The clinical reasoning process in randomized clinical trials with patients with non-specific neck pain is incomplete: A systematic review

Abstract

In the majority of studies (70%) the described clinical reasoning process was incomplete. A very small proportion (6%) had a 'diagnosed cause'. Therefore, a better methodological quality does not necessarily imply a better described clinical reasoning process.

Clinical reasoning in unimodal interventions in patients with non-specific neck pain in daily physiotherapy practice, a Delphi study

“…The experts state that pain alone is not an indication for physiotherapy, and that there must be other signs/symptoms present and/ or at least one or more positive diagnostic test to substantiate the indication for physiotherapy. However, the review of Maissan et al (2018) reported that only 16% of the 122 randomized controlled trials (RCTs) had a diagnosed cause, i.e. at least one diagnostic test was used as an inclusion criterion.…”

“…Secondly, we wanted information on the type of measurement instruments being used for diagnostic and/or evaluative purposes. For this purpose, we offered a list with the most frequently used measurement instruments in patients with non-specific neck pain selected from the 122 RCTs included in the review of Maissan et al (2018) We asked the experts which measurement instruments they use and whether they use additional measurement instruments. We also gathered information about the timing of the evaluative tests; i.e.…”

“…Only 11 (9%) out of 122 randomized controlled trials (RCT) described a complete clinical reasoning process whereby the diagnostic process ("the why"), i.e. other signs or symptoms or diagnostic tests in their inclusion criteria, could be linked to the therapeutic process ("the what") (Maissan et al, 2018). A remarkable outcome was that 46% of the 122 included RCT's described no impairment or activity limitation at all, with inclusion criteria limited to age and (duration of) pain.…”

Has the quality of physiotherapy care in patients with Whiplash-associated disorders (WAD) improved over time? A retrospective study using routinely collected data and quality indicators

“…In the majority of RCTs (n = 122) involving patients with nonspecific neck pain, the clinical reasoning process was reportedly incomplete, specifically in the diagnostic aspect of the process, with only 6% of the RCTs including a complete diagnostic process. 71 …”

Physiotherapie mit externem Fokus

“…In einer aktuellen Untersuchung reklamieren Maissan und Kollegen, dass in den meisten Studien zum Phänomen Nackenschmerz der dort beschriebene Clinical-Reasoning-Prozess unvollständig war, was folglich bedeutet, dass für die klinische Praxis bessere Leitlinien und Instrumente erforderlich sind [46].…”