Classification of Neck Pain: Difference between revisions
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== Introduction == | == Introduction == | ||
Evidence for the conservative management of neck pain in primary care does not support any particular approach and it remains unclear as to what the most effective method of treatment in terms of costs, time and resolution. As a result there has been a shift from the pathoanatomical model of diagnosis towards the development of prognostic tests that can separate a heterogeneous population into treatment-oriented subgroups that will inform patient management and be cost effective<ref name=":0">Childs MJ, Fritz JM, Piva SR, Whitman JM. [http://www.jospt.org/doi/pdf/10.2519/jospt.2004.34.11.686 Proposal of a classification system for patients with neck pain.]Journal of Orthopaedic & Sports Physical Therapy. 2004 Nov;34(11):686-700.</ref><ref>Childs J, Cleland J, Elliott J, Deydre T, Wainner R, Whitman J, et al. [http://www.ncbi.nlm.nih.gov/pubmed/18758050 Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association]. J Orthop Sports Phys Ther. 2008;38(9):A1-A34</ref>. This form of classification provides a general framework for identifying subgroups of patients based on the primary goal of treatment, with the ultimate aim of matching individuals to specific interventions from which they are most likely to benefit<ref name=":0" />. | |||
= | Classification of individuals with neck pain was first proposed by Wells et al in 2001<ref>Wells GA, Tugwell P, Brosseau L, et al. Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions: overview and methodology. Phys Ther. 2001;81:1629-1640.</ref>, their system used symptom location (neck pain only, arm pain with or without neck pain, or headache) and presumed pathological mechanisms (radicular versus referred pain) in the initial subgrouping of patients. The treatment based classification for individuals with neck pain was proposed in 2004 by Childs et al<ref name=":0" />, the system was based on the goals of treatment and the interventions used to achieve these goals, rather than an attempt to classify patients by pathology or symptom distribution. It was updated in 2008 as part of the APTA Orthopedic section ICF Guidelines with the four current classification categories including: neck pain with mobility deficits, neck pain with radiating pain ([[Cervical Radiculopathy|radicular]]), neck pain with movement coordination impairments ([[Whiplash Associated Disorders|WAD]]), and neck pain with headache ([[Cervicogenic Headache|cervicogenic]]). | ||
== | The principle supporting classification systems centres around the following notion: a decrease in uncertainty concerning appropriate, effective treatments could be observed via the linkage of an impairment diagnosis to a treatment choice<ref name=":1">Wang, W. T. J., Olson, S. L., Campbell, A. H. M., Hanten, W. P., & Gleeson, P. B. (2003). Effectiveness of Physical Therapy for Patients with Neck Pain: An Individualized Approach Using a Clinical Decision-Making Algorithm. American Journal of Physical Medicine & Rehabilitation, 82(3), 203-218.</ref>. Diagnostic algorithms and classification may be beneficial to clinical decision making and allows clinicians to easily identify the correct intervention strategy and predict a patient’s prognosis. | ||
== Classification Types == | |||
Different classification systems are often used in clinical practice: | |||
# Pathoanatomical - structurally based i.e. which structure is dysfunctional. The pathoanatomical model has proven limited for the correlation between diagnosis and clinical decisions regarding treatment management plans because different diagnoses often exhibit similar symptoms<ref name=":1" />. | |||
# Clinical condition - signs and symptoms based i.e. what condition does the individual have, such as cervical osteoarthritis, cervicogenic headache etc. | |||
# Response to movement - symptom response based i.e. how does movement change symptoms, such as with repeated movements and the centralisation phenomenon. Werneke et al<ref>Werneke, M., Hart, D., & Cook, D. (1999). A Descriptive Study of the Centralization Phenomenon: A Prospective Analysis. Spine, 24(7), 676-683.</ref> suggested categorisation by changes in pain location to mechanical assessment and treatment allowed identification of patients with improved treatment outcomes and facilitated planning of conservative treatment of patients with acute spinal pain syndromes. However, limited inference can be taken from this study as the authors reported pooled data for all participants, of which only 23% had neck pain<ref>Hing W. Differential Diagnosis and Classification of Neck Pain. WCPT Congress, 2015.</ref>. | |||
# Treatment based - based on matched interventions. Based on the goals of treatment and the interventions used to achieve these goals, rather than an attempt to classify patients by pathology or symptom distribution<ref name=":0" /><ref name=":2">Fritz, J. M., & Brennan, G. P. (2007). [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.944.1147&rep=rep1&type=pdf Preliminary Examination of a Proposed Treatment-Based Classification System for Patients Receiving Physical Therapy Interventions for Neck Pain.] Physical Therapy, 87(5), 513-524.</ref> | |||
== Summary == | |||
Therapists should be aware of the different classification systems that exist. These systems can guide specific assessment and treatment selection. The treatment based classification is a widely used system that has been proven to be effective for managing individuals with neck pain<ref name=":2" />. | |||
== References == | == References == | ||
<references /> | <references /> | ||
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Introduction[edit | edit source]
Evidence for the conservative management of neck pain in primary care does not support any particular approach and it remains unclear as to what the most effective method of treatment in terms of costs, time and resolution. As a result there has been a shift from the pathoanatomical model of diagnosis towards the development of prognostic tests that can separate a heterogeneous population into treatment-oriented subgroups that will inform patient management and be cost effective[1][2]. This form of classification provides a general framework for identifying subgroups of patients based on the primary goal of treatment, with the ultimate aim of matching individuals to specific interventions from which they are most likely to benefit[1].
Classification of individuals with neck pain was first proposed by Wells et al in 2001[3], their system used symptom location (neck pain only, arm pain with or without neck pain, or headache) and presumed pathological mechanisms (radicular versus referred pain) in the initial subgrouping of patients. The treatment based classification for individuals with neck pain was proposed in 2004 by Childs et al[1], the system was based on the goals of treatment and the interventions used to achieve these goals, rather than an attempt to classify patients by pathology or symptom distribution. It was updated in 2008 as part of the APTA Orthopedic section ICF Guidelines with the four current classification categories including: neck pain with mobility deficits, neck pain with radiating pain (radicular), neck pain with movement coordination impairments (WAD), and neck pain with headache (cervicogenic).
The principle supporting classification systems centres around the following notion: a decrease in uncertainty concerning appropriate, effective treatments could be observed via the linkage of an impairment diagnosis to a treatment choice[4]. Diagnostic algorithms and classification may be beneficial to clinical decision making and allows clinicians to easily identify the correct intervention strategy and predict a patient’s prognosis.
Classification Types[edit | edit source]
Different classification systems are often used in clinical practice:
- Pathoanatomical - structurally based i.e. which structure is dysfunctional. The pathoanatomical model has proven limited for the correlation between diagnosis and clinical decisions regarding treatment management plans because different diagnoses often exhibit similar symptoms[4].
- Clinical condition - signs and symptoms based i.e. what condition does the individual have, such as cervical osteoarthritis, cervicogenic headache etc.
- Response to movement - symptom response based i.e. how does movement change symptoms, such as with repeated movements and the centralisation phenomenon. Werneke et al[5] suggested categorisation by changes in pain location to mechanical assessment and treatment allowed identification of patients with improved treatment outcomes and facilitated planning of conservative treatment of patients with acute spinal pain syndromes. However, limited inference can be taken from this study as the authors reported pooled data for all participants, of which only 23% had neck pain[6].
- Treatment based - based on matched interventions. Based on the goals of treatment and the interventions used to achieve these goals, rather than an attempt to classify patients by pathology or symptom distribution[1][7]
Summary[edit | edit source]
Therapists should be aware of the different classification systems that exist. These systems can guide specific assessment and treatment selection. The treatment based classification is a widely used system that has been proven to be effective for managing individuals with neck pain[7].
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Childs MJ, Fritz JM, Piva SR, Whitman JM. Proposal of a classification system for patients with neck pain.Journal of Orthopaedic & Sports Physical Therapy. 2004 Nov;34(11):686-700.
- ↑ Childs J, Cleland J, Elliott J, Deydre T, Wainner R, Whitman J, et al. Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(9):A1-A34
- ↑ Wells GA, Tugwell P, Brosseau L, et al. Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions: overview and methodology. Phys Ther. 2001;81:1629-1640.
- ↑ 4.0 4.1 Wang, W. T. J., Olson, S. L., Campbell, A. H. M., Hanten, W. P., & Gleeson, P. B. (2003). Effectiveness of Physical Therapy for Patients with Neck Pain: An Individualized Approach Using a Clinical Decision-Making Algorithm. American Journal of Physical Medicine & Rehabilitation, 82(3), 203-218.
- ↑ Werneke, M., Hart, D., & Cook, D. (1999). A Descriptive Study of the Centralization Phenomenon: A Prospective Analysis. Spine, 24(7), 676-683.
- ↑ Hing W. Differential Diagnosis and Classification of Neck Pain. WCPT Congress, 2015.
- ↑ 7.0 7.1 Fritz, J. M., & Brennan, G. P. (2007). Preliminary Examination of a Proposed Treatment-Based Classification System for Patients Receiving Physical Therapy Interventions for Neck Pain. Physical Therapy, 87(5), 513-524.
