TY - JOUR
T1 - The Treatment of Neck Pain–Associated Disorders and Whiplash-Associated Disorders
T2 - A Clinical Practice Guideline
AU - Bussières, André E.
AU - Stewart, Gregory
AU - Al-Zoubi, Fadi
AU - Decina, Philip
AU - Descarreaux, Martin
AU - Hayden, Jill
AU - Hendrickson, Brenda
AU - Hincapié, Cesar
AU - Pagé, Isabelle
AU - Passmore, Steven
AU - Srbely, John
AU - Stupar, Maja
AU - Weisberg, Joel
AU - Ornelas, Joseph
N1 - Funding Information:
Funds provided by the Canadian Chiropractic Research Foundation. The views of the funding body have not influenced the content of the guideline. No conflicts of interest were reported for this study.
Funding Information:
The Clinical Practice Guideline Initiative was launched by the Canadian Chiropractic Association (CCA) and the Canadian Federation of Chiropractic Regulatory and Education Accrediting Boards (CFCREAB or Federation) over a decade ago to develop clinical practice guidelines (CPGs) to improve chiropractic care delivery in Canada. This is now known as the Canadian Chiropractic Guideline Initiative (CCGI), a 6-year project (2012-2018) funded by chiropractic stakeholders in Canada ( www.chiroguidelines.org ).
Publisher Copyright:
© 2016
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Objective The objective was to develop a clinical practice guideline on the management of neck pain–associated disorders (NADs) and whiplash-associated disorders (WADs). This guideline replaces 2 prior chiropractic guidelines on NADs and WADs. Methods Pertinent systematic reviews on 6 topic areas (education, multimodal care, exercise, work disability, manual therapy, passive modalities) were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and data extracted from admissible randomized controlled trials. We incorporated risk of bias scores in the Grading of Recommendations Assessment, Development, and Evaluation. Evidence profiles were used to summarize judgments of the evidence quality, detail relative and absolute effects, and link recommendations to the supporting evidence. The guideline panel considered the balance of desirable and undesirable consequences. Consensus was achieved using a modified Delphi. The guideline was peer reviewed by a 10-member multidisciplinary (medical and chiropractic) external committee. Results For recent-onset (0-3 months) neck pain, we suggest offering multimodal care; manipulation or mobilization; range-of-motion home exercise, or multimodal manual therapy (for grades I-II NAD); supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD). For persistent (>3 months) neck pain, we suggest offering multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioner's advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For workers with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD). Conclusions A multimodal approach including manual therapy, self-management advice, and exercise is an effective treatment strategy for both recent-onset and persistent neck pain.
AB - Objective The objective was to develop a clinical practice guideline on the management of neck pain–associated disorders (NADs) and whiplash-associated disorders (WADs). This guideline replaces 2 prior chiropractic guidelines on NADs and WADs. Methods Pertinent systematic reviews on 6 topic areas (education, multimodal care, exercise, work disability, manual therapy, passive modalities) were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and data extracted from admissible randomized controlled trials. We incorporated risk of bias scores in the Grading of Recommendations Assessment, Development, and Evaluation. Evidence profiles were used to summarize judgments of the evidence quality, detail relative and absolute effects, and link recommendations to the supporting evidence. The guideline panel considered the balance of desirable and undesirable consequences. Consensus was achieved using a modified Delphi. The guideline was peer reviewed by a 10-member multidisciplinary (medical and chiropractic) external committee. Results For recent-onset (0-3 months) neck pain, we suggest offering multimodal care; manipulation or mobilization; range-of-motion home exercise, or multimodal manual therapy (for grades I-II NAD); supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD). For persistent (>3 months) neck pain, we suggest offering multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioner's advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For workers with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD). Conclusions A multimodal approach including manual therapy, self-management advice, and exercise is an effective treatment strategy for both recent-onset and persistent neck pain.
KW - Chiropractic
KW - Disease Management
KW - Musculoskeletal Disorders
KW - Neck Pain
KW - Practice Guideline
KW - Therapeutic Intervention
KW - Whiplash Injuries
UR - http://www.scopus.com/inward/record.url?scp=84994682406&partnerID=8YFLogxK
U2 - 10.1016/j.jmpt.2016.08.007
DO - 10.1016/j.jmpt.2016.08.007
M3 - Journal article
C2 - 27836071
AN - SCOPUS:84994682406
SN - 0161-4754
VL - 39
SP - 523-564.e27
JO - Journal of Manipulative and Physiological Therapeutics
JF - Journal of Manipulative and Physiological Therapeutics
IS - 8
ER -