The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline.
Study Goal
The researchers aimed to evaluate the effectiveness of massage as part of multimodal care for persistent neck pain and whiplash-associated disorders.
Results Summary
The study suggests high-dose massage as an effective treatment for persistent neck pain (grades I-II NAD) when combined with other interventions like supervised exercise and advice. It supports massage as part of multimodal care for improving outcomes in persistent neck pain.
Population
Adults with persistent (>3 months) neck pain, including grades I-III neck pain-associated disorders (NADs) and whiplash-associated disorders (WADs).
Effective Dosage
High-dose massage (specific amount and frequency not detailed).
Duration
Not specified.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
multimodal care | decrease | recent-onset (0-3 months) neck pain | patients with grades I-II NAD | - | suggest offering | #1 |
manipulation or mobilization | decrease | recent-onset (0-3 months) neck pain | patients with grades I-II NAD | - | suggest offering | #2 |
range-of-motion home exercise | decrease | recent-onset (0-3 months) neck pain | patients with grades I-II NAD | - | suggest offering | #3 |
multimodal manual therapy | decrease | recent-onset (0-3 months) neck pain | patients with grades I-II NAD | - | suggest offering | #4 |
supervised graded strengthening exercise | decrease | recent-onset (0-3 months) neck pain | patients with grade III NAD | - | suggest offering | #5 |
multimodal care | decrease | recent-onset (0-3 months) neck pain | patients with grade III WAD | - | suggest offering | #6 |
multimodal care | decrease | persistent (>3 months) neck pain | patients with grades I-II NAD | - | suggest offering | #7 |
stress self-management | decrease | persistent (>3 months) neck pain | patients with grades I-II NAD | - | suggest offering | #8 |
manipulation with soft tissue therapy | decrease | persistent (>3 months) neck pain | patients with grades I-II NAD | - | suggest offering | #9 |
high-dose massage | decrease | persistent (>3 months) neck pain | patients with grades I-II NAD | - | suggest offering | #10 |
supervised group exercise | decrease | persistent (>3 months) neck pain | patients with grades I-II NAD | - | suggest offering | #11 |
supervised yoga | decrease | persistent (>3 months) neck pain | patients with grades I-II NAD | - | suggest offering | #12 |
supervised strengthening exercises | decrease | persistent (>3 months) neck pain | patients with grades I-II NAD | - | suggest offering | #13 |
home exercises | decrease | persistent (>3 months) neck pain | patients with grades I-II NAD | - | suggest offering | #14 |
multimodal care | decrease | persistent (>3 months) neck pain | patients with grades I-III NAD | - | suggest offering | #15 |
practitioner's advice | decrease | persistent (>3 months) neck pain | patients with grades I-III NAD | - | suggest offering | #16 |
supervised exercise with advice | decrease | persistent (>3 months) neck pain | patients with grades I-II WAD | - | suggest offering | #17 |
advice alone | decrease | persistent (>3 months) neck pain | patients with grades I-II WAD | - | suggest offering | #18 |
mixed supervised and unsupervised high-intensity strength training | decrease | persistent neck and shoulder pain | workers with grades I-III NAD | - | evidence supports | #19 |
advice alone | decrease | persistent neck and shoulder pain | workers with grades I-III NAD | - | evidence supports | #20 |
multimodal approach including manual therapy, self-management advice, and exercise | decrease | neck pain | patients with both recent-onset and persistent neck pain | - | is an effective treatment strategy | #21 |
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.