Utilization of Clinical Practice Guideline Interventions in the Conservative Management of Mechanical Neck Pain: A Retrospective Analysis

Abstract

Introduction: Neck pain is a common musculoskeletal condition frequently treated by physical therapists. The American Physical Therapy Association (APTA) published a clinical practice guideline (CPG) in 2008 with a revision in 2017 to improve the diagnosis and treatment of neck pain. One subset of neck pain in the CPG is "Neck Pain with Mobility Deficits," also called mechanical neck pain. Little data exists on the adherence of physical therapists to the CPG-recommended treatments for neck pain as well as the outcomes associated with the utilization of the CPG. The purpose of this study is to examine both CPG treatment adherence and associated outcomes in patients treated for mechanical neck pain by physical therapists in the outpatient setting.Methods: Retrospective chart review of patients (n=224) who received physical therapy for neck pain between 2018 and 2022. Data ranges were chosen due to the publication of the CPG revision in 2017. Six interventions for mechanical neck pain from the CPG were examined: thoracic manipulation, cervical mobilization, transcutaneous electrical stimulation (TENS), dry needling, advice to stay active, and scapular resistance exercises. The exclusion criteria were a history of cervical spine surgery. Other data collected included age, sex, characteristics of the evaluating physical therapist, and the number of visits.Results: For CPG treatment adherence, 4.5% of patients received thoracic manipulation, 47.8% of patients received cervical mobilization, 12.5% of patients received TENS, 22.8% of patients received dry needling, 99.1% of patients received advice to stay active, and 89.3% of patients received scapular resistance exercises. There was no significant improvement in pain, range of motion (ROM), and function based on a number of CPG interventions used during the bout of physical therapy (p=0.17 to p=0.74). Patients who were evaluated by a physical therapist who was an Orthopedic Certified Specialist (OCS) were more likely to receive more interventions recommended by the CPG (p<0.01).Conclusion: CPG-recommended treatments are used with varying frequency by physical therapists when treating mechanical neck pain. Thoracic manipulation is rarely used while scapular resistance exercises are frequently used. There was no significant improvement in pain, ROM, or function based on the number of CPG-recommended treatments used during the bout of physical therapy.

The Incidence of Postoperative Shoulder Stiffness After Arthroscopic Rotator Cuff Repair: A Systematic Review

“…Diabetes mellitus and increased time until rehabilitation after ARCR have been reported as independent risk factors for POSS in the literature [ 6 ]. Recently, the relationship between rehabilitation usage after ARCR and tear type has been investigated with ARCR for partial-thickness rotator cuff tears being associated with increased postoperative physical therapy [ 30 ]. One possible reason for this association could be the increased incidence of POSS in patients with ARCR for partial-thickness tears as indicated by the current study.…”

The Impact of the Addition of a Physical Therapy Assistant to the Treatment Team for Management of Neck Pain: A Retrospective Analysis of Outpatient Physical Therapy Clinics

“…The PT-only group had a mean pain improvement of 2.1 points ± 2.3 points (median: 2.0 points) whereas the PTA group had a mean pain improvement of 2.2 points ± 2.4 points (median: 2.0 points) with no significant difference between the two groups (p=0.573). Both groups demonstrated a clinically significant improvement in pain (greater than 1.37/10 points) on the Visual Analog Score based on the minimally clinical important difference (MCID) used in other orthopedic studies [ 11 , 14 ]. However, as noted above, it should be noted that the PTA group had significantly more visits as compared to the PT-only group with no significant difference in pain improvement.…”

“…There was also no significant difference in pain outcomes between groups with the PT-only group having a mean pain improvement of 2.1 points ± 2.3 points (median: 2.0 points) and the PTA group having a mean pain improvement of 2.2 points ± 2.4 points (median: 2.0 points)(p=0.573). Likewise, it is important to note that both groups had clinically significant improvements in pain (greater than 1.37/10 points) per the MCID of the Visual Analog Scale used for other orthopedic conditions [ 11 , 14 ]. The authors are not aware of any MCID values for cervical rotation AROM; therefore, the ability to determine the clinical significance of this improvement is limited in this study.…”

“…Neck pain is a common musculoskeletal pathology frequently treated by physical therapists (PTs) and PTAs in the outpatient clinical setting [ 11 - 13 ]. The need to improve quality of care while decreasing costs is increasingly relevant in the conservative treatment of neck pain as up to 70% of individuals will have neck pain at some point [ 11 - 13 ].…”

“…Neck pain is a common musculoskeletal pathology frequently treated by physical therapists (PTs) and PTAs in the outpatient clinical setting [ 11 - 13 ]. The need to improve quality of care while decreasing costs is increasingly relevant in the conservative treatment of neck pain as up to 70% of individuals will have neck pain at some point [ 11 - 13 ]. While studies examining the utilization of PTAs in other settings have reported improved outcomes, such as increased community discharges, the nature of the outpatient physical therapy treatment of neck pain poses new variables that impact generalizability of findings in the acute and sub-acute setting to the outpatient setting [ 7 , 9 ].…”