Non-specific neck pain: diagnosis and treatment - KCE

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2 Non-Specific Neck Pain: diagnosis and treatment KCE Reports 119 QUALITY APPRAISAL: RCTS ON TREATMENT ........................................................................................................... 38 QUALITY APPRAISAL: SYSTEMATIC REVIEWS .............................................................................................................. 38 QUALITY APPRAISAL: AGREE SCORES FOR THE 2 SELECTED GUIDELINES ................................................................. 39 APPENDIX 3: EVIDENCE TABLE OF INCLUDED SYSTEMATIC REVIEWS ................ 41 APPENDIX 4: EVIDENCE TABLE OF INCLUDED RCT’S FOR TREATMENT .............. 51 APPENDIX 5: EVIDENCE TABLE OF INCLUDED PUBLICATIONS DIAGNOSIS AND PROGNOSIS ............................................................................................................................. 55 APPENDIX 6: RECOMMENDATIONS COMPARED TO EXISTING GUIDELINES ...... 57 APPENDIX 7 : NECK DISABILITY INDEX .......................................................................... 60 ORIGINAL VERSION NECK DISABILITY INDEX: INSTRUMENT AND INTERPRETATION ........................................... 60 DUTCH VERSION NECK DISABILITY INDEX : INSTRUMENT AND INTERPRETATION .............................................. 67 7 REFERENCE LIST .......................................................................................................... 70
KCE Reports 119 Non-Specific Neck Pain: diagnosis and treatment 3 1 INTRODUCTION 1.1 PURPOSE OF THE STUDY This study aims to review scientific literature on diagnosis, prognosis and treatment of acute, subacute and chronic non-specific neck pain. The objective is to offer an overview of the currently available evidence to primary care and specialized practitioners involved with adults who suffer from non-specific neck pain. 1.2 NON-SPECIFIC NECK PAIN: DEFINITION AND EPIDEMIOLOGY 1.2.1 Definition Neck pain is a wide concept and many definitions exist. In this report non-specific neck pain is defined in accordance to established guidelines, high quality systematic reviews, key text books, search on the topic in Pubmed and discussion with experts 1-5 : Non-specific neck pain can be defined as simple (non-specific) neck pain without specific underlying disease causing the pain. Symptoms vary with physical activity and over time. Each form of acute, subacute or chronic neck pain, where no abnormal anatomic structure; as cause of pain, can be identified, is non-specific neck pain. There are different opinions about duration of symptoms but according to Binder, neck pain can be acute (< 4 weeks duration), sub-acute (1-4 months duration) or chronic (> 4 months duration) 1 . The symptoms of non-specific neck pain are very similar to the symptoms of whiplash associated disorders grades one and two (WAD I-II). Whiplash is an accelerationdeceleration mechanism of energy transfer to the neck and can result in injury to bony or soft tissue. The clinical symptoms, known as whiplash associated disorders, are for grade I ‘pain, stiffness and tenderness in the neck, but no physical signs’ and for grade II ‘neck complaints and other musculoskeletal complaints (e.g., a decreased range of motion and tender spots)’ 6 . The WAD’s can also include headache and numerous other symptoms e.g. dizziness, tinnitus, sleep disturbance, mood disturbance, pain in areas outside the neck. Therefore, as also mentioned in the methodology section, literature on WAD will be excluded in this review. However, although it is not our purpose to review WAD primary literature, probably the systematic reviews and primary RCT’s to be retrieved will not always allow us to separate this subgroup out from non-specific neck pain. In this case, these data will be accepted. Non-specific neck pain can be diagnosed on clinical grounds alone, provided there are no features (for example Table 1: ‘Red flags’) to suggest more serious conditions 1 . The red flags proposed in table 1 are based on a good quality guideline already mentioned above 3 , and represent the best available evidence in the field.
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Non-specific neck pain: diagnosis and treatment - KCE

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