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

Introduction

Welcome to the 'Manual Therapy and Exercise for Neck Pain: Clinical Treatment Tool-kit' 2012, written by Jordan Miller, Anita Gross, Tim Rogers and Jessica Willemse, COG, ICON from McMaster University; sponsored by LifeMark Health and Eramosa Physiotherapy Association (EPA).

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. 

File:Figure1 Steps.jpg

Figure 1. Five Steps that help make the evidence work for you.

Each Step of the tool-kit can be accessed through the following links:

• Step 1 – Identify your patient
• Step 2 – Determine the evidence
• Step 3 – Inform your technique
• Step 4 – Consider dosage
• Step 5 – Individualize care

Step 1: Identify your patient

A) Identify whether the patient is experiencing:

• Neck pain alone
• Neck pain with cervicogenic headache
• Whiplash associated disorder
• Neck pain with radiculopathy

B) Indentify whether the patients symptoms are:

• Acute (present for less than 12 weeks)
• Chronic (present for greater than 12 weeks)

C) Click on the appropriate duration of symptoms to go to Step 2 – Determining the evidence regarding the use of manual therapy and exercise for the treatment of this population

File:Figure2 Step1Chart.jpg

Acute	Acute	Acute	Acute
Chronic	Chronic	Chronic	Chronic
Unspecified

Step 2: Determine the evidence

• The evidence regarding the use of manual therapy and exercise for the treatment of neck pain is presented below, organized by patient characteristics

2.1 Neck pain alone
2.2 Neck pain with cervicogenic headache
2.3 Whiplash associated disorder
2.4 Neck pain with radiculopathy

• Once you have found the evidence most applicable to your patient, click on ‘Step 3-inform your technique’ to see the techniques utilized in the positive studies for that patient population

Step 3: Inform your technique

• The techniques utilized in the positive trials investigating the use of manual therapy and exercise for the treatment of neck pain are presented below, organized by patient characteristics

3.1 Neck pain alone
3.2 Neck pain with cervicogenic headache
3.3 Whiplash associated disorder
3.4 Neck pain with radiculopathy

• Once you have found the techniques most applicable to your patient, click on ‘Step 4-inform your technique’ to see the techniques utilized in the positive studies for that patient population

Step 4: Consider dosage

• The dosage corresponding to the techniques selected in step 3 is presented below, organized by patient characteristics

4.1 Neck pain alone
4.2 Neck pain with cervicogenic headache
4.3 Whiplash associated disorder
4.4 Neck pain with radiculopathy

• Once you have found the evidence most applicable to your patient, click on ‘Step 5- Individualize your treatment’ for other considerations in applying the evidence to your patient

Step 5: Individualize treatment

Individualized treatment takes into account the patient, practice setting, and practitioner.

References

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