TY - JOUR
T1 - Cluster Analysis of an International Pressure Pain Threshold Database Identifies 4 Meaningful Subgroups of Adults with Mechanical Neck Pain
AU - Walton, David M.
AU - Kwok, Timothy S.H.
AU - Mehta, Swati
AU - Loh, Eldon
AU - Smith, Ashley
AU - Elliott, James
AU - Kamper, Steven J.
AU - Kasch, Helge
AU - Sterling, Michele
N1 - Publisher Copyright:
© 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017
Y1 - 2017
N2 - Objective: To determine pressure pain detection threshold (PPDT) related phenotypes of individuals with mechanical neck pain that may be identifiable in clinical practice. Methods: This report describes a secondary analysis of 5 independent, international mechanical neck pain databases of PPDT values taken at both a local and distal region (total N=1176). Minor systematic differences in mean PPDT values across cohorts necessitated z-transformation before analysis, and each cohort was split into male and female sexes. Latent profile analysis (LPA) using the k-means approach was undertaken to identify the most parsimonious set of PPDT-based phenotypes that were both statistically and clinically meaningful. Results: LPA revealed 4 distinct clusters named according to PPDT levels at the local and distal zones: Low-low PPDT (67%), mod-mod (25%), mod-high (4%), and high-high (4%). Secondary predictor variables were evaluated for intracluster and cross-cluster significance. Low-low cluster was most affected, as indicated by pain intensity, disability, and catastrophization scores all significantly above the cohort-specific and sex-specific mean, and active range of motion scores significantly below the mean. Discussion: The results suggest that there are a large proportion of people with neck pain that present with signs indicating dysfunction beyond the local tissues. Ongoing exploration of these presentations may lead to more informed management and improved outcomes.
AB - Objective: To determine pressure pain detection threshold (PPDT) related phenotypes of individuals with mechanical neck pain that may be identifiable in clinical practice. Methods: This report describes a secondary analysis of 5 independent, international mechanical neck pain databases of PPDT values taken at both a local and distal region (total N=1176). Minor systematic differences in mean PPDT values across cohorts necessitated z-transformation before analysis, and each cohort was split into male and female sexes. Latent profile analysis (LPA) using the k-means approach was undertaken to identify the most parsimonious set of PPDT-based phenotypes that were both statistically and clinically meaningful. Results: LPA revealed 4 distinct clusters named according to PPDT levels at the local and distal zones: Low-low PPDT (67%), mod-mod (25%), mod-high (4%), and high-high (4%). Secondary predictor variables were evaluated for intracluster and cross-cluster significance. Low-low cluster was most affected, as indicated by pain intensity, disability, and catastrophization scores all significantly above the cohort-specific and sex-specific mean, and active range of motion scores significantly below the mean. Discussion: The results suggest that there are a large proportion of people with neck pain that present with signs indicating dysfunction beyond the local tissues. Ongoing exploration of these presentations may lead to more informed management and improved outcomes.
KW - Latent profile analysis
KW - assessment and evaluation
KW - nonspecific neck pain
KW - quantitative sensory testing
KW - whiplash-associated disorder
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U2 - 10.1097/AJP.0000000000000421
DO - 10.1097/AJP.0000000000000421
M3 - Article
C2 - 27518490
AN - SCOPUS:84981727682
SN - 0749-8047
VL - 33
SP - 422
EP - 428
JO - Clinical Journal of Pain
JF - Clinical Journal of Pain
IS - 5
ER -