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Real-World Effectiveness of Physical Therapy for Common Neck Pain Diagnoses

A Multivariate Analysis of 1554 Patients

Divi, Srikanth N., MD*; Eleswarapu, Ananth S., MD; Stout, Christopher E., PhD‡,§; Lee, Michael J., MD*

doi: 10.1097/BSD.0000000000000691

Study Design: Retrospective cohort study (Level of evidence—3).

Objective: The objective of this study was to investigate the real-life effectiveness of physical therapy (PT) for patients initially presenting with common neck pain diagnoses.

Summary of Background Data: Neck pain is a common cause of morbidity and a leading cause of disability in the United States. PT is prescribed as a first-line treatment for the vast majority of patients with neck pain; however, there is limited literature supporting the effectiveness of these treatments.

Methods: A total of 1554 patients enrolled in PT for the nonoperative treatment of neck pain were included in the study. Three primary patient-reported outcome (PRO) measures [neck disability index (NDI), resting numeric pain rating scale (NPRS), and activity NPRS] were recorded before and at conclusion of therapy. Improvement was noted if patients met a threshold value for a minimal clinically important difference (MCID). Bivariate analysis using a χ2 test and multiple logistic regression analysis were performed to determine risk factors predictive of treatment failure.

Results: About 40.5% of patients achieved MCID for NDI with an average change of −6.31 points. For resting NPRS and activity NPRS scores, 50.6% and 52.1% of patients achieved MCID with an average change of −1.93 and −2.36, respectively. After multiple logistic regression analysis, worker’s compensation status was found to be an independent predictor for treatment failure in all groups; whereas, Medicare status was found predictive of achieving MCID in the activity NPRS group.

Conclusions: We observed that up to half of the patients analyzed met the minimum criteria for improvement in neck pain with respect to the PRO measures, suggesting that real-life effectiveness of PT for common neck pain diagnoses may approach 50%.

*Department of Orthopaedic Surgery, University of Chicago Medical Center, Chicago, IL

Department of Orthopaedics, University of Miami Health System, Miami, FL

ATI, Bolingbrook, IL

§Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, IL

M.J.L. is a paid consultant for Stryker Spine and Depuy Synthes. The remaining authors declare that they have nothing to disclose.

Reprints: Srikanth N. Divi, MD, Department of Orthopaedic Surgery, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 3079, Chicago, IL 60637 (e-mail:

Received February 20, 2018

Accepted June 19, 2018

© 2018 by Lippincott Williams & Wilkins, Inc.