Parikh P, Santaguida P, Macdermid J, et al. Comparison of CPG's for the diagnosis, prognosis and management of non-specific neck pain: a systematic review. BMC Musculoskelet Disord. 2019 Feb 14;20(1):81. doi: 10.1186/s12891-019-2441-3. (Systematic review)

BACKGROUND: Neck pain (NP) is a very common musculoskeletal condition with potential for a high burden in disability and length of disorder. Clinical practice guidelines (CPG) give recommendations to clinicians for providing optimal care for patients however best practice recommendations are often contradictory. The purpose for this review was to conduct a SR of CPGs to assess the management recommendations for NP (diagnosis, treatment, prognosis, imaging).

METHODS: Standard SR methodology was employed including a grey literature search (including the National Guideline Clearing House). Medline, Cinahl, Embase, ILC, Cochrane, Central, and Lilacs were searched from 1995-to March 2018. Two raters evaluated all citations and a third rater resolved any disagreements. The AGREE II was used to assess risk of bias of each CPG. Data was extracted and included CPG purpose, type of NP problem and clinical recommendations. The AGREE II critical appraisal tool was used to assess risk of bias of each CPG.

RESULTS: From 640 articles, 241 were available for screening. A total of 46 guidelines were selected. CPG's were categorized by the NP population (General NP, whiplash, interventional, headache and risk for vertebral insufficiency) and type of clinical aim (diagnosis, prognosis, treatment, imaging). Each clinical NP population had a large overlap of clinical aims presented. The CPGs were directed to a variety of clinicians that included physicians, physiotherapists and chiropractors. Results suggest heterogeneity in CPG recommendations within each clinical aim. CPG characteristics accounting for these differences are outlined.

CONCLUSION: The majority of CPGs were developed for general NP that focused on treatment recommendations, with fewer number aimed at recommendations for diagnosis, prognosis, and outcomes. Heterogeneity of recommendations within the categories were noted as were potential factors associated with these differences, including CPG quality as assessed by the AGREE II.

Discipline Area Score
Physician 5 / 7
Comments from MORE raters

Physician rater

I don't think that clinicians would be interested to read this. AGREE II scores mean nothing to busy practicing physicians.

Physician rater

This is a very extensive review of guidelines around cervical spine issues. It's probably useful for some practitioners but not for all. You can pick what you need. The guidelines have not been studied for effectiveness. There is lack of independence if sponsored by an "organization". Isn't it organizations which initiate these?

Physician rater

It seems to indicate that there is a diversity of recommendations, none of which are especially helpful. We need one good guideline that might be adopted widely.

Physician rater

This is not directly clinically relevant. It's more useful for researchers and guideline developers. It's sobering to see the heterogeneity across guidelines. I hope the US re-establishes their guideline clearinghouse.

Physician rater

This review of Clinical Practice guidelines for 'neck pain' assessed and compared using the AGREE 2 tool. The CPG is very variable in benefit, better in quality since 2012 but there is no sign of evolution of CPG.

Physician rater

This very interesting review shows the shortcoming of current CPC's and biases. The advise for future CPC's are summarized. It is a pity the authors do not select the best CPC's for certain types of neck pain. This would have made the article more useful for clinical practice
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