Methods for the Best Evidence Synthesis on Neck Pain and Its Associated Disorders: The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders

doi:10.1016/j.jmpt.2008.11.009

Journal of Manipulative and Physiological Therapeutics

Volume 32, Issue 2, Supplement, February 2009, Pages S39-S45

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https://doi.org/10.1016/j.jmpt.2008.11.009 Get rights and content

Abstract

Study Design

Best evidence synthesis.

Objective

To provide a detailed description of the methods undertaken in a systematic search and perform a best evidence synthesis on the frequency, determinants, assessment, interventions, course and prognosis of neck pain, and its associated disorders.

Summary of Background Data

Neck pain is an important cause of health burden; however, the published information is vast, and stakeholders would benefit from a summary of the best evidence.

Methods

The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders conducted a systematic search and critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain. Citations were screened for relevance to the Neck Pain Task Force mandate, using a priori criteria, and relevant studies were critically reviewed for their internal scientific validity. Findings from studies meeting criteria for scientific validity were synthesized into a best evidence synthesis.

Results

We found 31,878 citations, of which 1203 were relevant to the mandate of the Neck Pain Task Force. After critical review, 552 studies (46%) were judged scientifically admissible and were compiled into the best evidence synthesis.

Conclusion

The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders undertook a best evidence synthesis to establish a baseline of the current best evidence on the epidemiology, assessment and classification of neck pain, as well as interventions and prognosis for this symptom. This article reports the methods used and the outcomes from the review. We found that 46% of the research literature was of acceptable scientific quality to inform clinical practice, policy-making, and future research.

Section snippets

Literature Search

The scientific literature published in 1980–2006 was searched. Seminal papers published before 1980 were identified by Neck Pain Task Force Scientific Secretariat members in consultation with professional groups and the Neck Pain Task Force Advisory Committee. These were included in the critical review process.

Results

A total of 31,878 citations were identified in Medline. After applying our inclusion/exclusion criteria to these studies and those identified in our other search strategies, 1203 studies were deemed relevant to the Neck Pain Task Force mandate and were therefore subjected to the critical review process. Of these, 552 (46%) were accepted as scientifically admissible, and comprise the Best Evidence Synthesis ( Fig. 1 ). A breakdown of critically appraised studies by topic area, and the number of

Discussion

We performed a systematic search of published literature on neck pain and its associated disorders. These studies were then screened for relevance to the Neck Pain Task Force mandate using a priori defined inclusion/exclusion criteria. Those deemed to be relevant to the mandate were subjected to a critical review. We performed critical reviews on 1203 studies, and of these, a total of 552 studies were judged as having sufficient internal validity, and comprise the list of studies available for

Uncited reference

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Acknowledgments

We are indebted to Ms. Oksana Colson and Ms. Leah Phillips (M.A.) for their administrative assistance. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders was supported by grants from the following: National Chiropractic Mutual Insurance Company (USA); Canadian Chiropractic Protective Association (Canada); State Farm Insurance Company (USA); Insurance Bureau of Canada; Länsförsäkringar (Sweden); The Swedish Whiplash Commission; Jalan Pacific Inc. (Brazil);

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Are psychological interventions effective for the management of neck pain and whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration
2016, Spine Journal
In 2008, the lack of published evidence prevented the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force [NPTF]) from commenting on the effectiveness of psychological interventions for the management of neck pain.
This study aimed to update findings of the NPTF and evaluate the effectiveness of psychological interventions for the management of neck pain and associated disorders (NAD) or whiplash-associated disorders (WAD).
This study used systematic review and best-evidence synthesis.
Randomized controlled trials, cohort studies, and case-control studies comparing psychological interventions to other non-invasive interventions or no intervention were the samples used in this study.
The outcome measures are (1) self-rated recovery; (2) functional recovery; (3) clinical outcomes; (4) administrative outcomes; and (5) adverse effects.
We searched six databases from 1990 to 2015. Randomized controlled trials, cohort studies, and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers used the Scottish Intercollegiate Guidelines Network criteria to critically appraise eligible studies. Studies with a low risk of bias were synthesized following best evidence synthesis principles. This study was funded by the Ontario Ministry of Finance.
We screened 1,919 articles, 19 were eligible for critical appraisal and 10 were judged to have low risk of bias. We found no clear evidence supporting relaxation training or cognitive behavioral therapy (CBT) for persistent grades I–III NAD for reducing pain intensity or disability. Similarly, we did not find evidence to support the effectiveness of biofeedback or relaxation training for persistent grade II WAD, and there is conflicting evidence for the use of CBT in this population. However, adding a progressive goal attainment program to functional restoration physiotherapy may benefit patients with persistent grades I–III WAD. Furthermore, Jyoti meditation may help reduce neck pain intensity and bothersomeness in patients with persistent NAD.
We did not find evidence for or against the use of psychological interventions in patients with recent onset NAD or WAD. We found evidence that a progressive goal attainment program may be helpful for the management of persistent WAD and that Jyoti meditation may benefit patients with persistent NAD. The limited evidence of effectiveness for psychological interventions may be due to several factors, such as interventions that are ineffective, poorly conceptualized, or poorly implemented. Further methodologically rigorous research is needed.
Is exercise effective for the management of neck pain and associated disorders or whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration
2016, Spine Journal
Citation Excerpt :
Rather, the SIGN criteria were used to assist reviewers make an informed overall judgment on the internal validity of studies. This methodology has been previously described [21,27–31]. Specifically, we critically appraised the following methodological aspects of a study: clarity of the research question; randomization method; concealment of treatment allocation; blinding of treatment and outcomes; similarity of baseline characteristics between/among treatment arms; co-intervention contamination; validity and reliability of outcome measures; follow-up rates; analysis according to intention-to-treat principles; and comparability of results across study sites (where applicable).
In 2008, the Neck Pain Task Force (NPTF) recommended exercise for the management of neck pain and whiplash-associated disorders (WAD). However, no evidence was available on the effectiveness of exercise for Grade III neck pain or WAD. Moreover, limited evidence was available to contrast the effectiveness of various types of exercises.
To update the findings of the NPTF on the effectiveness of exercise for the management of neck pain and WAD grades I to III.
Systematic review and best evidence synthesis.
Studies comparing the effectiveness of exercise to other conservative interventions or no intervention.
Outcomes of interest included self-rated recovery, functional recovery, pain intensity, health-related quality of life, psychological outcomes, and/or adverse events.
We searched eight electronic databases from 2000 to 2013. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. The results of scientifically admissible studies were synthesized following best-evidence synthesis principles.
We retrieved 4,761 articles, and 21 randomized controlled trials (RCTs) were critically appraised. Ten RCTs were scientifically admissible: nine investigated neck pain and one addressed WAD. For the management of recent neck pain Grade I/II, unsupervised range-of-motion exercises, nonsteroidal anti-inflammatory drugs and acetaminophen, or manual therapy lead to similar outcomes. For recent neck pain Grade III, supervised graded strengthening is more effective than advice but leads to similar short-term outcomes as a cervical collar. For persistent neck pain and WAD Grade I/II, supervised qigong and combined strengthening, range-of-motion, and flexibility exercises are more effective than wait list. Additionally, supervised Iyengar yoga is more effective than home exercise. Finally, supervised high-dose strengthening is not superior to home exercises or advice.
We found evidence that supervised qigong, Iyengar yoga, and combined programs including strengthening, range of motion, and flexibility are effective for the management of persistent neck pain. We did not find evidence that one supervised exercise program is superior to another. Overall, most studies reported small effect sizes suggesting that a small clinical effect can be expected with the use of exercise alone.
The Effectiveness of Multimodal Care for the Management of Soft Tissue Injuries of the Shoulder: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration
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We did not use a cutoff score to determine the internal validity of studies.21 Rather, we used the SIGN criteria to make an informed overall judgment on the risk of bias present in RCTs by assessing 10 methodological criteria: (1) clarity of the research question; (2) randomization method; (3) concealment of treatment allocation; (4) blinding of treatment and outcomes; (5) similarity of baseline characteristics between groups; (6) cointervention and contamination; (7) validity and reliability of outcome measures; (8) attrition; (9) intention-to-treat analysis; and (10) comparability of results across study sites (where applicable).22–27 Reviewers met to reach consensus on the internal validity of studies.
The purpose of this systematic review was to evaluate the effectiveness of multimodal care for the management of soft tissue injuries of the shoulder.
We conducted a systematic review and searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Two independent reviewers critically appraised studies using the Scottish Intercollegiate Guidelines Network criteria. We used best evidence synthesis to synthesize evidence from studies with low risk of bias.
We screened 5885 articles, and 19 were eligible for critical appraisal. Ten randomized controlled trials had low risk of bias. For persistent subacromial impingement syndrome, multimodal care leads to similar outcomes as sham therapy, radial extracorporeal shock-wave therapy, or surgery. For subacromial impingement syndrome, multimodal care may be associated with small and nonclinically important improvement in pain and function compared with corticosteroid injections. For rotator cuff tendinitis, dietary-based multimodal care may be more effective than conventional multimodal care (exercise, soft tissue and manual therapy, and placebo tablets). For nonspecific shoulder pain, multimodal care may be more effective than wait list or usual care by a general practitioner, but it leads to similar outcomes as exercise or corticosteroid injections.
The current evidence suggests that combining multiple interventions into 1 program of care does not lead to superior outcomes for patients with subacromial impingement syndrome or nonspecific shoulder pain. One randomized controlled trial suggested that dietary-based multimodal care (dietary advice, acupuncture, and enzyme tablets) may provide better outcomes over conventional multimodal care. However, these results need to be replicated.
The Effectiveness of Exercise on Recovery and Clinical Outcomes in Patients with Soft Tissue Injuries of the Hip, Thigh, or Knee: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration
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These criteria were used to guide reviewers in making an informed overall judgment on the internal validity of studies. This methodology has been previously described.26 -31 A quantitative score or a cutoff point to determine the internal validity of studies was not used for this review.32
The purpose of this systematic review was to determine the effectiveness of exercise for the management of soft tissue injuries of the hip, thigh, and knee.
We conducted a systematic review and searched MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, and CINAHL Plus with Full Text from January 1, 1990, to April 8, 2015, for randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effect of exercise on pain intensity, self-rated recovery, functional recovery, health-related quality of life, psychological outcomes, and adverse events. Random pairs of independent reviewers screened titles and abstracts and assessed risk of bias using the Scottish Intercollegiate Guidelines Network criteria. Best evidence synthesis methodology was used.
We screened 9494 citations. Eight RCTs were critically appraised, and 3 had low risk of bias and were included in our synthesis. One RCT found statistically significant improvements in pain and function favoring clinic-based progressive combined exercises over a “wait and see” approach for patellofemoral pain syndrome. A second RCT suggests that supervised closed kinetic chain exercises may lead to greater symptom improvement than open chain exercises for patellofemoral pain syndrome. One RCT suggests that clinic-based group exercises may be more effective than multimodal physiotherapy in male athletes with persistent groin pain.
We found limited high-quality evidence to support the use of exercise for the management of soft tissue injuries of the lower extremity. The evidence suggests that clinic-based exercise programs may benefit patients with patellofemoral pain syndrome and persistent groin pain. Further high-quality research is needed.
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The World Health Organization (WHO) Collaborating Center at Karolinska then felt that this work was of sufficient value to allow the use of the WHO Collaborating Center logo. A couple of years into the Task Force, the Bone and Joint Decade Steering Committee elected to become the sponsoring organization for the NPTF.20–26 Eventually, a number of the world’s most prominent spine societies agreed to participate in the program.
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This includes the dissemination and integration of existing practice guidelines about the burden of spine conditions and evidence-based approaches to its prevention and treatment [18]. Recent work, specifically related to NP and its associated disorders has also been integrated into our clinical approach [3,19]. We emphasize the importance of an interprofessional approach to manage the complex problems of spinal disorders through referrals to hospitals and specialized centers where they exist and when possible.

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: The manuscript submitted does not contain information about medical device(s)/drug(s).

: Corporate/Industry, Foundation, and Professional Organizational funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

: Reprinted from Carroll LJ et al. Methods for the best evidence synthesis on neck pain and its associated disorders. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 2008;33:S33-S38. Reprinted with permission from Lippincott Williams & Wilkins.

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MethodologyMethods for the Best Evidence Synthesis on Neck Pain and Its Associated Disorders: The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders

Abstract

Study Design

Objective

Summary of Background Data

Methods

Results

Conclusion

Section snippets

Literature Search

Results

Discussion

Uncited reference

Acknowledgments

J Clin Epidemiol

Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management

Spine

Understanding and using the Medical Subject Headings (MeSH) Vocabulary to perform literature searchers

JAMA

Case series and exposure series: the role of studies without controls in providing information about the etiology of injury or disease

Inj Prev

Best evidence synthesis on mild traumatic brain injury: results of the WHO Collaborating Centre for Neurotrauma, Prevention, Management and Rehabilitation Task Force on Mild Traumatic Brain Injury

J Rehabil Med

The revised CONSORT statement for reporting randomized trials: explanation and elaboration

JAMA

Improving the quality of reporting of randomized controlled trials. The CONSORT statement

JAMA

Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement

Am J Public Health

Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative

BMJ

Best evidence synthesis: an alternative to meta-analytic and traditional reviews

Educ Res

The sensitivity of review results to methods used to appraise and incorporate trial quality into data synthesis

Spine

The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders

Spine

The burden and determinants of neck pain in workers. Results of the Bone and Joint 2000–2010 Task Force on Neck Pain and Its Associated Disorders

Spine

The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders

Spine

Course and prognostic factors for neck pain in whiplash-associated disorders (WAD). Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders

Spine

Methodology
Methods for the Best Evidence Synthesis on Neck Pain and Its Associated Disorders: The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders