The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline
The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline
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DOI：
10.1016/j.jmpt.2016.08.007
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发表时间：
2016-10-01
影响因子：
1.3
通讯作者：
Ornelas, Joseph
中科院分区：
文献类型：
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作者：
Bussieres, Andre E.;Stewart, Gregory;Ornelas, Joseph
目的：制定颈部疼痛相关疾病(NADS)和鞭打相关疾病(WADS)的临床治疗指南。本指南取代了以前的2个脊椎疗法指南。方法：使用系统评价测量工具(AMSTAR)和从可接受的随机对照试验中提取的数据，对6个主题领域(教育、多模式护理、运动、工作残疾、手工治疗、被动模式)进行中肯的系统评价。我们将偏向风险评分纳入推荐评估、发展和评估的分级中。证据档案被用来总结对证据质量的判断，详细说明相对和绝对效果，并将建议与支持证据联系起来。指导小组审议了可取和不可取后果之间的平衡。使用改进的Delphi达成了共识。该指南由10名成员组成的多学科(医学和脊椎按摩)外部委员会进行同行评审。结果：对于最近出现的(0-3个月)颈部疼痛，我们建议提供多模式护理；手法或活动；活动范围在家锻炼或多模式手动治疗(对于I-II NAD级)；有监督的分级强化锻炼(III级NAD)；以及多模式护理(III级WAD)。对于持续性(>；3个月)颈部疼痛，我们建议提供多模式护理或压力自我管理；软组织治疗手法；大剂量按摩；有监督的集体锻炼；有监督的瑜伽；有监督的强化练习或家庭锻炼(I-II NAD级)；多模式护理或从业者的建议(I-III NAD)；以及只有建议或建议的有监督运动(I-II WAD)。对于持续性颈部和肩部疼痛的工人，证据支持混合监督和无监督的高强度力量训练或单独建议(I-III NAD级)。结论：包括手动治疗、自我管理建议和锻炼在内的多模式方法是治疗新发和持续性颈部疼痛的有效策略。
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.Methods: Pertinent systematic reviews on 6 topic areas (education, multimodal care, exercise, work disability, manual therapy, passive modalities) were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and data extracted from admissible randomized controlled trials. We incorporated risk of bias scores in the Grading of Recommendations Assessment, Development, and Evaluation. Evidence profiles were used to summarize judgments of the evidence quality, detail relative and absolute effects, and link recommendations to the supporting evidence. The guideline panel considered the balance of desirable and undesirable consequences. Consensus was achieved using a modified Delphi. The guideline was peer reviewed by a 10-member multidisciplinary (medical and chiropractic) external committee.Results: For recent-onset (0-3 months) neck pain, we suggest offering multimodal care; manipulation or mobilization; range-of-motion home exercise, or multimodal manual therapy (for grades I-II NAD); supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD). For persistent (>3 months) neck pain, we suggest offering multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioner's advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For workers with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD).Conclusions: A multimodal approach including manual therapy, self-management advice, and exercise is an effective treatment strategy for both recent-onset and persistent neck pain.