Clinical Course and Prognostic Factors in Acute Neck Pain: An Inception Cohort Study in General Practice


  • Original Research Article

Cees J. Vos, MD, PhD, Department of General Practice, Erasmus Medical Center, University of Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. Tel: +31-10-408-8109; Fax: +31-180-547229; E-mail:


Objective.  To describe the natural course of patients with acute neck pain presenting in general practice and to identify prognostic factors for recovery and sick leave.

Design.  We conducted a prospective cohort study with a 1-year follow-up in general practice. Questionnaires were collected at baseline and after 6, 12, 26, and 52 weeks. Days of sick leave were dichotomized into two groups: below and above 7 days of sick leave. Logistic regression was used to identify prognostic factors for recovery and sick leave.

Patients.  Consecutive patients with nonspecific neck pain lasting no longer than 6 weeks were invited to participate.

Results.  One hundred eighty-seven patients were included and 138 (74%) provided follow-up data. After 1 year, 76% of the patients stated to be fully recovered or much improved, although 47% reported to have ongoing neck pain. Almost half of the patients on sick leave at baseline returned to work within 7 days. Multivariate analysis showed that the highest association with recovery was the advice of the general practitioner (GP) “to wait and see” (odds ratio [OR] 6.7, 95% confidence interval [CI] 1.6–31.8). For sick leave, referral by the GP, for physical therapy or to a medical specialist, showed the highest association (OR 2.8, 95% CI 1.0–8.4).

Conclusion.  Acute neck pain had a good prognosis for the majority of patients, but still a relatively high proportion of patients reported neck pain after 1-year follow-up. The advice given by the GP “to wait and see” was associated with recovery, and “referral” was associated with prolonged sick leave.