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n 2012, the Global Burden of Disease ward (Figs. 1 and 2).11 Neck pain in the ity and quality of health care provid-
Study stated that neck pain is glob- working population seems to be quite ed by physical therapists, define the
ally the fourth largest physical com- persistent and takes a recurrent course; boundaries and the domain of physical
plaint with regard to years lived with 60% to 80% of workers with neck pain therapists in relation to patients with
a disability.1 The estimated 1-year inci- will report neck pain 1 year later.12 In neck pain, ensure that patients receive
dence of neck pain has been reported the population with trauma-related optimal care, and support physical ther-
to vary from 10.4% to 21.3%.2 Data from neck pain, an improvement in pain and apists in making decisions about diag-
2003 for the Dutch population 25 years disability mainly occurs within the first nostic and therapeutic interventions.
old or older showed that the neck is the 3 months following the accident.13 A
third most common location for mus- systematic review found recovery rates Method of Guideline
culoskeletal complaints, after the lower ranging from 16% to 99%.14 Approxi-
Table 3.
Summary of Recommendations
Grade II: no signs or symptoms of major structural pathology but major interference with activities of daily living
Grade III: no signs or symptoms of major structural pathology but presence of neurologic signs, such as decreased deep tendon
reflexes, weakness, or sensory deficits
Table 4.
Red Flags Per Possible Serious Pathology
cutoff is used to measure a patient’s im- ciation (APTA), shows similarities con- nonsteroidal antiinflammatory drugs,
provement.59,88 cerning treatment advice but differs in electrotherapy, acupuncture, and bot-
the subgrouping of patients.89 Whereas ulin toxin injections. These treatments
Discussion we used grades I to IV, as advised by are not regarded as physical therapist
the NPTF, the APTA guideline uses the treatments in the Netherlands. Two dif-
Limitations of the Guideline
International Statistical Classification of ferences in recommended treatments
The CPG is primarily based on system-
Diseases and Related Health Problems. are that laser is a treatment for consid-
atic reviews performed by the Cochrane
The prognostic factors can be found in eration in the OPTIMa guideline, but
network, the International Collaboration
both guidelines. The APTA CPG rec- the Dutch guideline advises against its
on Neck Pain, and the NPTF; this choice
ommends more tools to appraise these use. Also, the use of a cervical collar
was made because of limitations in time
constructs. Also, the APTA CPG places may be considered in the Dutch guide-
and funds. Other stakeholders, including
more emphasis on clinical prediction line but not in the OPTIMa guideline.
patients, were invited a fter the first con-
rules, whereas the Dutch CPG does
cept was finalized. To strengthen sup-
not address these at all because they This CPG is available in full (in Dutch)
port, it would be better to include these
are not regarded as valid enough to be at www.fysionet-evidencebased.nl.
stakeholders at an earlier stage. In this
recommended. Both guidelines address
guideline, profile C was used when re-
the same treatments: manual therapy, Author Contributions
covery was delayed on the basis of psy-
exercise, multimodal treatments, educa-
chosocial factors. No evidence was avail- Concept/idea/research design: J.D. Bier , E.
tion, and physical agents (dry needling,
able for this choice, and no evidence Beekman, J. Knoop, G. Meerhoff, J. Pool,
laser, ultrasound, and transcutaneous
that addressing these psychosocial fac- W.G.M. Scholten-Peeters, J.B. Staal, M.W.
electrical nerve stimulation). The Dutch
tors will lead to recovery from neck pain van Tulder, A.P. Verhagen
CPG for physical therapists provides Writing: J.D. Bier, E. Beekman, J. Knoop, J.
is available. The same can be said for ad-
less direction on the form of manipu- Pool, W.G.M. Scholten-Peeters, M.W. van
dressing other prognostic factors.
lation, exercise, or other modalities and Tulder, A.P. Verhagen
when to use each form. Among the dif- Data collection: J.D. Bier, A.P. Verhagen
The CPG is issued for Dutch physi-
ferences in treatment recommendations Data Analysis: J.D. Bier, M.W. van Tulder, A.
cal therapist practice. This means that Verhagen
are that dry needling and laser are not
only interventions that are within the Project management: G. Meerhoff, A.P.
recommended in the Dutch CPG.
professional domain of Dutch physical Verhagen
therapists, as defined by the KNGF, are Fund procurement: A.P. Verhagen
The Ontario Protocol for Traffic Inju-
included. The validation process also Providing participants: J. Knoop
ry Management (OPTIMa) published a Providing facilities//equipment: G. Meerhoff
took place only in the Netherlands.
guideline in 2016.90 This guideline fo- Providing institutional liaisons: G. Meerhoff,
Both factors may influence the interna-
cuses on the same grades of neck pain A.P. Verhagen
tional generalizability of the guideline.
but limits the duration of neck pain to Clerical/secretarial support: G. Meerhoff
6 months. In the recommendations of Consultation (including review of man-
Similarities to and Differences treatments, OPTIMa makes a distinc- uscript before submitting): E. Beekman,
From International Guidelines tion between 0 to 3 months and 3 to J. Knoop, G. Meerhof, J. Pool, W.G.M.
A recently updated CPG on neck pain, 6 months. The Dutch guideline does Scholten-Peeters, J.B. Staal, M.W. van Tulder
issued by the Orthopedic Section of Guideline Development Group (in alphabet-
not make that distinction. The OPTIMa
the American Physical Therapy Asso- ical order):
guideline also recommends the use of
Emmylou Beekman, PhD; provided earlier References 13 Walton DM, Carroll LJ, Kasch H, et al.
research, gave feedback on the clinical prac- An overview of systematic reviews on
1 Vos T, Flaxman AD, Naghavi M, et al. prognostic factors in neck pain: results
tice guideline (CPG). Years lived with disability (YLDs) for from the International Collaboration on
Jasper D. Bier, MSc; secretary to the Guide- 1160 sequelae of 289 diseases and in- Neck Pain (ICON) Project. Open Orthop
juries 1990–2010: a systematic analysis
line Development Group, primary author of for the Global Burden of Disease Study
J. 2013;7:494–505.
the CPG, evaluated the studies and the level 2010. Lancet. 2012;380:2163–2196. 14 Walton D. A review of the definitions of
of evidence for the included studies, devel- 2 Hoy DG, Protani M, De R, Buchbinder
“recovery” used in prognostic studies on
oped informational material for patients and whiplash using an ICF framework. Disa-
R. The epidemiology of neck pain. Best bil Rehabil. 2009;31:943–957.
physical therapists, provided education and Pract Res Clin Rheumatol. 2010;24:783–
presentations for implementation purposes. 792. 15 Carroll LJ, Holm LW, Hogg-Johnson S, et al.
Course and prognostic factors for neck
Jesper Knoop, PhD; checked for consistency 3 Picavet HS, Schouten JS. Musculoskele- pain in whiplash-associated disorders
between the different documents and initi- tal pain in the Netherlands: prevalences,
63 Rubinstein SM, Pool JJ, van Tulder MW, 73 Michaleff ZA, Ferreira ML. Physiothera- 84 Mejuto-Vazquez MJ, Salom-Moreno J,
Riphagen II, de Vet HC. A systematic re- py rehabilitation for whiplash associat- Ortega-Santiago R, Truyols-Dominguez
view of the diagnostic accuracy of pro- ed disorder II: a systematic review and S, Fernandez-de-Las-Penas C. Short-
vocative tests of the neck for diagnos- meta-analysis of randomised controlled term changes in neck pain, widespread
ing cervical radiculopathy. Eur Spine J. trials. Br J Sports Med. 2012;46:662–663. pressure pain sensitivity, and cervical
2007;16:307–319. range of motion after the application
74 Driessen MT, Lin CW, van Tulder MW. of trigger point dry needling in patients
64 Cook C, Hegedus E. Diagnostic utility of Cost-effectiveness of conservative treat- with acute mechanical neck pain: a ran-
clinical tests for spinal dysfunction. Man ments for neck pain: a systematic review domized clinical trial. J Orthop Sports
Ther. 2011;16:21–25. on economic evaluations. Eur Spine J. Phys Ther. 2014;44:252–260.
2012;21:1441–1450.
65 Shabat S, Leitner Y, David R, Folman Y. 85 Gross AR, Dziengo S, Boers O, et al. Low
The correlation between Spurling test 75 Gross A, Kay TM, Paquin J-P, level laser therapy (LLLT) for neck pain:
and imaging studies in detecting cer- et al. Exercises for mechanical neck a systematic review and meta-regres-
vical radiculopathy. J Neuroimaging. disorders. Cochrane Database Syst Rev. sion. Open Orthop J. 2013;7:396–419.