Patient education for neck pain with or without radiculopathy
Abstract
Background
Neck disorders are common, disabling, and costly. The effectiveness of patient education strategies is unclear.
Objectives
To assess whether patient education strategies, either alone or in combination with other treatments, are of benefit for pain, function, global perceived effect, quality of life, or patient satisfaction, in adults with neck pain with and without radiculopathy.
Search methods
Computerized bibliographic databases were searched from their start up to May 31, 2008.
Selection criteria
Eligible studies were quasi or randomized trials (RCT) investigating the effectiveness of patient education strategies for neck disorder.
Data collection and analysis
Paired independent review authors carried out study selection, data abstraction, and methodological quality assessment. Relative risk and standardized mean differences (SMD) were calculated. The appropriateness of combining studies was assessed on clinical and statistical grounds. Because of differences in intervention type or disorder, no studies were considered appropriate to pool.
Main results
Of the 10 selected trials, two (20%) were rated high quality. Advice was assessed as follows:
Eight trials of advice focusing on activation compared to no treatment or to various active treatments, including therapeutic exercise, manual therapy and cognitive behavioural therapy, showed either inferiority or no difference for pain, spanning a full range of follow‐up periods and disorder types. When compared to rest, two trials that assessed acute whiplash‐associated disorders (WAD) showed moderate evidence of no difference for various forms of advice focusing on activation.
Two trials studying advice focusing on pain & stress coping skills found moderate evidence of no benefit for pain in chronic mechanical neck disorder (MND) at intermediate/long‐term follow‐up.
One trial compared the effects of 'traditional neck school ' to no treatment, yielding limited evidence of no benefit for pain at intermediate‐term follow‐up in mixed acute/subacute/chronic neck pain.
Authors' conclusions
This review has not shown effectiveness for educational interventions in various disorder types and follow‐up periods, including advice to activate, advice on stress coping skills, and 'neck school'. In future research, further attention to methodological quality is necessary. Studies of multimodal interventions should consider study designs, such as factorial designs, that permit discrimination of the specific educational components.
PICOs
Plain language summary
Patient Education for Neck Pain with or without radiculopathy
Neck disorders, such as whiplash‐associated disorders, are common, disabling and costly. A large proportion of direct health care costs associated with neck disorders is attributable to visits to health care providers, sick leave and the related loss of productive capacity.
Advice and education is commonly given during the treatment of neck pain. The most common educational approaches are advice (focused on rest, activation, or stress coping skills), neck school, or education concurrent with other treatments.
Electronic bibliographic databases were searched up to May 2008. Ten randomized controlled trials (RCTs; 1660 participants) looking at the effectiveness of patient education strategies for neck disorders were included. Of the ten selected trials, two were rated as being of high quality. Participants who received advice to stay active reported little or no difference in pain compared to those who received no treatment, treatments focusing on rest, treatments focusing on exercise, physiotherapy and cognitive behavioural therapy. Additionally, stress management therapies, when compared to no treatment, did not seem to have an effect on pain intensity in patients with mechanical neck disorders. Finally, traditional neck school (psychological counselling, ergonomics, exercise, self‐care, relaxation) does not seem to have an effect on pain when compared to no treatment.
No adverse events were reported in the trials.
In summary, the review authors concluded that there is no strong evidence for the effectiveness of educational interventions in various neck disorders.
