Broad External Validation and Update of a Prediction Model for Persistent Neck Pain After 12 Weeks

Birgitte Lawaetz Myhrvold, Alice Kongsted, Pernille Irgens, Hilde Stendal Robinson, Magne Thoresen, Nina Køpke Vøllestad

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Abstract

STUDY DESIGN: A prospective observational study.

OBJECTIVE: To externally validate the prediction model developed by Schellingerhout and colleagues predicting global perceived effect at 12 weeks in patients with neck pain and to update and internally validate the updated model.

SUMMARY OF BACKGROUND DATA: Only one prediction model for neck pain has undergone some external validation with good promise. However, the model needs testing in other populations before implementation in clinical practice.

METHODS: Patients with neck pain (n = 773) consulting Norwegian chiropractors were followed for 12 weeks. Parameters from the original prediction model were applied to this sample for external validation. Subsequently, two random samples were drawn from the full study sample. One sample (n = 436) was used to update the model; by recalibration, removing noninformative covariates, and adding new possible predictors. The updated model was tested in the other sample (n = 303) using stepwise logistic regression analysis. Main outcomes for performance of models were discrimination and calibration plots.

RESULTS: Three hundred seventy patients (47%) in the full study sample reported persistent pain at 12 weeks. The performance of the original model was poor, area under the receiver operating characteristics curve was 0.55 with a Confidence Interval of 0.51-0.59. The updated model included Radiating pain to shoulder and/or elbow, education level, physical activity, consultation-type (first- time, follow-up or maintenance consultation), expected course of neck pain, previous course of neck pain, number of pain sites, and the interaction term Physical activity##Number of pain sites. The area under the receiver operating characteristics curve was 0.65 with a 95% Confidence Interval of 0.58-0.71 for the updated model.

CONCLUSION: The predictive accuracy of the original model performed insufficiently in the sample of patients from Norwegian chiropractors and the model is therefore not recommended for that setting. Only one predictor from the original model was retained in the updated model, which demonstrated reasonable good performance predicting outcome at 12 weeks. Before considering clinical use, a new external validation is required.

LEVEL OF EVIDENCE: 3.

Original languageEnglish
JournalSpine
Volume44
Issue number22
Pages (from-to)E1298-E1310
ISSN0362-2436
DOIs
Publication statusPublished - 15. Nov 2019

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Neck Pain
ROC Curve
Referral and Consultation
Confidence Intervals
Exercise
Elbow
Logistic Models
Regression Analysis
Maintenance
Prospective Studies
Education
Population

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Myhrvold, B. L., Kongsted, A., Irgens, P., Robinson, H. S., Thoresen, M., & Vøllestad, N. K. (2019). Broad External Validation and Update of a Prediction Model for Persistent Neck Pain After 12 Weeks. Spine, 44(22), E1298-E1310. https://doi.org/10.1097/BRS.0000000000003144
Myhrvold, Birgitte Lawaetz ; Kongsted, Alice ; Irgens, Pernille ; Robinson, Hilde Stendal ; Thoresen, Magne ; Vøllestad, Nina Køpke. / Broad External Validation and Update of a Prediction Model for Persistent Neck Pain After 12 Weeks. In: Spine. 2019 ; Vol. 44, No. 22. pp. E1298-E1310.
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abstract = "STUDY DESIGN: A prospective observational study.OBJECTIVE: To externally validate the prediction model developed by Schellingerhout and colleagues predicting global perceived effect at 12 weeks in patients with neck pain and to update and internally validate the updated model.SUMMARY OF BACKGROUND DATA: Only one prediction model for neck pain has undergone some external validation with good promise. However, the model needs testing in other populations before implementation in clinical practice.METHODS: Patients with neck pain (n = 773) consulting Norwegian chiropractors were followed for 12 weeks. Parameters from the original prediction model were applied to this sample for external validation. Subsequently, two random samples were drawn from the full study sample. One sample (n = 436) was used to update the model; by recalibration, removing noninformative covariates, and adding new possible predictors. The updated model was tested in the other sample (n = 303) using stepwise logistic regression analysis. Main outcomes for performance of models were discrimination and calibration plots.RESULTS: Three hundred seventy patients (47{\%}) in the full study sample reported persistent pain at 12 weeks. The performance of the original model was poor, area under the receiver operating characteristics curve was 0.55 with a Confidence Interval of 0.51-0.59. The updated model included Radiating pain to shoulder and/or elbow, education level, physical activity, consultation-type (first- time, follow-up or maintenance consultation), expected course of neck pain, previous course of neck pain, number of pain sites, and the interaction term Physical activity##Number of pain sites. The area under the receiver operating characteristics curve was 0.65 with a 95{\%} Confidence Interval of 0.58-0.71 for the updated model.CONCLUSION: The predictive accuracy of the original model performed insufficiently in the sample of patients from Norwegian chiropractors and the model is therefore not recommended for that setting. Only one predictor from the original model was retained in the updated model, which demonstrated reasonable good performance predicting outcome at 12 weeks. Before considering clinical use, a new external validation is required.LEVEL OF EVIDENCE: 3.",
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Myhrvold, BL, Kongsted, A, Irgens, P, Robinson, HS, Thoresen, M & Vøllestad, NK 2019, 'Broad External Validation and Update of a Prediction Model for Persistent Neck Pain After 12 Weeks', Spine, vol. 44, no. 22, pp. E1298-E1310. https://doi.org/10.1097/BRS.0000000000003144

Broad External Validation and Update of a Prediction Model for Persistent Neck Pain After 12 Weeks. / Myhrvold, Birgitte Lawaetz; Kongsted, Alice; Irgens, Pernille; Robinson, Hilde Stendal; Thoresen, Magne; Vøllestad, Nina Køpke.

In: Spine, Vol. 44, No. 22, 15.11.2019, p. E1298-E1310.

Research output: Contribution to journalJournal articleResearchpeer-review

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T1 - Broad External Validation and Update of a Prediction Model for Persistent Neck Pain After 12 Weeks

AU - Myhrvold, Birgitte Lawaetz

AU - Kongsted, Alice

AU - Irgens, Pernille

AU - Robinson, Hilde Stendal

AU - Thoresen, Magne

AU - Vøllestad, Nina Køpke

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N2 - STUDY DESIGN: A prospective observational study.OBJECTIVE: To externally validate the prediction model developed by Schellingerhout and colleagues predicting global perceived effect at 12 weeks in patients with neck pain and to update and internally validate the updated model.SUMMARY OF BACKGROUND DATA: Only one prediction model for neck pain has undergone some external validation with good promise. However, the model needs testing in other populations before implementation in clinical practice.METHODS: Patients with neck pain (n = 773) consulting Norwegian chiropractors were followed for 12 weeks. Parameters from the original prediction model were applied to this sample for external validation. Subsequently, two random samples were drawn from the full study sample. One sample (n = 436) was used to update the model; by recalibration, removing noninformative covariates, and adding new possible predictors. The updated model was tested in the other sample (n = 303) using stepwise logistic regression analysis. Main outcomes for performance of models were discrimination and calibration plots.RESULTS: Three hundred seventy patients (47%) in the full study sample reported persistent pain at 12 weeks. The performance of the original model was poor, area under the receiver operating characteristics curve was 0.55 with a Confidence Interval of 0.51-0.59. The updated model included Radiating pain to shoulder and/or elbow, education level, physical activity, consultation-type (first- time, follow-up or maintenance consultation), expected course of neck pain, previous course of neck pain, number of pain sites, and the interaction term Physical activity##Number of pain sites. The area under the receiver operating characteristics curve was 0.65 with a 95% Confidence Interval of 0.58-0.71 for the updated model.CONCLUSION: The predictive accuracy of the original model performed insufficiently in the sample of patients from Norwegian chiropractors and the model is therefore not recommended for that setting. Only one predictor from the original model was retained in the updated model, which demonstrated reasonable good performance predicting outcome at 12 weeks. Before considering clinical use, a new external validation is required.LEVEL OF EVIDENCE: 3.

AB - STUDY DESIGN: A prospective observational study.OBJECTIVE: To externally validate the prediction model developed by Schellingerhout and colleagues predicting global perceived effect at 12 weeks in patients with neck pain and to update and internally validate the updated model.SUMMARY OF BACKGROUND DATA: Only one prediction model for neck pain has undergone some external validation with good promise. However, the model needs testing in other populations before implementation in clinical practice.METHODS: Patients with neck pain (n = 773) consulting Norwegian chiropractors were followed for 12 weeks. Parameters from the original prediction model were applied to this sample for external validation. Subsequently, two random samples were drawn from the full study sample. One sample (n = 436) was used to update the model; by recalibration, removing noninformative covariates, and adding new possible predictors. The updated model was tested in the other sample (n = 303) using stepwise logistic regression analysis. Main outcomes for performance of models were discrimination and calibration plots.RESULTS: Three hundred seventy patients (47%) in the full study sample reported persistent pain at 12 weeks. The performance of the original model was poor, area under the receiver operating characteristics curve was 0.55 with a Confidence Interval of 0.51-0.59. The updated model included Radiating pain to shoulder and/or elbow, education level, physical activity, consultation-type (first- time, follow-up or maintenance consultation), expected course of neck pain, previous course of neck pain, number of pain sites, and the interaction term Physical activity##Number of pain sites. The area under the receiver operating characteristics curve was 0.65 with a 95% Confidence Interval of 0.58-0.71 for the updated model.CONCLUSION: The predictive accuracy of the original model performed insufficiently in the sample of patients from Norwegian chiropractors and the model is therefore not recommended for that setting. Only one predictor from the original model was retained in the updated model, which demonstrated reasonable good performance predicting outcome at 12 weeks. Before considering clinical use, a new external validation is required.LEVEL OF EVIDENCE: 3.

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DO - 10.1097/BRS.0000000000003144

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