PhD defence R.W. (Roeland) Wingbermühle

Summary:

Neck pain is a common global health problem leading to substantial pain, disability, and economic costs in most countries. This also applies to neck pain in primary care in the Netherlands, which shows high incidence and prevalence numbers in general practice and is the second most registered diagnostic code by physiotherapists. Neck pain is usually divided into specific and non-specific neck pain. The vast majority of neck pain concerns conditions without an identifiable pathoanatomical cause and are thus labelled as nonspecific. The prognosis of non-specific neck pain is after a few weeks generally unfavourable. Recovery of neck pain mainly takes place in the first 4-6 weeks, without further evident reduction of neck pain and disability afterwards. In general practice in the Netherlands, 47% of acute non-specific neck pain patients reported still having neck pain at 1-year follow-up. This indicates that, when people do not recover within the first few weeks, prognosis leads for a substantial proportion of people to persistent or intermittent pain and disability. Identification of patients very likely to recover in the short term may reduce the risk of overtreatment and health costs. Moreover, early identification of neck pain patients with expected worse outcomes enables clinicians to offer effective treatments timely and may abate patient’s burden and health costs. Patients with neck pain have concerns about their future and like to know their prognosis when consulting their primary  are clinician. The prognosis of recovery of non-specific neck pain in individual patients is a challenging task for a clinician. Prognostic factors and prognostic models can provide a clinician with additional information to improve the estimation of the patients’ individual prognosis. Prognostic factors yet provide information on the prognosis of people with neck pain in general, while an accurate prognostic model is preferable since it has the advantage of providing an individual prognosis for a specific patient. Prognostic models are used for providing an individual prognosis by clinicians in various healthcare domains and settings and could be useful for the prognosis of non-specific neck pain in primary care. Studies of prognostic models comprise three consecutive stages: model development (derivation), preferably with internal validation; validation in new settings (external validation); and assessment of a model’s clinical impact.
The shift to personalized medicine has led to a vast amount of published prognostic models. 

The general aim of this thesis was to improve predictions of recovery of non-specific neck pain in individual patients in primary care with the use of prognostic prediction models.