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Citation
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Sutton DA, Côté P, Wong JJ, Varatharajan S, Randhawa K, Yu H, Southerst D, Shearer HM, van der Velde G, Nordin M, Carroll LJ, Mior S, Taylor-Vaisey A, Stupar M. Spine J. 2014; ePub(ePub): ePub. |
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Affiliation
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Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC); Post-doctoral Fellow, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC). |
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Abstract
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BACKGROUND CONTEXT: Little is known about the effectiveness of multimodal care for individuals with whiplash-associated disorders (WAD) and neck pain and associated disorders (NAD).
PURPOSE: To update findings of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders and evaluate the effectiveness of multimodal care for the management of patients with WAD or NAD. STUDY DESIGN/SETTING: Systematic review and best evidence synthesis. SAMPLE: We included randomized controlled trials (RCTs), cohort studies, and case-control studies. OUTCOME MEASURES: 1) self-rated recovery; 2) functional recovery (e.g. disability, return to activities, work or school); 3) pain intensity; 4) health-related quality of life; 5) psychological outcomes (e.g. depression, fear); or 6) adverse events.
METHODS: We systematically searched five electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials) from 2000 to 2013. RCTs, cohort and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Scientifically admissible studies were summarized using evidence tables and synthesized following best evidence synthesis principles. This study was funded by the Ministry of Finance.
RESULTS: We retrieved 2187 articles and 23 articles were eligible for critical appraisal. Of those, 18 articles from 14 different RCTs were scientifically admissible. There were a total of 31 treatment arms, including 27 unique multimodal programs of care. Overall, the evidence suggests that multimodal care that includes manual therapy, education and exercise may benefit patients with grade I and II WAD and NAD. General practitioner care that includes reassurance, advice to stay active, and resumption of regular activities may be an option for the early management of WAD grade I and II. Our synthesis suggests that patients receiving high intensity health care tend to experience poorer outcomes than those who receive fewer treatments for WAD and NAD.
CONCLUSIONS: Multimodal care can benefit patients with WAD and NAD with early or persistent symptoms. The evidence does not indicate that one multimodal care package is superior to another. Clinicians should avoid high-utilization of care for patients with WAD and NAD. Systematic Review Registration Number: CRD42013004999.
Language: en |