Introduction. A structured and rigorous methodology was developed for the formulation of evidence-based clinical practice guidelines (EBCPGs), then was used to develop EBCPGs for selected rehabilitation interventions for the management of neck pain. Methods. Evidence from randomized controlled trials (RCTs) and observational studies was identified and synthesized using methods defined by the Cochrane Collaboration that minimize bias by using a systematic approach to literature search, study selection, data extraction, and 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 evidence and the recommendation. The panel decided that evidence of clinically important benefit (defined as 15% greater relative to a control based on panel expertise and empiric results) in patient-important outcomes was required for a recommendation. Statistical significance was also required but was insufficient alone. Patient-important outcomes were decided by consensus as being pain, function, patient global assessment, quality of life, and return to work, providing that these outcomes were assessed with a scale for which measurement reliability and validity have been established. Validating the Recommendations. A feedback survey questionnaire was sent to 324 practitioners from 6 professional organizations. The response rate was 51%.
For neck pain, therapeutic exercises were the only intervention with clinically important benefit relative to a control (grade A for pain and function, grade B for patient global assessment). There was good agreement with this recommendation from practitioners (93%). For several interventions and
indications (eg, thermotherapy, therapeutic ultrasound, massage, electrical stimulation), there was a lack of evidence regarding efficacy.
This methodology of developing EBCPGs provides a structured approach to assessing the literature and developing guidelines that incorporates clinicians’ feedback and is widely acceptable to practicing clinicians. Further well-designed RCTs are warranted regarding the use of several interventions for patients with neck pain where evidence was insufficient to make recommendations.
[Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Neck Pain. Phys Ther. 2001;81:1701–1717.]
Key Words: Clinical practice guidelines, Evidence-based practice, Meta-analysis, Neckpain, Physical
therapy, Practitioner feedback survey, Rehabilitation, Systematic reviews.