Does Structured Patient Education Improve the Recovery
and Clinical Outcomes of Patients with Neck Pain?
A Systematic Review from the Ontario Protocol for
Traffic Injury Management (OPTIMa) Collaboration

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:     Frankp@chiro.org

FROM:   Spine J. 2016 (Dec); 16 (12): 1524–1540

Hainan Yu, MBBS, MS, Pierre Côté, DC, PhD, Danielle Southerst, BScH, DC, FCCS(C), Jessica J. Wong, BSc, DC, FCCS(C), Sharanya Varatharajan, MSc, Heather M. Shearer, DC, MSc, FCCS(C), Douglas P. Gross, PhD, Gabrielle M. van der Velde, DC, PhD, Linda J. Carroll, PhD, Silvano A. Mior, DC, PhD, Arthur Ameis, MD, FRCPC, DESS, DABPM&R, Craig L. Jacobs, BFA, DC, MSc, FCCS(C), Anne L. Taylor-Vaisey, MLS

UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation,
University of Ontario Institute of Technology (UOIT) and
Canadian Memorial Chiropractic College (CMCC),
6100 Leslie St, Toronto, Ontario M2H 3J1, Canada;
Division of Graduate Education and Research,
Canadian Memorial Chiropractic College
hainan.yu@uoit.ca

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BACK GROUND CONTEXT:   In 2008, the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders recommended patient education for the management of neck pain. However, the effectiveness of education interventions has recently been challenged.

PURPOSE:   To update the findings of the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders and evaluate the effectiveness of structured patient education for the management of patients with whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD).

STUDY DESIGN/SETTING:   Systematic review of the literature and best-evidence synthesis.

PATIENT SAMPLE:   Randomized controlled trials that compared structured patient education with other conservative interventions.

OUTCOME MEASURES:   Self-rated recovery, functional recovery (eg, disability, return to activities, work, or school), pain intensity, health-related quality of life, psychological outcomes such as depression or fear, or adverse effects.

METHODS:   We systematically searched eight electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Central Register of Controlled Trials, DARE, PubMed, and ICL) from 2000 to 2012. Randomized controlled trials, cohort studies, and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Scientifically admissible studies were summarized in evidence tables and synthesized following best-evidence synthesis principles.

RESULTS:   We retrieved 4,477 articles. Of those, nine were eligible for critical appraisal and six were scientifically admissible. Four admissible articles investigated patients with WAD and two targeted patients with NAD. All structured patient education interventions included advice on activation or exercises delivered orally combined with written information or as written information alone. Overall, as a therapeutic intervention, structured patient education was equal or less effective than other conservative treatments including massage, supervised exercise, and physiotherapy. However, structured patient education may provide small benefits when combined with physiotherapy. Either mode of delivery (ie, oral or written education) provides similar results in patients with recent WAD.

CONCLUSIONS:   This review adds to the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders by defining more specifically the role of structured patient education in the management of WAD and NAD. Results suggest that structured patient education alone cannot be expected to yield large benefits in clinical effectiveness compared with other conservative interventions for patients with WAD or NAD. Moreover, structured patient education may be of benefit during the recovery of patients with WAD when used as an adjunct therapy to physiotherapy or emergency room care. These benefits are small and short lived.

KEYWORDS:   Neck pain and associated disorders; Outcome; Patient education; Recovery; Systematic review; Whiplash-associated disorders

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