Philadelphia panel evidence-based clinical practice guidelines on selectedrehabilitation interventions for neck pain

Introduction. A structured and rigorous methodology was developed for the f ormulation of evidence-based clinical practice guidelines (EBCPGs), then wa s used to develop EBCPGs for selected rehabilitation interventions for the management of neck pain. Methods. Evidence from randomized controlled trial s (RCTs) and observational studies was identified and synthesized using met hods defined by the Cochrane Collaboration that minimize bias by using a sy stematic approach to literature search, study selection, data extraction, a nd data synthesis. Meta-analysis was conducted where possible. The strength of evidence was graded as level I for RCTs or level II for nonrandomized, studies. Developing Recommendations. An expert panel was formed by inviting stakeholder professional organizations to nominate a representative. This panel developed a set of criteria for grading the strength of both the evid ence and the recommendation. The panel decided that evidence of clinically important benefit (defined as 15 % greater relative to a control based on p anel expertise and empiric results) in patient-important outcomes was requi red for a recommendation. Statistical significance was also required but wa s insufficient alone. Patient-important outcomes were decided by consensus as being pain, function, patient global assessment, quality of life, and re turn to work, providing that these outcomes were assessed with a scale for which measurement reliability and validity have been established. Validatin g the Recommendations. A feedback survey questionnaire was sent to 324 prac titioners from 6 professional organizations. The response rate was 51%. Res ults. For neck pain, therapeutic exercises were the only intervention with clinically important benefit relative to a control (grade A for pain and fu nction, grade B for patient global assessment). There was good agreement wi th this recommendation from practitioners (93%). For several interventions and indications (eg, thermotherapy, therapeutic ultrasound, massage, electr ical stimulation), there was a lack of evidence regarding efficacy. Conclus ions. This methodology of developing EBCPGs provides a structured approach to assessing the literature and developing guidelines that incorporates cli nicians' feedback and is widely acceptable to practicing clinicians. Furthe r well-designed RCTs are warranted regarding the use of several interventio ns for patients with neck pain where evidence was insufficient to make reco mmendations.