Citation

Shearer HM, Carroll LJ, Wong JJ, Côté P, Varatharajan S, Southerst D, Sutton DA, Randhawa K, Yu H, Mior S, van der Velde G, Nordin M, Stupar M, Taylor-Vaisey A. Spine J. 2015; 16(12): 1566-1581.

Affiliation

Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC).

Copyright

(Copyright © 2015, Elsevier Publishing)

DOI

10.1016/j.spinee.2015.08.011

PMID

26279388

Abstract

BACKGROUND CONTEXT: In 2008, the lack of published evidence prevented the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (NPTF) from commenting on the effectiveness of psychological interventions for the management of neck pain.

PURPOSE: To update findings of the NPTF and evaluate the effectiveness of psychological interventions for the management of neck pain and associated disorders (NAD) or whiplash-associated disorders (WAD). STUDY DESIGN/SETTING: Systematic review and best-evidence synthesis. SAMPLE: Randomized controlled trials, cohort studies and case-control studies comparing psychological interventions to other non-invasive interventions or no intervention. OUTCOME MEASURES: 1) self-rated recovery; 2) functional recovery; 3) clinical outcomes; 4) administrative outcomes; and/or 5) adverse effects.

METHODS: We searched six databases from 1990 to 2015. Randomized controlled trials (RCTs), cohort studies and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers used the Scottish Intercollegiate Guideline Network criteria to critically appraise eligible studies.  Studies with a low risk of bias were synthesized following best evidence synthesis principles. This study was funded by the Ministry of Finance.

RESULTS: We screened 1919 articles, 19 were eligible for critical appraisal and 10 were judged to have low risk of bias. We found no clear evidence supporting relaxation training or cognitive behavioural therapy (CBT) for persistent grade I-III NAD for reducing pain intensity or disability. Similarly, we did not find evidence to support the effectiveness of biofeedback or relaxation training for persistent grade II WAD and there is conflicting evidence for the use of CBT in this population. However, adding a progressive goal attainment program to functional restoration physiotherapy may benefit patients with persistent grade I-III WAD. Furthermore, Jyoti meditation may help reduce neck pain intensity and bothersomeness in those with persistent NAD.

CONCLUSIONS: We did not find evidence for or against the use of psychological interventions in patients with recent onset NAD or WAD. We found evidence that a progressive goal attainment program may be helpful for the management of persistent WAD and that Jyoti meditation may benefit patients with persistent NAD. The limited evidence of effectiveness for psychological interventions may be due to several factors: interventions that are ineffective, poorly conceptualized or poorly implemented. Further methodologically rigorous research is needed. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRDXXXXXXXXXXX.

Language: en