.69 ) was a poor discriminator . Neck disability index was also most responsive to postoperative improvement ( SRM difference 0.78 ) , followed by NRS-AP ( SRM difference 0.59 ) and NRS-NP ( SRM difference 0.46 ) . For general health and quality of life , SF-12 PCS ( AUC=0.79 ) was the only valid discriminator of meaningful improvement . Euro-Qol-5D ( AUC=0.68 ) and SF-12 MCS ( AUC=0.44 ) were poor discriminators . Short-form 12 physical component summary ( SRM difference 1.08 ) was also most responsive compared with EQ-5D ( SRM difference 0.89 ) and SF-12 MCS ( SRM difference 0.01 ) . CONCLUSIONS For pain and disability , NDI is the most valid and responsive measure of improvement after surgery for neck and arm pain . Numeric rating scale for neck pain and NRS-AP are poor substitutes for NDI when measuring effectiveness of care in registry efforts . For health-related quality of life , only SF-12 PCS could accurately discriminate meaningful improvement after cervical surgery and was found to be most valid and responsive . Large-scale registry efforts aim ed at measuring effectiveness of cervical spine surgery should use NDI and SF-12 to accurately assess improvements in pain , disability , and quality of life Study Design . Pragmatic , cross-sectional study . Objective . To assess the interrater reliability of 3 tools used by the Cervical Overview Group ( COG ) for the assessment of the internal validity of r and omized controlled trials ( RCTs ): Jadad , van Tulder , and risk of bias ( RoB ) . Summary of Background Data . For clinicians to implement evidence -based practice , they need to critically appraise health care literature . Checklists , scales , and domain-based criteria exist to evaluate the internal validity of RCTs for rehabilitation studies , but there is a lack of research reporting the reliability of existing assessment tools . Methods . Four members of the COG with multiprofessional and method ological background independently evaluated the internal validity of 54 RCTs using prepiloted Jadad and van Tulder reporting forms , and 18 RCTs using RoB , from June 2003 to May 2009 . The & kgr ; statistic was calculated for each combination of raters and assessment tools . St and ard agreement categorizations were used . Results . For Jadad , 4 of 7 items demonstrated mean & kgr ; statistic ranges from moderate to substantial agreement ( mean values , 0.42–0.78 ) , as did 8 of 11 items on the van Tulder tool ( mean values , 0.44–0.77 ) . The RoB demonstrated moderate to substantial ( mean values , 0.56–0.76 ) agreement on 3 of 12 items . Consistent substantial agreement was found across all assessment tools for the domain “ allocation concealment ” : Jadad 0.69 ( mean range , 0.60–0.77 ) ; van Tulder 0.77 ( mean range , 0.73–0.81 ) ; RoB 0.76 ( mean range , 0.65–0.88 ) ; and moderate to substantial across 2 tools for the domain “ sequence generation ” : van Tulder 0.53 ( mean range , 0.37–0.66 ) and RoB 0.66 ( mean range , 0.45–0.88 ) . Other domains demonstrated slight or fair agreement . Conclusion . Consistent interrater agreement was found across the 3 assessment tools for allocation concealment and for 2 tools for sequence generation . However , users should acknowledge that moderate variation exists within other items requiring more judgment . When evaluating rehabilitation RCTs , clinicians should consider limitations of rating certain items within the selected assessment tool The purpose of the present study was to assess five manual tests for pain provocation of the neck to determine their suitability for epidemiological investigations . To 75 r and omly selected men , five manual pain-provoking tests were applied in a single-blind design . Prevalence of reported neck dysfunction , sensitivity , specificity , and positive and negative predicted value for each test were calculated . 22 of the 75 reported present neck pain , while the remainder reported freedom from neck pain for at least one year . Palpation over the facet joints in the cervical spine was found to be the most appropriate screening test to corroborate the replies in self-reported question naires on dysfunctions of the neck . The outcome of this test was quite consistent with the reported neck pain . The test of the formina intervertebralia and the upper limb tension test caused pain in almost all subjects with reported neck dysfunctions , though not causing referred pain in the arm as an indication of neurogenous tissue origin , as it was aim ed to . Neither the neck rotation test nor the active flexion/extension test was sufficiently provocative to confirm the reported neck pain in these subjects , as both were insufficiently sensitive
Screening protocol s have high predictive values to detect cervical spine fracture in alert , low-risk patients seeking emergency care after blunt neck trauma .
Computerized tomography ( CT ) scans had better validity ( in adults and elderly ) than radiographs in assessing high-risk and /or multi-injured blunt trauma neck patients .
In the absence of serious pathology , clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression .
One exception is the manual provocation test for cervical radiculopathy , which has high positive predictive value .
There was no evidence that specific MRI findings are associated with neck pain , cervicogenic headache , or whiplash exposure .
No evidence supports using cervical provocative discography , anesthetic facet , or medial branch blocks in evaluating neck pain .
Reliable and valid self-report question naires are useful in assessing pain , function , disability , and psychosocial status in individuals with neck pain .
CONCLUSION The scientific evidence supports screening protocol s in emergency care for low-risk patients ; and CT-scans for high-risk patients with blunt trauma to the neck .
In nonemergency neck pain without radiculopathy , the validity of most commonly used objective tests is lacking .
OBJECTIVE To critically appraise and synthesize the literature on assessment of  neck pain .
SUMMARY OF BACKGROUND DATA The published literature on assessment of neck pain is large and of variable quality .
There have been no prior systematic review s of this literature .