For workers with persistent neck and shoulder pain , evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone ( grade s I-III NAD ) .
A multimodal approach including manual therapy , self-management advice , and exercise is an effective treatment strategy for both recent-onset and persistent neck pain
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 .
The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain.
BACKGROUND CONTEXT Evidence -based clinical practice guidelines ( CPGs ) for the management of patients with acute mechanical low back pain ( AM-LBP ) have been defined on an international scale . Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments . To date , the value of implementing full and exclusively CPG-based treatment remains unclear . PURPOSE To determine if full CPGs-based study care ( SC ) results in greater improvement in functional outcomes than family physician-directed usual care ( UC ) in the treatment of AM-LBP . STUDY DESIGN / SETTING A two-arm , parallel design , prospect i ve , r and omized controlled clinical trial using blinded outcome assessment . Treatment was administered in a hospital-based spine program outpatient clinic . PATIENT SAMPLE Inclusion criteria included patients aged 19 to 59 years with Quebec Task Force Categories 1 and 2 AM-LBP of 2 to 4 weeks ' duration . Exclusion criteria included " red flag " conditions and comorbidities contraindicating chiropractic spinal manipulative therapy ( CSMT ) . OUTCOME MEASURES PRIMARY OUTCOME improvement from baseline in Rol and -Morris Disability Question naire ( RDQ ) scores at 16 weeks . SECONDARY OUTCOMES improvements in RDQ scores at 8 and 24 weeks ; and in Short Form-36 ( SF-36 ) bodily pain ( BP ) and physical functioning ( PF ) scale scores at 8 , 16 , and 24 weeks . METHODS Patients were assessed by a spine physician , then r and omized to SC ( reassurance and avoidance of passive treatments , acetaminophen , 4 weeks of lumbar CSMT , and return to work within 8 weeks ) , or family physician-directed UC , the components of which were recorded . RESULTS Ninety-two patients were recruited , with 36 SC and 35 UC patients completing all follow-up visits . Baseline prognostic variables were evenly distributed between groups . The primary outcome , the unadjusted mean improvement in RDQ scores , was significantly greater in the SC group than in the UC group ( p=.003 ) . Regarding unadjusted mean changes in secondary outcomes , improvements in RDQ scores were also greater in the SC group at other time points , particularly at 24 weeks ( p=.004 ) . Similarly , improvements in SF-36 PF scores favored the SC group at all time points ; however , these differences were not statistically significant . Improvements in SF-36 BP scores were similar between groups . In repeated- measures analyses , global adjusted mean improvement was significantly greater in the SC group in terms of RDQ ( p=.0002 ) , nearly significantly greater in terms of SF-36 PF ( p=.08 ) , but similar between groups in terms of SF-36 BP ( p=.27 ) . CONCLUSIONS This is the first reported r and omized controlled trial comparing full CPG-based treatment , including spinal manipulative therapy administered by chiropractors , to family physician-directed UC in the treatment of patients with AM-LBP . Compared to family physician-directed UC , full CPG-based treatment including CSMT is associated with significantly greater improvement in condition-specific functioning
For workers with persistent neck and shoulder pain , evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone ( grade s I-III NAD ) .
A multimodal approach including manual therapy , self-management advice , and exercise is an effective treatment strategy for both recent-onset and persistent neck pain
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 .