Identifying classes with different disability profiles amongst patients with persistent neck pain
DOI:
https://doi.org/10.2340/jrm.v58.46022Keywords:
Disability evaluation, latent class analysis, neck pain, patient reported outcome measuresAbstract
Objective: To identify latent classes with distinct disability profiles among patients with persistent neck pain using item-level responses from the Neck Disability Index, and to examine demographic, clinical, and lifestyle factors associated with class membership.
Design: Cross-sectional survey-based study.
Patients: 962 patients with persistent neck pain.
Methods: This survey-based study included 962 patients with persistent neck pain. Latent class analysis was performed using the 10 dichotomized items of the Neck Disability Index (NDI) as indicator variables. Demographic, clinical, and lifestyle characteristics were subsequently examined across the identified latent classes.
Results: The mean age was 50 (SD 32.5) years and 647 (67%) were women. Three distinct classes were identified: class with no or mild disability (47% of the sample); class with moderate disability in reading, driving, and lifting but not in personal care and concentration (15% of the sample); and class with overall severe disability (37% of the sample). Lower educational level, obesity, physical inactivity, worse pain, and lower occupational status were associated with a higher probability of belonging to the severe disability class.
Conclusion: Patients with persistent neck pain appear to exhibit distinct disability profiles rather than a single uniform pattern of functional limitation. Identifying these profiles may improve the characterization of patient heterogeneity and provide a basis for future research evaluating their clinical and prognostic relevance. Further studies are needed to determine whether these profiles are reproducible in other populations and whether they have implications for treatment planning and outcomes.
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References
Wu A-M, Cross M, Elliott JM, Culbreth GT, Haile LM, Steinmetz JD, et al. Global, regional, and national burden of neck pain, 1990– 2020, and projections to 2050: a systematic analysis of the Global Burden of -Disease Study 2021. Lancet Rheumatol 2024; 6: e142–e155.
Fejer R, Hartvigsen J. Neck pain and disability due to neck pain: what is the relation? Eur Spine J 2008; 17: 80–88. DOI: https://doi.org/10.1007/s00586-007-0521-9
Carroll LJ, Hurwitz EL, Côté P, Hogg-Johnson S, Carragee EJ, Nordin M, et al. Research priorities and methodological implications: the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. J Manip Physiol Ther 2009; 32: S244–S251.
Feleus A, Bierma-Zeinstra SMA, Miedema HS, Bernsen RMD, Verhaar JAN, Koes BW. Incidence of non-traumatic complaints of arm, neck and shoulder in general practice. Man Ther 2008; 13: 426–433. DOI: https://doi.org/10.1016/j.math.2007.05.010
Yang JQ, Wu J, Guo JE, Yang ZX, Liu JY, Wang YM, et al. Neck pain and emotional state in cervical spondylosis: a dual trajectory model analysis. World J Psychiatry 2025; 15: 108009. DOI: https://doi.org/10.5498/wjp.v15.i10.108009
Widbom-Kolhanen SS, Pernaa KI, Lintuaho RE, -Kotkansalo A, Saltychev M. Disability and pain after anterior cervical decompression and fusion: a group-based trajectory analysis. Scand J Surg 2024; 113: 166–173. DOI: https://doi.org/10.1177/14574969241241969
Ailliet L, Rubinstein SM, Hoekstra T, van Tulder MW, de Vet HCW. Long-term trajectories of patients with neck pain and low back pain presenting to chiropractic care: a latent class growth analysis. Eur J Pain 2018; 22: 103–113. DOI: https://doi.org/10.1002/ejp.1094
Weller BE, Bowen NK, Faubert SJ. Latent Class Analysis: a guide to best practice. J Black Psychol 2020; 46: 287–311. DOI: https://doi.org/10.1177/0095798420930932
Dianat I, Alipour A, Asghari Jafarabadi M. Multigroup latent class model of musculoskeletal pain combinations in children/adolescents: identifying high-risk groups by gender and age. J Headache Pain 2018; 19: 52. DOI: https://doi.org/10.1186/s10194-018-0880-0
Hartvigsen J, Davidsen M, Hestbaek L, Sogaard K, Roos EM. Patterns of musculoskeletal pain in the population: a latent class analysis using a nationally representative interviewer-based survey of 4817 Danes. Eur J Pain 2013; 17: 452–460. DOI: https://doi.org/10.1002/j.1532-2149.2012.00225.x
Gallagher KM, Howie EK, Carney M. Musculoskeletal pain latent classes and biopsychosocial characteristics among emerging adults. BMC Musculoskelet Disord 2023; 24: 334. DOI: https://doi.org/10.1186/s12891-023-06412-y
Seet V, Abdin E, Jeyagurunathan A, Chik TS, Kit LJ, Sing LE, et al. Health and disability: a multi-group latent class analysis of the World Health Organization Disability Assessment Schedule 2.0 among those with mental and physical health conditions. Health Qual Life Outcomes 2024; 22: 57. DOI: https://doi.org/10.1186/s12955-024-02273-8
Obbarius A, Fischer F, Liegl G, Obbarius N, van Bebber J, Hofmann T, et al. A step towards a better understanding of pain phenotypes: latent class analysis in chronic pain patients receiving multimodal inpatient treatment. J Pain Res 2020; 13: 1023–1038. DOI: https://doi.org/10.2147/JPR.S223092
Rundell SD, Meier EN, Jarvik JG, Friedly JL, Horn ME, Suri P, et al. Phenotypes of patients with symptomatic lumbar spinal stenosis presenting for nonoperative care: baseline data from the Lumbar Stenosis Prognostic Subgroups for Personalizing Care and Treatment Study (PROSPECTS). Pain Med 2026; 27: 177–188. DOI: https://doi.org/10.1093/pm/pnaf099
Yang J, Lafage V, Lafage R, Smith J, Klineberg EO, Shaffrey CI, et al. Determinants of patient satisfaction 2 years after spinal deformity surgery: a latent class analysis. Spine (Phila Pa 1976) 2019; 44: E45–E52. DOI: https://doi.org/10.1097/BRS.0000000000002753
Vernon H. The Neck Disability Index: state-of-the-art, 1991–2008. J Manipulative Physiol Ther 2008; 31: 491–502. DOI: https://doi.org/10.1016/j.jmpt.2008.08.006
Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 1991; 14: 409–415. DOI: https://doi.org/10.1037/t35122-000
Widbom-Kolhanen SS, Pernaa KI, Saltychev M. Change in functioning profile after cervical surgery. Int J Rehabil Res 2023; 46: 35–40. DOI: https://doi.org/10.1097/MRR.0000000000000555
Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, -Cleeland CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 1995; 61: 277–284. DOI: https://doi.org/10.1016/0304-3959(94)00178-H
Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, -Bassett DR Jr, Tudor-Locke C, et al. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc 2011; 43: 1575–1581. DOI: https://doi.org/10.1249/MSS.0b013e31821ece12
Kazeminasab S, Nejadghaderi SA, Amiri P, Pourfathi H, Araj-Khodaei M, Sullman MJM, et al. Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord 2022; 23: 26. DOI: https://doi.org/10.1186/s12891-021-04957-4
Lacey RJ, Strauss VY, Rathod T, Belcher J, Croft PR, Natvig B, et al. Clustering of pain and its associations with health in people aged 50 years and older: cross-sectional results from the North Staffordshire Osteoarthritis Project. BMJ Open 2015; 5: e008389. DOI: https://doi.org/10.1136/bmjopen-2015-008389
Young JJ, Chang NHS, Nim C, S ON, McNaughton DT, Jensen RK, et al. Digital pain diagrams to identify common lumbar spinal stenosis pain distribution patterns: a cross-sectional latent class analysis. Eur Spine J 2025; 34: 5596–5603. DOI: https://doi.org/10.1007/s00586-025-09218-9
Molgaard Nielsen A, Hestbaek L, Vach W, Kent P, Kongsted A. Latent class analysis derived subgroups of low back pain patients: do they have prognostic capacity? BMC Musculoskelet Disord 2017; 18: 345. DOI: https://doi.org/10.1186/s12891-017-1708-9
Van Gorp B, Lesnak J, Fleagle T, Hulshizer K, Nielsen-Wise A, Kestel L, et al. Categories of the patient-specific functional scale activities in chronic neck pain and their relationship to the Neck Disability Index. Rehabil Res Pract 2024; 2024: 3126892. DOI: https://doi.org/10.1155/2024/3126892
Michaelson P, Michaelson M, Jaric S, Latash ML, Sjölander P, Djupsjöbacka M. Vertical posture and head stability in patients with chronic neck pain. J Rehabil Med 2003; 35: 229–235. DOI: https://doi.org/10.1080/16501970306093
Cheung J, Kajaks T, Macdermid JC. The relationship between neck pain and physical activity. Open Orthop J 2013; 7: 521–529. DOI: https://doi.org/10.2174/1874325001307010521
Alshahrani A, Ghulam HSH, Alqhtani RS, Al Sharyah YHH, Ahmed H, Aafreen A, et al. Cervical health parameters in car drivers: assessing the influence of driving on neck pain, mobility, proprioception and craniovertebral angle – a cross-sectional study. J Multidiscip Healthc 2024; 17: 2013–2020. DOI: https://doi.org/10.2147/JMDH.S458364
Wlodyka-Demaille S, Poiraudeau S, Catanzariti JF, Rannou F, Fermanian J, Revel M. The ability to change of three questionnaires for neck pain. Joint Bone Spine 2004; 71: 317–326. DOI: https://doi.org/10.1016/j.jbspin.2003.04.004
Chiu TT, Lam TH, Hedley AJ. Correlation among physical impairments, pain, disability, and patient satisfaction in patients with chronic neck pain. Arch Phys Med Rehabil 2005; 86: 534–540. DOI: https://doi.org/10.1016/j.apmr.2004.02.030
Clair D, Edmondston S, Allison G. Variability in pain intensity, physical and psychological function in non-acute, non-traumatic neck pain. Physiother Res Int 2004; 9: 43–54. DOI: https://doi.org/10.1002/pri.299
Hansen J, Hansen H, Nilsson C, Ekholm O, Molsted S. Association between educational level and self-reported musculoskeletal pain and physical functioning in Danes 60–70 years old from 2010 to 2017: a longitudinal analysis of trends over time on data from the Danish Health and Morbidity Survey. BMJ Open 2023; 13: e073523. DOI: https://doi.org/10.1136/bmjopen-2023-073523
Gou L, Zheng Q. How to reduce the risk of cervicalgia and low back pain in obese individuals: a Mendelian randomization study. Medicine (Baltimore) 2023; 102: e33710. DOI: https://doi.org/10.1097/MD.0000000000033710
Wu A-M, Cross M, Elliott JM, Culbreth GT, Haile LM, -Steinmetz JD, et al. Global, regional, and national burden of neck pain, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2024; 6: e142–e155. DOI: https://doi.org/10.2139/ssrn.4427441
Christakou A, Loizou A, Chytas D. Gender differences between disability, quality of life, and sedentary behavior in individuals with chronic non-specific neck pain. J Clin Med 2025; 14: 8155. DOI: https://doi.org/10.3390/jcm14228155
Guzy G, Polczyk R, Szpitalak M, Vernon H. Age moderates the relationships between family functioning and neck pain/disability. PLoS One 2016; 11: e0153606. DOI: https://doi.org/10.1371/journal.pone.0153606
Edwards RR. Age differences in the correlates of physical functioning in patients with chronic pain. J Aging Health 2006; 18: 56–69. DOI: https://doi.org/10.1177/0898264305280976
Safiri S, Kolahi AA, Hoy D, Buchbinder R, Mansournia MA, Bettampadi D, et al. Global, regional, and national burden of neck pain in the general population, 1990–2017: systematic analysis of the Global Burden of Disease Study 2017. BMJ 2020; 368: m791. DOI: https://doi.org/10.1136/bmj.m791
GBD 2021 Neck Pain Collaborators. Global, regional, and -national burden of neck pain, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of -Disease Study 2021. Lancet Rheumatol 2024; 6: e142–e155.
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