Predictors for Immediate and Short-Term Effects from Mechanical Cervical Traction in Patients with Neck Pain

• Main Authors: Pin-Yi Lee, 李秉怡
• Other Authors: Tzyy-Jiuan Wang
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/15250178661237623943

碩士 === 國立陽明大學 === 物理治療研究所 === 93 === Background: Mechanical cervical traction is a widely accepted therapeutic modality for the treatment of cervical pain and radicular symptoms. However, mechanical cervical traction has not shown to be effective for neck disorders despite that most of the clinical trials have low methodological quality. More clinical studies with good quality are needed to conclude the effects of mechanical cervical traction. An effective and clinically applicable method for classifying patients with neck pain could improve decision making and treatment outcomes by matching intervention to the patients who are most likely to benefit. Identifying predictors for immediate effects of mechanical cervical traction in patients with neck pain becomes an important issue. Study purpose: The purposes of this study were 1) to identify predictors for immediate effects from mechanical cervical traction, and 2) to identify predictors for the short-term (2-3 weeks) cervical traction plus physical therapy treatment for patients with neck pain. Study design: An exploratory study, pre-post test design. Subjects: We recruited 202 subjects with neck pain who were referred to physical therapy for treatment and excluded patients with rheumatic arthritis, severe osteoporosis, infectious diseases of spine, history of cervical fracture, histories of cervical surgeries, psychological diseases, or other neurological diseases, such as stroke. Procedures: After an initial evaluation, the patient received a single session of mechanical cervical traction. Then, the treatment effects were evaluated immediately using several outcome measures which served as the criteria for classifying the subjects into responders or non-responders. After six sessions of cervical traction plus physical therapy within 2 to 3 weeks, re-evaluation was carried out for all subjects. The subjects were classified again according to a set of criteria. Main outcome measures: Responders or non-responders for the immediate effects were classified by fulfilling one of the following criteria: improvements on symptom intensity ≧1.5 (0-10 points, numerical rating scale), increase of painfree cervical active range of motion ≧15%, perceived improvement (15-point global rating scale) ≧3, and demonstrating centralization phenomenon. The short-term effects were judged by fulfilling one of the following criteria: improvements on symptom intensity ≧2 (0-10 points, numerical rating scale), increase of painfree cervical active range of motion ≧15%, and improvements on disability score ≧5 (0-50 Neck Disability Index). Data analysis: Univariate analyses comparing differences between responders and nonresponders was used to identify possible immediate predictors. Independent t tests were used for continuous variables and chi-square tests were used for categorical variables (p<0.05). Logistic regression analyses were then used to identify significant predictors for treatment responders from a single cervical traction (p<0.05). Short-term predictors were established by the same statistical procedure except the significant level was set at 0.10 for the univariate analysis. Results: Patients who were female, needed to perform repetitive work with upper extremities > 1 hr/day, felt worse as the day went on, had sensory deficit in the arm, had initial pain score more than 5.5, appeared to be more likely to obtain the immediate effects from cervical traction (cumulative adjusted R2=0.38). The presence of three or more of these predictors increased the probability of success with mechanical cervical traction from 32% to 93%. Patients who were not smokers, did not combine with low back pain, had initial pain score more than 7.5, would be more likely to obtain the short-term effects from cervical traction plus general physical therapy (cumulative adjusted R2=0.15). The presence of three or more of these predictors increased the probability of success with mechanical cervical traction plus general physical therapy from 57% to 89%. Using favorable predictors to identify treatment responders before administering mechanical cervical traction could significantly increase the probabilities of a successful treatment. Discussion and Conclusion: This was the first clinical trial to investigate predictors for mechanical cervical traction effects. We found five factors significantly predicted the immediate effects of mechanical cervical traction and three factors were found significantly predicted the short term effects of mechanical cervical traction plus general physical therapy. These predictors can be used to significantly improve the success rate of a single mechanical cervical traction or a short course of physical therapy treatment. These study findings may enhance the efficacy of clinical decision-making in using mechanical cervical traction intervention.