Manual Therapy and Exercise for Neck Pain: Clinical Treatment Tool-kit

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Course Description

Welcome to Texas State University's Orthopaedic Evidence-based Practice Assignment project. This project was created by and for the students in the Doctor of Physical Therapy Program at Texas State University -San Marcos, and is part of the Orthopaedic curriculum.  This project is a component of the Orthopaedic Coursework in the Doctor of Physical Therapy Program at Texas State University. PT 7349, 7449, 7559

Course Instructors

Dr. Eric Robertson & Dr. Rob Wainner & Dr. Brenda Boucher

Project Dates

1. Peripheral Component - November 2010
2. Spinal Component - May 2011

Instructions

The assignment will challenge you to explore a given topic related to upper extremity course topics, integrate best evidence, including analysis of clinical trials, and develop and present professional digital content on a public wiki targeted to practicing professionals and students around the world. Your task is to develop a Physiopedia page after a review of the current best evidence on a given orthopaedic topic. The page should be an evidence-based review of your findings. This project will also consist of an oral group presentation of your page and topic, as well as the off-line submission of a one page critical analysis of a high-quality clinical trial.

Objectives

• Coherently present diagnostic methods and intervention strategies or techniques for patients with selected disorders.  

• These disorders are often described via a classic disease or impairment/tissue model, however, you need to draw the link to physical therapy in terms of a impairment or disablement model and PT treatment. In other words what are the "key impairments" that result from these disorders and how can you as a therapist address these.

• Search for, analyze, and integrate the best evidence related to a given topic to guide physical therapist practice.  

• Evidence for treatment approaches that have been documented via clinical trials or other clinical research, if available, should be emphasized; if not the relative value of the alternative sources should be clarified.

• Develop digital media (web page, images, and video as appropriate) to present findings to the class, other students, and the general body of practicing physical therapists via an open international wiki site.

• The focus should be to create a targeted mini in-service on the assigned topic. It should be concise and targeted to your audience of fellow therapists. The web page should make sure to emphasize why these topics are relevant to physical therapy.

Here are some examples of the links you could add to the resources section: 

• Medical sites related to the disorder
• Video/photos related to the disorder
• Links to abstract of research in Pubmed/Medline

A template for the article pages which contains sub-headings headings for the disorder has been provided, please follow the template for uniformity of content.

Articles

Below are links to the articles created during this project.

Head & Cervical Spine

• Adult-Onset Idiopathic Torticollis
• Cervicogenic Headache
• Surgical & Post-op Management of Cervical Spinal Stenosis

Thoracic Spine

• Scheuermann's Kyphosis
• Thoracic Spine Fracture

Lumbar Spine

• Lumbar Spine Fracture

Low Back

• Chronic Low Back Pain 
• Occupational Related Low Back Pain
• Low Back Pain and Pelvic Floor Disorders
• Low Back Pain and Pregnancy

Shoulder

• Adhesive Capsulitis
• Posterior Shoulder Instability
• Throwing Injuries and Rehabilitation
• Total Shoulder Arthroplasty
• Axillary Nerve Injuries in Dislocation
• Internal Impingement
• Thoracic Outlet Syndrome (TOS)
• Pediatric Humeral Fracture
• Calcific tendonitis of the shoulder

Elbow

• Postero-lateral Elbow Instability
• Cubital Tunnel Syndrome
• Posterior Elbow Dislocation
  
• Little League Elbow

Wrist and Hand

• De Quervain's Tenosynovitis
• Distal Radial Fractures
• Scapholunate Dissociation
• Trigger Finger
• Ulnar Impaction Syndrome

Hip & Pelvis

• Hip Labral Tears
• Snapping Hip Syndrome

General Lower Extremity

• Leg and Foot Stress Fractures

Knee

• Knee Rotary Instability

Foot & Ankle

• Ankle Impingement
• Syndesmotic Ankle Sprains
• Tarsal Tunnel Syndrome
• Total Ankle Arthroplasty TXST

Original Editor - Your name will be added here if you created the original content for this page.

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

References

References will automatically be added here, see adding references tutorial.

Background
Systematic reviews incorporate information gathered from a large volume of primary research; however, it is often difficult to draw from this pooled data specific treatment techniques and dosages. Many clinicians have a positive attitude towards evidence-based practice, but may not have the time or resources to seek out the specific technique and dosage information from positive trials investigating the effectiveness of treatment strategies. Knowledge translation tools can be used to help clinicians access the evidence provided in systematic reviews and provide the specific technique and dosage information so that it can be implemented in clinical practice.
Purpose
The purpose of ‗Manual therapy and exercise for neck pain: clinical treatment tool-kit‘ is to provide a resource for clinical decision making by providing evidence, techniques, and dosages for the use of manual therapy and exercise in the treatment of neck pain.
Tool-kit description
The information contained in the ‗Manual therapy and exercise for neck pain: clinical treatment tool-kit‘ is drawn from three of the Cervical Overview Group‘s (COG) systematic reviews, which include sixty randomized controlled trials on manual therapy and exercise for neck pain. This tool-kit was produced in association with the International Collaboration on Neck Pain (ICON), who evaluated the three systematic review included in this tool-kit at 8-9/12 using the ‗Assessment of Multiple Systematic Reviews‘ (AMSTAR) methodological rating tool. It utilizes tables, pictures, and symbols to depict key positive or negative findings for specific techniques, dosages, and outcomes. Related disorder types (whiplash associated disorder, cervicogenic headache, radiculopathy), duration of disorder (acute, subacute, chronic) and follow-up periods (short, intermediate, and long-term – one two, or three GRADE symbols) characterize the findings. The ‗Manual therapy and exercise for neck pain: clinical treatment tool-kit‘ has not been formally evaluated, but treatment recommendations are based on the Cochrane GRADE approach (high ♦, moderate •, low▲).
Using the Tool-kit
The ‗Manual therapy and exercise for neck pain: clinical treatment tool-kit‘ is meant to be applied judiciously. We suggest this tool be used as a resource to inform treatment decisions, but clinicians must understand that treatments should be individualized to each patient and that only the treatments that are within each clinician‘s scope and abilities should be performed. We suggest there are five steps in utilizing this tool-kit as a resource for clinical decision making (Figure 1). The user should identify characteristics of the patient they are treating in Step 1. The evidence is depicted for each patient group in Step 2. The treatment techniques utilized in each positive trial are presented in Step 3 and the corresponding dosage in Step 4. Finally, Step 5 involves individualizing care to each individual patient. The tool-kit is interactive and will allow the participant to click on a link to directly go to the corresponding location in the next step. 

Background……………………………………………………….... 2
Purpose……...………………………...……………………..…….. 2
Tool-Kit description……………………………………………….. 2
Using the tool-kit…………………………………………………... 2
Step 1 – Identify your patient…………………………………........ 4
Step 2 – Determine the evidence ……………...…………………... 5
Step 3 – Inform your technique …....……...…...………………….. 11
Step 4 – Consider dosage …..……………………………………... 58
Step 5 – Individualize care…………...……..…………………….. 69
References………..………………………………………………… 70