Evidence-based physiotherapy for patients with neck pain

This report is intended to be used as reference and educational material. It represents one of two documents that critically review the scientific evidence underlying the therapies and interventions provided by physiotherapists.

The report presents a systematic literature review of the scientific basis for treating neck problems by physiotherapy. Among the findings, it reveals a need for further research and more studies to strengthen the foundation for evidence-based physiotherapy. The report is published in collaboration with the federation of licenced physiotherapists in Sweden (LSR) and a Swedish foundation that supports research in health care and allergy care (Vårdalstiftelsen).

Summary and Conclusions

The literature review shows that few of the therapies used by physiotherapists to relieve neck pain have effects that are scientifically documented. Most therapies have not been assessed by scientifically acceptable methods. However, the fact that a method is not scientifically assessed does not necessarily imply the method has no value, it simply means that its value is uncertain. Interaction between research and clinical practice is necessary to change physiotherapy from an opinion-based discipline to an evidence-based discipline. To achieve this goal, clinical studies that assess treatment outcomes and costs are fundamental. The literature review identified 37 randomized controlled studies. Only nine of the studies were found to be of high quality. Common deficiencies in the remaining studies included: too few subjects in the groups, inadequate followup times, and inadequate descriptions of measurement methods, treatments, and interventions.

The review supported the following:

• that Orthopedic Manual Therapy (OMT) can reduce pain and increase mobility in the cervical spine in chronic neck pain, and
• that active and passive movement in the cervical spine at an early stage can reduce neck pain following whiplash injuries.

Somewhat less support was found for the following:

• that OMT can reduce pain and increase mobility in the cervical spine in acute neck pain,
• that traction can reduce pain and increase mobility in the cervical spine in chronic neck pain,
• that physical exercise including strength training in the neck and shoulder muscles can reduce pain in chronic neck pain, and
• that acupuncture can give short-term reduction in pain from chronic neck pain.

An analysis of the literature showed that several treatments and interventions remain to be assessed. Since new treatment methods are constantly being proposed, assessment should be viewed as an ongoing process. These efforts can be accelerated through multicenter studies. Furthermore, measurement and assessment methods should be revised to permit uniform reporting. Implementing these proposed changed would probably require national collaboration.