Consistent evidence was found to support the use of ' red flags ' to screen for serious pathologies , judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance .
Neck pain and whiplash injuries are a common presentation to the ED , and a frequent cause of disability globally .
This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED .
Can Primary Care for Back and/or Neck Pain in the Netherlands Benefit From Stratification for Risk Groups According to the STarT Back Tool Classification?
OBJECTIVE To evaluate whether current Dutch primary care clinicians offer tailored treatment to patients with low back pain ( LBP ) or neck pain ( NP ) according to their risk stratification , based on the Keele STarT ( Subgroup Targeted Treatment ) Back-Screening Tool ( SBT ) . DESIGN Prospect i ve cohort study with 3-month follow-up . SETTING Primary care . PARTICIPANTS General practitioners ( GPs ) and physiotherapists included patients ( N=284 ) with nonspecific LBP , NP , or both . INTERVENTIONS Patients completed a baseline question naire , including the Dutch SBT , for either LBP or NP . A follow-up measurement was conducted after 3 months to determine recovery ( using Global Perceived Effect Scale ) , pain ( using Numeric Pain Rating Scale ) , and function ( using Rol and Disability Question naire or Neck Disability Index ) . A question naire was sent to the GPs and physiotherapists to evaluate the provided treatment . MAIN OUTCOME MEASURES Prevalence of patients ' risk profile and clinicians ' applied care , and the percentage of patients with persisting disability at follow-up . A distinction was made between patients receiving the recommended treatment and those receiving the nonrecommended treatment . RESULTS In total , 12 GPs and 33 physiotherapists included patients . After 3 months , we analyzed 184 patients with LBP and 100 patients with NP . In the LBP group , 52.2 % of the patients were at low risk for persisting disability , 38.0 % were at medium risk , and 9.8 % were at high risk . Overall , 24.5 % of the patients with LBP received a low-risk treatment approach , 73.5 % a medium-risk , and 2.0 % a high-risk treatment approach . The specific agreement between the risk profile and the received treatment for patients with LBP was poor for the low-risk and high-risk patients ( 21.1 % and 10.0 % , respectively ) , and fair for medium-risk patients ( 51.4 % ) . In the NP group , 58.0 % of the patients were at low risk for persisting disability , 37.0 % were at medium risk , and 5.0 % were at high risk . Only 6.1 % of the patients with NP received the low-risk treatment approach . The medium-risk treatment approach was offered the most ( 90.8 % ) , and the high-risk approach was applied in only 3.1 % of the patients . The specific agreement between the risk profile and received treatment for patients with NP was poor for low-risk and medium-risk patients ( 6.3 % and 48.0 % , respectively ) ; agreement for high-risk patients could not be calculated . CONCLUSIONS Current Dutch primary care for patients with nonspecific LBP , NP , or both does not correspond to the recommended stratified-care approach based on the SBT , as most patients receive medium-risk treatment . Most low-risk patients are overtreated , and most high-risk patients are undertreated . Although the stratified-care approach has not yet been vali date d in Dutch primary care , these results indicate there may be substantial room for improvement
Consistent evidence was found to support the use of ' red flags ' to screen for serious pathologies , judicious use of imaging through clinical decision rule application and promotion of functional exercise coupled with advice and reassurance .
Neck pain and whiplash injuries are a common presentation to the ED , and a frequent cause of disability globally .
This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED .