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Leaver A1,2,3, Polat A1, Bandong A-N1,2, Zadro J1, DeBarrosPinheiro M1
1The University of Sydney, Faculty of Health Sciences, Lidcombe, Australia, 2The University of the Philippines, College of Allied Medical Profession, Manilla, Philippines, 3Westmead Hospital, Physiotherapy, Sydney, Australia
Background: Neck pain is a prevalent condition that causes significant burden to individuals and society. Clinical practice guidelines (CPG) for neck pain have been produced by professional associations, government bodies and funding agencies with the aim of encouraging best practice.
Purpose: To assess the quality and consistency of recommendations in CPG for the management of neck pain.
Methods: Systematic review. CPGs were identified using the advanced search function of the PEDro database in June 2018. CPGs were included if they made recommendations about; assessment, prognosis, interventions or review / referral; for non-specific neck pain, cervical radiculopathy or whiplash. CPGs that had been rescinded or had updated versions were excluded. Data were extracted by two independent reviewers and included guideline characteristics, summary recommendations and quality items. Guidelines for the use of single interventions were excluded from the synthesis of recommendations. Guideline recommendations were extracted verbatim and collated. Content analysis was undertaken independently by three researchers to code and summarise key recommendations. The results were presented to the research team for review and refinement. Guideline quality was assessed independently by three researchers using the Appraisal of Guidelines for Research & Evaluation (AGREE II) tool. Disagreements were resolved by consensus.
Results: Thirty-one guidelines were identified and 13 were included in the quality assessment. Two guidelines covered single modality interventions and were excluded from the synthesis of recommendations. Two guidelines focused on whiplash, one on neck pain in workers, one on radiculopathy and the remainder on neck pain more generally. Guideline quality was variable. Five guidelines had AGREE scores ≥5/7. The lowest average scoring quality item was guideline applicability 12.5%±12.3. Nine guidelines made recommendation about assessment and diagnosis with all recommending screening for serious pathologies. All nine also recommended that neurological conditions be classified separately from neck pain. Six guidelines recommended classifying neck pain according to the Quebec Task Force criteria or modified Quebec criteria for all neck pain. One guideline recommended impairment-based classification. Eight guidelines made recommendations regarding radiological assessment with the consistent recommendation about limiting plain and specialised radiological assessment to case of suspected serious pathology or neurological compromise. Seven guideline made recommendations about assessment of prognosis with four drawing from evidence from prognostic studies from whiplash and neck pain and the remainder extrapolating from the musculoskeletal literature on yellow flags. Two guidelines recommended stratified-care based on risk of disability, one guideline recommended different treatments for impairment-based subgroups, and four studies had separate recommendations for acute versus chronic neck pain. Most guidelines recommended a first-line of care that included advice, reassurance and encouragement of physical activity. The strength of recommendations about other interventions including exercise, medications, manual therapies and other passive treatments varied considerably across the guidelines.
Conclusion(s): Recommendations from several high-quality CPG for neck pain were reasonably similar in relation to assessment and overall approaches to management. There were some inconsistencies in relation to the strength of recommendation for individual treatment modalities.
Implications: There is generally good consensus about best practice approaches for neck pain.
Keywords: Neck pain, Systematic Review, Clinical Practice Guidelines
Funding acknowledgements: No external funding
Purpose: To assess the quality and consistency of recommendations in CPG for the management of neck pain.
Methods: Systematic review. CPGs were identified using the advanced search function of the PEDro database in June 2018. CPGs were included if they made recommendations about; assessment, prognosis, interventions or review / referral; for non-specific neck pain, cervical radiculopathy or whiplash. CPGs that had been rescinded or had updated versions were excluded. Data were extracted by two independent reviewers and included guideline characteristics, summary recommendations and quality items. Guidelines for the use of single interventions were excluded from the synthesis of recommendations. Guideline recommendations were extracted verbatim and collated. Content analysis was undertaken independently by three researchers to code and summarise key recommendations. The results were presented to the research team for review and refinement. Guideline quality was assessed independently by three researchers using the Appraisal of Guidelines for Research & Evaluation (AGREE II) tool. Disagreements were resolved by consensus.
Results: Thirty-one guidelines were identified and 13 were included in the quality assessment. Two guidelines covered single modality interventions and were excluded from the synthesis of recommendations. Two guidelines focused on whiplash, one on neck pain in workers, one on radiculopathy and the remainder on neck pain more generally. Guideline quality was variable. Five guidelines had AGREE scores ≥5/7. The lowest average scoring quality item was guideline applicability 12.5%±12.3. Nine guidelines made recommendation about assessment and diagnosis with all recommending screening for serious pathologies. All nine also recommended that neurological conditions be classified separately from neck pain. Six guidelines recommended classifying neck pain according to the Quebec Task Force criteria or modified Quebec criteria for all neck pain. One guideline recommended impairment-based classification. Eight guidelines made recommendations regarding radiological assessment with the consistent recommendation about limiting plain and specialised radiological assessment to case of suspected serious pathology or neurological compromise. Seven guideline made recommendations about assessment of prognosis with four drawing from evidence from prognostic studies from whiplash and neck pain and the remainder extrapolating from the musculoskeletal literature on yellow flags. Two guidelines recommended stratified-care based on risk of disability, one guideline recommended different treatments for impairment-based subgroups, and four studies had separate recommendations for acute versus chronic neck pain. Most guidelines recommended a first-line of care that included advice, reassurance and encouragement of physical activity. The strength of recommendations about other interventions including exercise, medications, manual therapies and other passive treatments varied considerably across the guidelines.
Conclusion(s): Recommendations from several high-quality CPG for neck pain were reasonably similar in relation to assessment and overall approaches to management. There were some inconsistencies in relation to the strength of recommendation for individual treatment modalities.
Implications: There is generally good consensus about best practice approaches for neck pain.
Keywords: Neck pain, Systematic Review, Clinical Practice Guidelines
Funding acknowledgements: No external funding
Topic: Musculoskeletal; Service delivery/emerging roles
Ethics approval required: No
Institution: NA
Ethics committee: NA
Reason not required: systematic review of guidelines
All authors, affiliations and abstracts have been published as submitted.
