Impact Of An Intervention Based On ICF Assessment Of Chronic Widespread Pain On Outcomes Inpatients With Chronic Axial Neck Pain

Objective:According to the International Classification of Functioning,Disability and Health(ICF)the simple corset of chronic widespread pain of the chronic axial neck pain is used to evaluate the patients with chronic axial neck pain,develop an individualized rehabilitation scheme according to the evaluation result and target the Restricted functional items of the patients,and verify an intervention scheme based on the ICF Chronic widespread pain assessment,can effectively and permanently affect the treatment outcome of patients with chronic axial neck pain.Methods: This study was designed using the evaluator single-blind randomized controlled clinical trial.60 patients with chronic axial neck pain who were treated in a rehabilitation center from September 2020 to September 2022 were collected in the order of admission.They were randomly assigned to two groups in a1:1 ratio.They are the ICF assessment treatment group(N = 30)and the traditional assessment treatment group(N = 30).The ICF evaluation group assessed the functional status of patients according to the ICF brief core combination of chronic widespread pain and developed an intervention plan to give the patients corresponding treatment measures.Except for items that require active patient participation,the treatment,frequency,duration,equipment used,etc.,were given to the patient by the medical staff exactly the same as in the traditional assessment group.The traditional evaluation treatment group was given rehabilitation treatment methods widely used in clinic according to the symptoms,signs and functional limitations of the patients,such as: Acupuncture,massage,medium frequency physiotherapy,wax therapy,movement therapy,occupational therapy,and the application of necessary drugs.Patients were assessedfor ICF,NDI,and VAS at three time points.The first assessment is at the time of admission,which is the first assessment,the baseline(T0);After 2 weeks of treatment,the second evaluation was performed(T1).The last assessment was the third assessment(T2)at the 8th week after discharge.The ICF assessment was the primary outcomemeasure.The Neck Disability Index(NDI)and Visual Analogue Scale(VAS)were used as secondary outcomes.The data were collected and analyzed by SPSS17.0software,and P< 0.05 was statistically significant.Results: According to the trial procedure and the inclusion exclusion criteria,60 patients completed all the evaluation and treatment procedures and the number of patients required to complete the sample size.There were no serious adverse events during treatment in both groups,and no patient suspended or discontinued treatment due tospecial events.The basic data of the two groups were compared,P> 0.05 in sex,age and course of disease.There was no statistical difference between the two groups.The following results were analyzed,the ICF assessment group was referred to as Group A and the traditional assessment group as Group B.1.The main outcome was ICF score,P<0.05 was statistically significant.(1)The total ICF scores of the two groupswere compared at T0,T1 and T2.The T0 data indicated that there’s no difference in the functional status of the two groups at admission and the baseline was comparable.The T1 data indicated that after 14 days of treatment,there was no significant difference in treatment between the two groups.The T2 data showed that the two groups had a difference in treatment after discharge for 8 weeks,and the overall effect of group A was better.(2)During hospitalization.Each T0 and T1 score were paired in group A.The data indicated that the scores of all items except walking function were improved and treatment was effective.In-group B analysis at the same stage gave similar scores as in group A,and treatmen twas also effective.(3)From discharge to follow-up.Each T1 and T2 score were paired in group A.The data indicated that the patients in group A had no significant change in the score except for the health professional item,and the treatment effect was maintained well.In group B,the scores of each T1 and T2 were paired and analyzed.Some items were P< 0.05,i.e.: 2 pain perception,3 motor tolerance,4 mental activity,7 sleep,8 mental content,9 functions related to the production of strength by muscle or muscle contraction,13 gainful employment,14 intimate relationships,18 lifting and carrying objects,and total scores.The results indicated that group B patients had decreased therapeutic effect on these functions.(4)The whole process from hospital admission to follow-upperiod.Each T0 and T2 score was paired in group A.Data suggested that all items except walking function were improved in group A,and the protocol based on ICF evaluation showed a clear efficacy.In the same stage,the scores in Group B were similar to those in Group A.Conventional treatment was also more effective,only slightly worse than group A.2.Secondary outcomes: NDI index and VAS score P < 0.05 was statistically significant.(1)The total score of NDI index and VAS score were compared at T0,T1 and T2.The T0 data indicated that there’s no difference in the relative functional status and the baseline was comparable.T1 data showed that after 14 days of treatment,the difference in efficacy between the two groups was not significant,but both scores decreased significantly relative to T0,suggesting that treatment was effective.The T2 data showed that the two groups had a difference in treatment after discharge for 8 weeks,and the overall effect of group A was better.(2)During hospitalization.Each T0 and T1 score was paired in group A.Data indicated that patients in group A had improved function and treatment was effective.In the same stage,the scores obtained in Group B were similar to those in Group A.(3)From discharge to follow-up.Each T1 and T2 score were compared in group A.The results indicated that the function of specific items had no obvious change except the total score of NDI index.In thepaired analysis of each T1 and T2 score within group B,there’re P > 0.05 for some of the following items,which wasn’t statistically significant but clinically significant,i.e.:2self-care,4reading,10 entertainment.The Results indicated that group B patients had decreased thet herapeutic effect on these functions.(4)The whole process from hospital admission to follow-up period.Each T0 and T2 score were paired in group A.The data showed that the function of allitemsin group A was improved.The protocal based on ICF was effective.In group B,each T0 and T2 score was paired.The data showed that the function of all other items was improved,except that driving was not changed.The other items were also improved,only slightly worse than group A.Conclusions:(1)Interventions based on ICF assessment of chronic generalized pain caneffectively and permanently affect the outcome of patients with chronic axial neck pain.(2)The advantages which based on the ICF brief core set of chronic widespread pain are that the functional status of patients can be morecomprehensively and systematically understood by considering the physical function and structure,activity and participation,and environmental factors.(3)The evaluation based on the brief corset of ICF for chronic widespread pain is beneficial to the development of a more specific and effective individualized protocol.