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.
Appendix 1. CCGI Executive Summary: Structure and Methods
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). CCGI organization chart
Author keywords: Practice Guideline, Neck Pain, Whiplash Injuries, Chiropractic, Therapeutic Intervention, Disease Management, Musculoskeletal Disorders
Author affiliations: AEB, FA-Z: School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada; AEB: Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada; GS: St Anne's Rd Chiropractic, Winnipeg, MB, Canada; GS: Faculty of Science, University of Winnipeg, Winnipeg, MB, Canada; PD, MS: Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada; MD: Département des Sciences de l'Activité Physique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada; JH: Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada; BH: Faculty of Health and Community Studies, Mount Royal University, Calgary, AB, Canada; CH: University Health Network, Toronto Western Research Institute, University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada; IP: Département d'Anatomie, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada; SP: Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, MB, Canada; JS: Human Health and Nutritional Science, University of Guelph, Guelph, ON, Canada; JW: Downsview Chiropractic, Toronto, ON, Canada; JO: Health Systems Management, Rush University, Chicago, IL
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