Pierre Côté1,2, Jessica J Wong3,4, Deborah Sutton3,4, Heather M Shearer3,4, Silvano Mior4,5, Kristi Randhawa3,4,6, Arthur Ameis7, Linda J Carroll8, Margareta Nordin9,10, Hainan Yu3,4, Gail M Lindsay5, Danielle Southerst11, Sharanya Varatharajan3,4,6, Craig Jacobs3,12, Maja Stupar3, Anne Taylor-Vaisey3, Gabrielle van der Velde13,14,15, Douglas P Gross16,17, Robert J Brison18,19, Mike Paulden20, Carlo Ammendolia15,21, J David Cassidy22,23, Patrick Loisel4,24, Shawn Marshall25, Richard N Bohay26, John Stapleton27, Michel Lacerte28,29, Murray Krahn21, Roger Salhany30. 1. Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, ON, L1H 7L7, Canada. pierre.cote@uoit.ca. 2. UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada. pierre.cote@uoit.ca. 3. UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada. 4. Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada. 5. Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, ON, L1H 7L7, Canada. 6. Undergraduate Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada. 7. Certification Program in Insurance Medicine and Medico-legal Expertise, Faculty of Medicine, University of Montreal, N-414, Roger-Gaudry Building, 2900, Boulevard Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada. 8. Injury Prevention Centre and School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB, T6G 1C9, Canada. 9. Department of Orthopedic Surgery, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, 550 1st Avenue, New York, NY, 10016, USA. 10. Department of Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, 550 1st Avenue, New York, NY, 10016, USA. 11. Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, 60 Murray Street, 2nd Floor (Main), Toronto, ON, M5T 3L9, Canada. 12. Division of Clinical Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada. 13. Toronto Health Economics and Technology Assessment (THETA) Collaborative, 144 College Street, Toronto, ON, M5S 3M2, Canada. 14. Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON, M5S 3M2, Canada. 15. Institute for Work and Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada. 16. Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada. 17. Rehabilitation Research Centre, University of Alberta, 3-62 Corbett Hall, Edmonton, AB, T6G 2G4, Canada. 18. Clinical Research, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada. 19. Department of Emergency Medicine, School of Medicine, Queen's University, 15 Arch Street, Kingston, ON, K7L 3N6, Canada. 20. Faculty of Medicine and Dentistry, University of Alberta, 116 St & 85 Ave, Edmonton, AB, T6G 2R3, Canada. 21. Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. 22. University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. 23. Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. 24. Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. 25. University of Ottawa, 505 Smyth Road, Ottawa, ON, K1H 8M2, Canada. 26. Schulich School of Medicine and Dentistry, Western University, Dental Sciences Building, London, ON, N6A 5C1, Canada. 27. Open Policy Ontario, Toronto, Canada. 28. Université de Montréal, 2375 Cote Ste-Catherine, Montreal, QC, H3T 1A8, Canada. 29. Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A 5C1, Canada. 30. , Toronto, Canada.
Abstract
PURPOSE: To develop an evidence-based guideline for the management of grades I-III neck pain and associated disorders (NAD). METHODS: This guideline is based on recent systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences (obtained from qualitative research) when formulating recommendations. Target audience includes clinicians; target population is adults with grades I-III NAD <6 months duration. RECOMMENDATION 1: Clinicians should rule out major structural or other pathologies as the cause of NAD. Once major pathology has been ruled out, clinicians should classify NAD as grade I, II, or III. RECOMMENDATION 2: Clinicians should assess prognostic factors for delayed recovery from NAD. RECOMMENDATION 3: Clinicians should educate and reassure patients about the benign and self-limited nature of the typical course of NAD grades I-III and the importance of maintaining activity and movement. Patients with worsening symptoms and those who develop new physical or psychological symptoms should be referred to a physician for further evaluation at any time during their care. RECOMMENDATION 4: For NAD grades I-II ≤3 months duration, clinicians may consider structured patient education in combination with: range of motion exercise, multimodal care (range of motion exercise with manipulation or mobilization), or muscle relaxants. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, strain-counterstrain therapy, relaxation massage, cervical collar, electroacupuncture, electrotherapy, or clinic-based heat. RECOMMENDATION 5: For NAD grades I-II >3 months duration, clinicians may consider structured patient education in combination with: range of motion and strengthening exercises, qigong, yoga, multimodal care (exercise with manipulation or mobilization), clinical massage, low-level laser therapy, or non-steroidal anti-inflammatory drugs. In view of evidence of no effectiveness, clinicians should not offer strengthening exercises alone, strain-counterstrain therapy, relaxation massage, relaxation therapy for pain or disability, electrotherapy, shortwave diathermy, clinic-based heat, electroacupuncture, or botulinum toxin injections. RECOMMENDATION 6: For NAD grade III ≤3 months duration, clinicians may consider supervised strengthening exercises in addition to structured patient education. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, cervical collar, low-level laser therapy, or traction. RECOMMENDATION 7: For NAD grade III >3 months duration, clinicians should not offer a cervical collar. Patients who continue to experience neurological signs and disability more than 3 months after injury should be referred to a physician for investigation and management. RECOMMENDATION 8: Clinicians should reassess the patient at every visit to determine if additional care is necessary, the condition is worsening, or the patient has recovered. Patients reporting significant recovery should be discharged.
PURPOSE: To develop an evidence-based guideline for the management of grades I-III neck pain and associated disorders (NAD). METHODS: This guideline is based on recent systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences (obtained from qualitative research) when formulating recommendations. Target audience includes clinicians; target population is adults with grades I-III NAD <6 months duration. RECOMMENDATION 1: Clinicians should rule out major structural or other pathologies as the cause of NAD. Once major pathology has been ruled out, clinicians should classify NAD as grade I, II, or III. RECOMMENDATION 2: Clinicians should assess prognostic factors for delayed recovery from NAD. RECOMMENDATION 3: Clinicians should educate and reassure patients about the benign and self-limited nature of the typical course of NAD grades I-III and the importance of maintaining activity and movement. Patients with worsening symptoms and those who develop new physical or psychological symptoms should be referred to a physician for further evaluation at any time during their care. RECOMMENDATION 4: For NAD grades I-II ≤3 months duration, clinicians may consider structured patient education in combination with: range of motion exercise, multimodal care (range of motion exercise with manipulation or mobilization), or muscle relaxants. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, strain-counterstrain therapy, relaxation massage, cervical collar, electroacupuncture, electrotherapy, or clinic-based heat. RECOMMENDATION 5: For NAD grades I-II >3 months duration, clinicians may consider structured patient education in combination with: range of motion and strengthening exercises, qigong, yoga, multimodal care (exercise with manipulation or mobilization), clinical massage, low-level laser therapy, or non-steroidal anti-inflammatory drugs. In view of evidence of no effectiveness, clinicians should not offer strengthening exercises alone, strain-counterstrain therapy, relaxation massage, relaxation therapy for pain or disability, electrotherapy, shortwave diathermy, clinic-based heat, electroacupuncture, or botulinum toxin injections. RECOMMENDATION 6: For NAD grade III ≤3 months duration, clinicians may consider supervised strengthening exercises in addition to structured patient education. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, cervical collar, low-level laser therapy, or traction. RECOMMENDATION 7: For NAD grade III >3 months duration, clinicians should not offer a cervical collar. Patients who continue to experience neurological signs and disability more than 3 months after injury should be referred to a physician for investigation and management. RECOMMENDATION 8: Clinicians should reassess the patient at every visit to determine if additional care is necessary, the condition is worsening, or the patient has recovered. Patients reporting significant recovery should be discharged.
Entities:
Keywords:
Clinical practice guideline; Disease management; Management; Neck pain; Practice guideline; Therapies; Therapy; Treatment; Whiplash
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