The determinants of function and disability in neck patients referred to a specialized outpatient clinic

Clin J Pain. 2013 Dec;29(12):1029-35. doi: 10.1097/AJP.0b013e31828027a2.


Aim/objectives/background: Considerable attention has been paid to assessing the risk factors for the development of disability following neck pain (NP) in the general population, but we still lack knowledge regarding disability in NP patients referred to a specialist level of care. This study investigated the associations among the socio-demographic characteristics, work ability, self-reported pain, emotional distress, fear of movement and disability of NP patients referred to a specialised neck and back outpatient clinic. In total, 221 patients participated in this cross-sectional study, which was conducted from December 2007 to December 2009.

Methods: The associations between demographics, pain reports, emotional distress, fear of movement and the self-reported disability of NP were investigated by correlation and regression analyses.The pain intensity was assessed using the numeric rating scale (NRS), the pain distribution was assessed by the number of pain areas drawn, emotional distress was assessed by the Hopkins Symptom Checklist version 25 (HSCL-25), and the fear of movement was assessed by the Tampa Scale for Kinesiophobia (TSK). The self-rated disability was assessed using the Neck Disability Index (NDI).

Results: The mean NDI score was 41.9 (SD, 16). According to the multiple regression analysis, emotional distress explained 37% of the variance in the NDI, the pain intensity 12%, and the pain distribution and the fear of movement accounted for 4%. The pain intensity and emotional distress were the strongest individual explanatory variables (β-values: 0.36 [95% CI, 1.96-3.56] and 0.33 [95% CI, 0.24-0.51], respectively).

Conclusions: These results suggest that emotion should be considered in any assessment of patients with chronic NP and targeting emotional factors should be an integral part of treatment strategies.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Ambulatory Care Facilities
  • Cross-Sectional Studies
  • Disability Evaluation*
  • Disabled Persons / psychology*
  • Fear / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neck Pain / diagnosis*
  • Neck Pain / psychology
  • Pain Measurement
  • Risk Factors
  • Self Report
  • Severity of Illness Index
  • Stress, Psychological / psychology
  • Surveys and Questionnaires