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Development and External Validation of Individualized Prediction Models for Pain Intensity Outcomes in Patients with Neck Pain, Low Back Pain, or both in Primary Care Settings

Archer, Lucinda; Snell, Kym I E; Stynes, Siobhán; Axen, Iben; Dunn, Kate M; Foster, Nadine E; Wynne-Jones, Gwenllian; Windt, Daniëlle A; Hill, Jonathan C


Lucinda Archer

Kym I E Snell

Iben Axen

Nadine E Foster


Objective The purpose of this study was to develop and externally validate multivariable prediction models for future pain intensity outcomes to inform targeted interventions for patients with neck or low back pain in primary care settings. Methods Model development data was obtained from a group of 679 adults with neck or low back pain who consulted a participating United Kingdom general practice. Predictors included self-report items regarding pain severity and impact from the STarT MSK Tool. Pain intensity at 2 and 6 months were modelled separately for continuous and dichotomized outcomes using linear and logistic regression, respectively. External validation of all models was conducted in a separate group of 586 patients recruited from a similar population with patients’ predictor information collected both at point of consultation and 2 to 4 weeks later using self-report questionnaires. Calibration and discrimination of the models were assessed separately using STarT MSK Tool data from both time points to assess differences in predictive performance. Results Pain intensity and patients reporting their condition would last a long time contributed most to predictions of future pain intensity conditional on other variables. On external validation, models were reasonably well calibrated on average when using tool measurements taken 2 to 4 weeks after consultation (calibration slope = 0.848 [95% CI = 0.767–0.928] for 2-month pain intensity score), but performance was poor using point-of-consultation tool data (calibration slope for 2-month pain intensity score of 0.650 [95% CI = 0.549–0.750]). Conclusion Model predictive accuracy was good when predictors were measured 2 to 4 weeks after primary care consultation, but poor when measured at the point of consultation. Future research will explore whether additional, nonmodifiable predictors improve point-of-consultation predictive performance. Impact External validation demonstrated that these individualized prediction models were not sufficiently accurate to recommend their use in clinical practice. Further research is required to improve performance through inclusion of additional nonmodifiable risk factors.

Journal Article Type Article
Acceptance Date Jul 14, 2023
Online Publication Date Sep 26, 2023
Deposit Date Oct 9, 2023
Journal Physical Therapy
Print ISSN 0031-9023
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Article Number pzad128
Keywords Physical Therapy, Sports Therapy and Rehabilitation