Systematic Review of Neck Pain AssessmentDiagnosing the cause of neck pain can be a difficult and expensive process. There are many tests and procedures that can be done. Doctors need to know what tests to use with each type of neck pain patient.
A large group of doctors, physical therapists, chiropractors, and other health care specialists were part of a committee to conduct a systematic review of neck pain assessment. The focus was on diagnostic tests to use. Surveys used for self-reported disability assessment were also reviewed.
A systematic review is very helpful to doctors and other clinicians. It gives them a summary of the important findings of all the quality studies published. It saves them time and helps them find out which recommendations are evidence-based and worth paying attention to.
The committee carefully reviewed 95 articles on diagnosis of neck pain. Test research in each paper was evaluated for usefulness, validity (accuracy), and reliability. After presenting the present clinical practice used in diagnosing neck pain, current research results were offered.
Emergency and nonemergency situations were included. Assessment of emergency patients must include ruling out bone fracture, dislocation, and/or spinal cord injury. Immediate imaging studies are used more often in emergency cases than in nonemergency care.
Nonemergency neck pain patients are examined for motion, strength, trigger points, and function. A careful patient history is also taken. Blood testing, electrodiagnostic testing such as electromyography (EMG), and imaging studies may be ordered for some patients. A review of each testing procedure was provided.
The authors list evidence-based statements for the screening of emergency neck patients. There is strong evidence that using a standard screening protocol is a good idea. It alerts the doctor when there is a high risk of cervical spine fracture. It's less likely that a serious injury will be missed when using a screening protocol. Findings regarding the use of X-rays, MRIs, and other imaging studies were also presented.
A list of findings for clinical assessment of the nonemergency neck pain patients was also presented. Again, these suggestions are based on the best evidence found after doing a systematic review. The authors report how much evidence was found for each one (e.g., none, limited, some, and consistent evidence).
The committee concluded that tests should only be used when they have been proven to be accurate. Doctors should know what are the benefits and limits of each test used in the diagnosis of neck pain. There is a great need for further studies to establish the reliability, utility, and validity of many test procedures used when diagnosing patients with neck pain.
Margareta Nordin, PT, Dr Med Sc, et al. Assessment of Neck Pain and Its Associated Disorders. In Spine. Supplement to February 15, 2008. Vol. 33. No. 4S. Pp. 101-122.
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