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

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.

Access the Tool-kit

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

Sponsors

References by Topic

Cervical Overview Group Systematic Reviews Included

1. Miller J, Gross A, D’Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Bronfort G, Hoving JL. Manual therapy and exercise for neck pain. Manual Therapy 2010;15(4):334-54.a
2. KayTM, Gross A, Goldsmith CH, Hoving JL, Santaguida PL, Rutherford S, McCall R, Voth S, Bronfort G. Exercises for neck pain. Cochrane Database of Systematic Reviews 2011 (update in progress).
3. Gross A, Miller J, D’Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Bronfort G, Hoving JL. Manipulation or mobilization for neck pain: a Cochrane Review. Manual Therapy 2010; 15(4):315-33.
   

Included studies: Manual Therapy and Exercise (Miller et al, 2010)

1. Allison GT, Nagy BM, Hall T. A randomized clinical trial of manual therapy for cervico-brachial pain syndrome e a pilot study. Manual Therapy 2002;7 (2):95-102.
2. Bonk AD, Ferrari R, Giebel GD, Edelmann M, Huser R. Prospective, randomized, controlled study of activity versus collar, and the natural history for whiplash injury, in Germany. Journal of Musculoskeletal Pain 2000;8(1/2):123-32.
3. Brodin H. Cervical pain and mobilization. International Journal of Rehabilitation Research 1984;7(2):190-1.
   - Brodin H. Cervical pain and mobilization. Manual Medicine 1985;2:18-22.
4. Bronfort G, Evan R, Nelson B, Aker PD, Goldsmith CH, Vernon H. A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine 2001;26(7):788-99.
   - Evans R, Bronfort G, Nelson B, Goldsmith C. Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain. Spine 2002;27:2383-
5. Giebel GD, Edelmann M, Huser R. Die distorsion der halswirbelsaule: Fruhfunktionalle vs. ruhigstellende behandlung. Zentralbibliotak Chiropractic 1997;122:517-21.
6. Hoving JL, Koes BW, de Vet HCW, van der Windt DAWM, Assendelft WJJ, van Mameren H, et al. Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized controlled trial. Annals of Internal Medicine 2002;136:713-22.
   - Hoving JL, Koes BW, de Vet HCW, van der Windt DAWM, Assendelft WJJ, van Mameren H, et al. Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain: long-term results from a pragmatic randomized clinical trial. Clinical Journal of Pain 2006;22(4):370-7.
    - Hoving JL, de Vet HCW, Koes BW, van Mameren H, Deville WJLM, van der Windt DAWM, et al. In: Hoving JL, editor. Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain: long-term results from a pragmatic randomized trial. 1st ed. Wageningen: Pons & Looijen BV; 2001. p. 59-73.
   - Karlberg M, Magnusson M, Eva-Maj M, Melander A, Moritz U. Postural and symptomatic improvement after physiotherapy in patients with dizziness of suspected cervical origin. Archives of Physical Medicine and Rehabilitation 1996;77:874-82.
   - Korthals-de Bos IB, Hoving JL, van Tulder MW, Rutten-van Molken MP, Ader HJ, de Vet HC, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomized controlled trial. British Medical Journal 2003;326(7395):911.
   - Korthals-de Bos IB, Hoving JL, van Tulder MW, Rutten-van Molken MP, Ader HJ, de Vet HC, et al. Manual therapy is more cost-effective than physical therapy and GP care for patients with neck pain. 1st ed. Wageningen: Pons & Looijen BV; 2001. pp. 75-89.
7. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002;27(17):1835-43.
8. Jull G, Sterling M, Kenardy J, Beller E. Does the presence of sensory hypersensitivity influence outcomes of physical rehabilitation for chronic whiplash? A preliminary RCT. Pain 2007;129:28-34.
9. McKinney LA, Dornan JO, Ryan M. The role of physiotherapy in the management of acute neck sprains following road-traffic accidents. Archives of Emergency Medicine 1989;6(1):27-33.
   - McKinney MB. Behandlung der HWS-Distorsionen bei sog. Schleuderverletzungen. Orthopade 1994;23:287-90.
10. Mealy K, Brennan H, Fenelon GC. Early mobilization of acute whiplash injuries. British Medical Journal 1986;92:656-7.
11. Palmgren PJ, Sandstrom PJ, Lundqvist FJ, Heikkila H. Improvement after chiropractic care in cervicocephalic kinesthetic sensibility and subjective pain intensity in patients with nontraumatic chronic neck pain. Journal of Manipulative and Physiological Therapeutics 2006;29:100-6.
12. Persson L, Karlberg M, Magnusson M. Effects of different treatments on postural performance in patients with cervical root compression. A randomized prospective study assessing the importance of the neck in postural control. Journal of Vestibular Research 1996;6(6):439-53.
    - Persson LCG, Carlsson CA, Carlsson JY. Long-lasting cervical radicular pain managed with surgery, physiotherapy, or a cervical collar. A prospective, randomized study. Spine 1997;22(7):751-8.
    - Persson LCG, Lilja A. Pain, coping, emotional state and physical function in patients with chronic radicular neck pain. A comparison between patients treated with surgery, physiotherapy or neck collar e a blinded, prospective randomized study. Disability and Rehabilitation 2001;23(8):325-35.
    - Persson LCG, Moritz U, Brandt L, Carlsson CA. Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar. A prospective, controlled study. European Spine Journal 1994;6(4):256-66.
13. Provinciali L, Baroni M, Illuminati L, Ceravolo MG. Multimodal treatment to prevent the late whiplash syndrome. Scandinavian Journal of Rehabilitation Medicine 1996;28:105-11.
14. Skargren EI, Carlsson PG, Oberg BE. One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Spine 1998;23(17):1875-84.
    - Skargren EI, Oberg BE, Carlsson PG, Gade M. Cost and effectiveness analysis of chiropractic and physiotherapy treatment for low back and neck pain, Sixmonth follow-up. Spine 1997;22(18):2167-71.
    - Skargren EI, Oberg BE. Predictive factors for 1-year outcome of low-back and neck pain in patients treated in primary care: comparison between the treatment strategies chiropractic and physiotherapy. Pain 1998;77:201-7.
15. Vasseljen O, Johansen BM, Westgaard RH. The effect of pain reduction on perceived tension and EMG-recoded trapezius muscle activity in workers with shoulder and neck pain. Scandinavian Journal of Rehabilitation Medicine 1995;27:243-52.
16. Walker MJ, Boyles RE, Young BA, Strunce JB, Garber MB, Whitman JM, et al. The effectiveness of manual physical therapy and exercise for mechanical neck pain. Spine 2008;33(22):2371-8.
17. Ylinen J, Takala EP, Nykanen M, Hakkinen A, Malkia E, Pohjolainen T, et al. Active neck muscle training in the treatment of chronic neck pain in women. JAMA 2003;289(19):2509-16.