Utilization Outcomes for Physical Therapy Clinical Practice Guideline Recommendations for Mechanical Cervicalgia: A Retrospective Analysis

Research Objectives: To investigate the outcomes and utilization of Clinical Practice Guideline (CPG) treatment recommendations among physical therapists for patients with mechanical neck pain

Design: Retrospective cohort study

Setting: Multiple outpatient physical therapy clinics within a single hospital system

Participants: Patients (n=200) who received physical therapy for mechanical neck pain after 2018 were included. Exclusion criteria was history of cervical or thoracic spine surgery.

Interventions: Patients received standard physical therapy care as determined by the treating clinicians. CPG recommended treatments included thoracic manipulation, cervical mobilization, dry needling, transcutaneous electrical stimulation (TENS), dry needling, advice to stay active, and scapular retraction exercises.

Main Outcome Measures: Primary outcomes measured included presence (yes/no) of the CPG recommended treatments, pain (Visual Analog Scale), and function (Neck Disability Index). Groups were based on number of interventions used. For pain, the “Less than 3” group (n=67) was compared to the “3 or greater” group (n=99). For function, the “Less than 3” group (n=31) was compared to the “3 or greater” group (n=36).

Results: Patients had an average age (standard deviation, SD) of 61.7 (15.2) years old. For treatment utilization, 5% of patients received thoracic manipulation, 47% received cervical mobilization, 15% received TENS, 23% received dry needling, 99% received advice to stay active, and 84% received scapular resistance exercises. There was no significant difference in improvement in pain (p=.72) or function (p=.09) between the “Less than 3” group and the “3 or greater” group.

Conclusions: CPG recommended treatments are used with varying frequency when treating patients with mechanical neck pain in outpatient physical therapy clinics. Interventions such as advice to stay active, scapular resistance exercises, and cervical mobilizations are commonly used whereas others are used infrequently. Thoracic manipulation was rarely used despite CPG recommendations. There was no significant difference in pain or functional outcomes based on the number of CPG recommended interventions utilized during treatment.

Author(s) Disclosures: None of the authors have any conflicts to disclose.