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Management of Neck Pain and Associated Disorders

By Frank M. Painter|March 23, 2016|Guidelines, Neck Pain, Whiplash|

Management of Neck Pain and Associated Disorders: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

SOURCE: Eur Spine J. 2016 (Mar 16) [Epub]

Côté P, Wong JJ, Sutton D, Shearer HM, Mior S et. al.

Canada Research Chair in
Disability Prevention and Rehabilitation,
University of Ontario Institute of Technology (UOIT),
2000 Simcoe Street North,
Oshawa, ON, L1H 7L7, Canada.

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.

There are more articles like this @ our:

Practice Guidelines Page and the:

Chronic Neck Pain and Chiropractic Page

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Importance of Psychological Factors for the Recovery From a First Episode of Acute Non-specific Neck Pain

By Frank M. Painter|March 18, 2016|Chronic Pain|

Importance of Psychological Factors for the Recovery From a First Episode of Acute Non-specific Neck Pain – A Longitudinal Observational Study

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2016 (Mar 16); 24: 9

Brigitte Wirth, B. Kim Humphreys and Cynthia Peterson

Chiropractic Medicine Department,
Faculty of Medicine,
University of Zurich and University Hospital Balgrist

It has been established that psychological factors (appear to play) an important role in chronic non-specific neck pain. Particularly anxiety, depression and catastrophizing appear to negatively affect pain intensity and disability in this patient group. [5]To test whether these emotional elements are the natural side-effect of chronic pain as opposed to being causal, these researchers worked with 850 patients with acute non-specific neck pain with no history of previous neck or arm pain.

The results were quite fascinating:

They found that the psychological factors measured at baseline had no influence on the self-reported outcome at 1 week and 1 month
A high reduction in anxiety between 1 week and 1 month after the first consultation was linked to a significantly higher chance for self-reported improvement at 1 month in both models
Poor outcome at 1 and 3 months went along with high levels of anxiety. High baseline anxiety was not a risk factor for poor outcome, but its reduction during the first month was highly related to favorable recovery.
In contrast, high level of depression at baseline was fairly related to poor recovery at 3 months.

Thus, patients with acute non-specific neck pain might benefit from adequate information and communication that targets at reducing anxiety by encouraging self-management of the problem.

Background The influence of psychological factors on acute neck pain is sparsely studied. In a secondary analysis of prospectively collected data, this study investigated how several psychological factors develop in the first three months of acute neck pain and how these factors influence self-perceived recovery.

Methods Patients were recruited in various chiropractic practices throughout Switzerland between 2010 and 2014. The follow-up telephone interviews were conducted for all patients by research assistants in the coordinating university hospital following a standardized procedure. The population of this study consisted of 103 patients (68 female; mean age = 38.3 ± 13.8 years) with a first episode of acute (<4 weeks) neck pain. Prior to the first treatment, the patients filled in the Bournemouth Questionnaire (BQ). One week and 1 and 3 months later, they completed the BQ again along with the Patient Global Impression of Change (PGIC). The temporal development (repeated measure ANOVA) of the BQ questions 4 (anxiety), 5 (depression), 6 (fear-avoidance) and 7 (pain locus of control) as well as the influence of these scores on the PGIC were investigated (binary logistic regression analyses, receiver operating curves (ROC)).

Results All psychological parameters showed significant reduction within the first month. The parameter ‘anxiety’ was associated with outcome at 1 and 3 months (p = 0.013, R2 = 0.40 and p = 0.039, R2 = 0.63, respectively). Baseline depression (p = 0.037, R2 = 0.21), but not baseline anxiety, was a predictor for poor outcome. A high reduction in anxiety within the first month was a significant predictor for favorable outcome after 1 month (p < 0.001; R2 = 0.57).

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Chronic Neck Pain and Chiropractic Page and the:

The Biopsychosocial Model Page

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Happy St. Patty’s Day! (2016)

By Frank M. Painter|March 16, 2016|Uncategorized|

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Is the WCA Trying to Create a New Profession?

By Frank M. Painter|March 14, 2016|Announcement|

Is the WCA Trying to Create a New Profession?

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic ~ March 15, 2016

The Wisconsin Chiropractic Association (WCA) is the driving force behind the introduction of a bill to create a new health care profession to be known as “primary spinal care practitioners.” [1] This is the apparent culmination of significant effort that began when “the WCA Board of Directors – at a special meeting on August 7, 2014 – voted unanimously to release a white paper outlining the Primary Spine Care Physician (PSCP) initiative to WCA members and the public.” [2]

According to the bill’s authors, Wisconsin Senator Frank Lasee and Representative Joe Sanfelippo, “[T]his bill creates a new type of health care provider in Wisconsin called the Primary Spine Care Practitioner (PSCP) designed to address the growing burden of spine related disorders and the overuse of prescription drugs in Wisconsin. The Primary Spine Care Practitioner would be a new practice act governed by the Medical Examining Board available to licensed chiropractors who meet the educational and clinical training requirements.” [3]

The bill includes rights and privileges for primary spinal care practitioners not currently enjoyed by doctors of chiropractic. In addition, the bill:

“[E]stablishes a licensure program for primary spinal care practitioners to be administered by the Spinal Medicine Affiliated Credentialing Board, which is created in the bill and attached to the Medical Examining Board.

“[D]efines ‘spinal medicine’ in relevant part as the integration and application of the practice of chiropractic and the practice of medicine and surgery, both as defined under current law, that is limited to conditions of the spine and the musculoskeletal, neuromuscular, and nervous systems.

Provides that “a licensed primary spinal care practitioner has authority to prescribe and administer prescription drugs.” [4]

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Best Practices Recommendations for Chiropractic Care for Older Adults

By Frank M. Painter|March 12, 2016|Medicare|

Best Practices Recommendations for Chiropractic Care for Older Adults: Results of a Consensus Process

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2010 (Jul); 33 (6): 464-473

Cheryl Hawk, DC, PhD, Michael Schneider, DC, PhD,
Paul Dougherty, DC, Brian J. Gleberzon, DC,
Lisa Z. Killinger, DC

Cleveland Chiropractic College,
Overland Park, KS 66210, USA.

OBJECTIVE: At this time, the scientific evidence base supporting the effectiveness of chiropractic care for musculoskeletal conditions has not yet definitively addressed its appropriateness for older adults. Expert consensus, as a form of evidence, must be considered when higher levels of evidence are lacking. The purpose of this project was to develop a document with evidence-based recommendations on the best practices for chiropractic care of older adults.

METHODS: A set of 50 seed statements was developed, based on the clinical experience of the multidisciplinary steering committee and the results of an extensive literature review. A formal Delphi process was conducted, following the rigorous RAND-UCLA (University of California, Los Angeles) methodology. The statements were circulated electronically to the Delphi panel until consensus was reached. Consensus was defined as agreement by at least 80% of the panelists. There were 28 panelists from 17 US states and Canada, including 24 doctors of chiropractic, 1 physical therapist, 1 nurse, 1 psychologist, and 1 acupuncturist.

RESULTS: The Delphi process was conducted in January-February 2010; all 28 panelists completed the process. Consensus was reached on all statements in 2 rounds. The resulting best practice document defined the parameters of an appropriate approach to chiropractic care for older adults, and is presented in this article.

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Medicare Information Page

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Patients’ Experiences With Vehicle Collision to Inform the Development of Clinical Practice Guidelines

By Frank M. Painter|March 8, 2016|Evidence-based Practice, Whiplash|

Patients’ Experiences With Vehicle Collision to Inform the Development of Clinical Practice Guidelines: A Narrative Inquiry

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2016 (Feb 26) [EPub]

Gail M. Lindsay, RN, PhD, Silvano A. Mior, DC, PhD,
Pierre Côté, DC, PhD, Linda J. Carroll, PhD,
Heather M. Shearer, DC, MSc

Associate Professor,
Faculty of Health Sciences,
University of Ontario Institute of Technology,
Oshawa, ON

OBJECTIVE: The purpose of this narrative inquiry was to explore the experiences of persons who were injured in traffic collisions and seek their recommendations for the development of clinical practice guideline (CPG) for the management of minor traffic injuries.

METHODS: Patients receiving care for traffic injuries were recruited from 4 clinics in Ontario, Canada resulting in 11 adult participants (5 men, 6 women). Eight were injured while driving cars, 1 was injured on a motorcycle, 2 were pedestrians, and none caused the collision. Using narrative inquiry methodology, initial interviews were audiotaped, and follow-up interviews were held within 2 weeks to extend the story of experience created from the first interview. Narrative plotlines across the 11 stories were identified, and a composite story inclusive of all recommendations was developed by the authors. The research findings and composite narrative were used to inform the CPG Expert Panel in the development of new CPGs.

RESULTS: Four recommended directions were identified from the narrative inquiry process and applied. First, terminology that caused stigma was a concern. This resulted in modified language (“injured persons”) being adopted by the Expert Panel, and a new nomenclature categorizing layers of injury was identified. Second, participants valued being engaged as partners with health care practitioners. This resulted in inclusion of shared decision-making as a foundational recommendation connecting CPGs and care planning. Third, emotional distress was recognized as a factor in recovery. Therefore, the importance of early detection and the ongoing evaluation of risk factors for delayed recovery were included in all CPGs. Fourth, participants shared that they were unfamiliar with the health care system and insurance industry before their accident. Thus, repeatedly orienting injured persons to the system was advised.

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Whiplash Page

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