Peters Renske, Hallegraeff Joannes, Koes Bart, van Trijffel Emiel
SOMT University of Physiotherapy, Amersfoort, Utrecht, The Netherlands.
Erasmus University Rotterdam, Department of General Practice, Rotterdam, Zuid Holland, The Netherlands.
Phys Ther. 2025 Feb 6;105(2). doi: 10.1093/ptj/pzae179.
This systematic review aimed to determine the methodological quality of international clinical practice guidelines (CPGs) and the clinical credibility and implementability of recommendations regarding manipulation or mobilization treatment recommendations proposed in CPGs for the management of people with neck pain. A secondary aim of this review was to provide an overview of recommendations for manipulation or mobilization in patients with neck pain. Manipulation or mobilization treatment of patients with neck pain is under debate for its potential risk of serious adverse events. Serious adverse events are rare, but it is the clinicians' responsibility to thoroughly screen patients at risk of vascular complications. A third aim of this review was to describe the extent to which the included guidelines inform clinical practice about screening for the risk of complications due to vascular pathology in the cervical spine.
A systematic review of 13 electronic databases and 4 repositories was performed for potentially relevant guidelines published between January 1, 2000 and September 22, 2022. Two reviewers independently appraised eligible guidelines using Appraisal of Guidelines for Research and Evaluation II (AGREE II) and Appraisal of Guidelines for Research and Evaluation: Recommendation EXcellence (AGREE-REX) criteria. A best evidence synthesis was performed, and screening of risk factors was assessed.
A total of 19 CPGs were included, of which 5 were of high quality. All high-quality guidelines recommend the use of manipulation or mobilization, with or without exercise. Eight (42%) guidelines described the screening of risk factors for adverse events. Two (11%) guidelines met the a priori defined criteria for screening and scored present and complete.
International CPGs consistently recommend the use of manipulations and mobilizations in the treatment of neck pain. There is a notable absence of recommendations regarding the identification of patients at risk for vascular complications.
The findings of this study allow guideline developers to improve the quality of future neck pain guidelines and consider including vascular screening tools. Furthermore, it proposes recommendations to physical therapists interested in applying manipulations and mobilizations in the treatment of patients with neck pain.
International clinical practice guidelines consistently recommend the use of manipulations and mobilizations in the treatment of neck pain. There is a notable absence of recommendations regarding identifying patients at risk for vascular complications.
本系统评价旨在确定国际临床实践指南（CPG）的方法学质量，以及CPG中提出的关于颈部疼痛患者手法治疗或松动治疗建议的临床可信度和可实施性。本评价的第二个目的是概述颈部疼痛患者手法治疗或松动治疗的建议。颈部疼痛患者的手法治疗或松动治疗因其潜在的严重不良事件风险而备受争议。严重不良事件很少见，但临床医生有责任对有血管并发症风险的患者进行全面筛查。本评价的第三个目的是描述纳入的指南在多大程度上为临床实践提供了关于筛查颈椎血管病变并发症风险的信息。
对2000年1月1日至2022年9月22日期间发布的潜在相关指南进行了13个电子数据库和4个知识库的系统评价。两名评价者使用《研究与评价指南II》（AGREE II）和《研究与评价指南：推荐卓越性》（AGREE-REX）标准独立评价符合条件的指南。进行了最佳证据综合，并评估了风险因素的筛查情况。
共纳入19项CPG，其中5项质量高。所有高质量指南均推荐使用手法治疗或松动治疗，可联合或不联合运动。8项（42%）指南描述了不良事件风险因素的筛查。2项（11%）指南符合预先定义的筛查标准，评分显示存在且完整。
国际CPG一致推荐在颈部疼痛治疗中使用手法治疗和松动治疗。关于识别有血管并发症风险患者的建议明显缺乏。
本研究结果使指南制定者能够提高未来颈部疼痛指南的质量，并考虑纳入血管筛查工具。此外，它还为有兴趣在颈部疼痛患者治疗中应用手法治疗和松动治疗的物理治疗师提出了建议。
国际临床实践指南一致推荐在颈部疼痛治疗中使用手法治疗和松动治疗。关于识别有血管并发症风险患者的建议明显缺乏。
