A professor at the University of Rhode Island led an international team of experts who spent several years revising and expanding clinical practice guidelines for the treatment of neck pain. The Journal of Orthopaedic & Sports Physical Therapy published "Neck Pain Guidelines: Revision 2017, Using the Evidence to Guide Physical Therapist Practice" in its July issue.
Professor Peter Blanpied of the Department of Physical Therapy in the College of Health Sciences, part of the Academic Health Collaborative, brought together researchers and clinicians from universities and health-care institutions in the U.S. and Canada, with input from member organizations from the International Federation of Orthopaedic Manipulative Physical Therapists, to refine guidelines for non-surgical treatment recommendations developed from research-based best practices. "It was a huge effort, all volunteer. They are incredible, brilliant, hardworking colleagues," Blanpied said of his team, who already have agreed to work together on revisions, due in five years.
In addition to refining treatment recommendations and reorganizing information to be presented in a more user-friendly format, the team expanded the guidelines, last updated in 2008, to include information on screening, evaluation, diagnosis and treatment–based classifications. The guidelines are used by physical therapists in clinical settings, insurers/payers, policy-makers, graduate students and educators.
"This is a significant contribution to our field, and Blanpied did a tremendous job leading this project over the course of several years," Jeff Konin, chair of the Department of Physical Therapy said of the in-depth, 52-page work.
The researchers began work on the guidelines in 2013, conducting reviews of the research literature from 2007-2016 on the treatment of neck pain. They screened 4,000 articles and reviewed 748 papers, restricting their analyses to systematic reviews and meta-analyses. The team worked with the International Collaboration on Neck Pain to identify leading practices, and the guidelines were reviewed and revised based on feedback from experts in the U.S and around the globe, Blanpied said.
The researchers focused on finding the best existing evidence for manual therapy, exercise, education and other treatment options to help decrease neck pain and improve function. They looked at treatment options based on whether the patient had neck pain with limited motion, neck pain associated with whiplash associated disorders, headaches related to neck pain and neck and nerve-related pain into the arm.
"It is pretty comprehensive. We hope the recommendations allow clinicians to be even more specific in their treatment of an individual patient," Blanpied said.
For the next set of revisions, Blanpied and his team have identified an interesting area of research: changes in how to approach whiplash prognosis and treatment. Blanpied explained that individuals recovering from whiplash associated disorders can be divided into three categories: 20-30% are expected to recover with minimal intervention; 50-60% recover more slowly, requiring a more comprehensive, individualized physical therapy plan considering physiological and psychological factors; and the 20-30% of individuals can expect to have longer-term pain and disability. "The problem is in prognosis; how do you determine which group your individual patient falls into," he said. "There is pretty exciting work going on around that and we hope to address it in the next set of revisions."
In addition to the full 2017 publication -; which includes detailed tables stretching across pages that delineate each condition and recommendations with research citations -; the team created condensed handouts targeted at either patients or practitioners, the latter of which includes a table that concisely classifies conditions through clinical findings, their common symptoms, expected exam findings and recommended treatments.