Optimizing management of neck pain though the pain and disability drivers management model for neck pain: A feasibility trial

Abstract

Background: Neck pain represents a major burden. Guideline-based interventions demonstrated modest clinical benefits. The added value of subgrouping tools remains limited, potentially reflecting an incomplete assessment of key factors. The Pain and Disability Drivers Management model for neck pain (PDDM-Np) was adapted to address this gap, but its feasibility and acceptability remain unknown.

Objectives: To evaluate the feasibility and acceptability of implementing PDDM-Np and its impact on clinical decision-making.

Design: Prospective feasibility study.

Method: Physiotherapists were eligible if they completed the PDDM-Np workshop and agreed to use its clinical decision support system (CDSS). Adult patients consulting for a new episode of neck pain were consecutively recruited. Clinicians attended a workshop on PDDM-Np, and used the CDSS, which generated a dashboard to guide management. Primary outcomes were feasibility and acceptability. Secondary exploratory outcomes included clinician-reported changes in clinical decision-making and patient-reported outcomes.

Results: Seventeen clinicians and 50 patients were enrolled. Clinician recruitment exceeded target, while patient enrollment was below projections. The follow-up rate was 78%. The CDSS was acceptable to clinicians and patients. One-third of clinicians reported an additional workload burden. Based on results, the decision was to perform a definitive study with minor protocol changes. All clinicians reported at least minor modifications in their decision-making process. Six weeks after baseline, 94% of patients reported clinical improvements.

Conclusions: Implementing PDDM-Np in private practice is feasible and acceptable, although it is associated with added burden. After minor adjustments, a definitive study can be conducted to evaluate the effectiveness and implementation of PDDM-Np.

Keywords: Neck pain; Physiotherapy; Rehabilitation; Stratified care.