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Meta-Analysis
. 2012 Mar 14;2012(3):CD005106.
doi: 10.1002/14651858.CD005106.pub4.

Patient education for neck pain

Anita Gross  1 , Mario Forget, Kerry St George, Michelle M H Fraser, Nadine Graham, Lenora Perry, Stephen J Burnie, Charles H Goldsmith, Ted Haines, David Brunarski
Affiliations
Meta-Analysis

Patient education for neck pain

Anita Gross et al. Cochrane Database Syst Rev. .

Abstract

Background: Neck disorders are common, disabling, and costly. The effectiveness of patient education strategies is unclear.

Objectives: To assess the short- to long-term effects of therapeutic patient education (TPE) strategies on pain, function, disability, quality of life, global perceived effect, patient satisfaction, knowledge transfer, or behaviour change in adults with neck pain associated with whiplash or non-specific and specific mechanical neck pain with or without radiculopathy or cervicogenic headache.

Search methods: We searched computerised bibliographic databases (inception to 11 July 2010).

Selection criteria: Eligible studies were randomised controlled trials (RCT) investigating the effectiveness of TPE for acute to chronic neck pain.

Data collection and analysis: Paired independent review authors conducted selection, data abstraction, and 'Risk of bias' assessment. We calculated risk ratio (RR) and standardised mean differences (SMD). Heterogeneity was assessed; no studies were pooled.

Main results: Of the 15 selected trials, three were rated low risk of bias. Three TPE themes emerged.Advice focusing on activation: There is moderate quality evidence (one trial, 348 participants) that an educational video of advice focusing on activation was more beneficial for acute whiplash-related pain when compared with no treatment at intermediate-term [RR 0.79 (95% confidence interval (CI) 0.59 to 1.06)] but not long-term follow-up [0.89 (95% CI, 0.65 to 1.21)]. There is low quality evidence (one trial, 102 participants) that a whiplash pamphlet on advice focusing on activation is less beneficial for pain reduction, or no different in improving function and global perceived improvement from generic information given out in emergency care (control) for acute whiplash at short- or intermediate-term follow-up. Low to very low quality evidence (nine trials using diverse educational approaches) showed either no evidence of benefit or difference for varied outcomes. Advice focusing on pain & stress coping skills and workplace ergonomics: Very low quality evidence (three trials, 243 participants) favoured other treatment or showed no difference spanning numerous follow-up periods and disorder subtypes. Low quality evidence (one trial, 192 participants) favoured specific exercise training for chronic neck pain at short-term follow-up.Self-care strategies: Very low quality evidence (one trial, 58 participants) indicated that self-care strategies did not relieve pain for acute to chronic neck pain at short-term follow-up.

Authors' conclusions: With the exception of one trial, this review has not shown effectiveness for educational interventions, including advice to activate, advice on stress-coping skills, workplace ergonomics and self-care strategies. Future research should be founded on sound adult learning theory and learning skill acquisition.

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Conflict of interest statement

none

Figures

1
1
PRISMA Study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Forest plot of comparison: 2 ADVICE ‐ focus on activation vs PLACEBO or CONTROL for acute to chronic MND, outcome: 2.1 pain [intensity].
5
5
Four Steps in Therapeutic Patient Education
1.1
1.1. Analysis
Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL for acute WAD, Outcome 1 pain [present].
1.2
1.2. Analysis
Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL for acute WAD, Outcome 2 function [self‐report].
1.3
1.3. Analysis
Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL for acute WAD, Outcome 3 sick leave [number of people].
1.4
1.4. Analysis
Comparison 1 ADVICE ‐ focus on activation vs PLACEBO or CONTROL for acute WAD, Outcome 4 global perceived improvement [felt worse or no change].
2.1
2.1. Analysis
Comparison 2 ADVICE ‐ focus on activation vs PLACEBO or CONTROL for acute to chronic MND, Outcome 1 pain [intensity].
2.7
2.7. Analysis
Comparison 2 ADVICE ‐ focus on activation vs PLACEBO or CONTROL for acute to chronic MND, Outcome 7 additional health contacts for neck disorder.
2.9
2.9. Analysis
Comparison 2 ADVICE ‐ focus on activation vs PLACEBO or CONTROL for acute to chronic MND, Outcome 9 Disability.
3.1
3.1. Analysis
Comparison 3 ADVICE ‐ focus on activation vs ANOTHER TREATMENT for acute to chronic MND, Outcome 1 pain [intensity].
3.3
3.3. Analysis
Comparison 3 ADVICE ‐ focus on activation vs ANOTHER TREATMENT for acute to chronic MND, Outcome 3 function [self‐report].
3.5
3.5. Analysis
Comparison 3 ADVICE ‐ focus on activation vs ANOTHER TREATMENT for acute to chronic MND, Outcome 5 self‐experienced physical impairment.
3.7
3.7. Analysis
Comparison 3 ADVICE ‐ focus on activation vs ANOTHER TREATMENT for acute to chronic MND, Outcome 7 working ability.
3.9
3.9. Analysis
Comparison 3 ADVICE ‐ focus on activation vs ANOTHER TREATMENT for acute to chronic MND, Outcome 9 self‐experienced benefit of treatment.
3.11
3.11. Analysis
Comparison 3 ADVICE ‐ focus on activation vs ANOTHER TREATMENT for acute to chronic MND, Outcome 11 Quality of Life.
4.1
4.1. Analysis
Comparison 4 ADVICE ‐ focus on activation vs ANOTHER TREATMENT for acute WAD, Outcome 1 pain [intensity].
4.4
4.4. Analysis
Comparison 4 ADVICE ‐ focus on activation vs ANOTHER TREATMENT for acute WAD, Outcome 4 sick leave [number of people].
4.5
4.5. Analysis
Comparison 4 ADVICE ‐ focus on activation vs ANOTHER TREATMENT for acute WAD, Outcome 5 global perceived improvement [felt worse or no change].
4.6
4.6. Analysis
Comparison 4 ADVICE ‐ focus on activation vs ANOTHER TREATMENT for acute WAD, Outcome 6 Function.
4.7
4.7. Analysis
Comparison 4 ADVICE ‐ focus on activation vs ANOTHER TREATMENT for acute WAD, Outcome 7 Quality of life.
5.1
5.1. Analysis
Comparison 5 ADVICE‐ focus on activation oral ED vs written ED for acute WAD, Outcome 1 Pain intensity.
5.2
5.2. Analysis
Comparison 5 ADVICE‐ focus on activation oral ED vs written ED for acute WAD, Outcome 2 Neck disability.
6.1
6.1. Analysis
Comparison 6 ADVICE ‐ focus on pain & stress‐coping skills vs CONTROL for subacute WAD, Outcome 1 pain [intensity].
6.2
6.2. Analysis
Comparison 6 ADVICE ‐ focus on pain & stress‐coping skills vs CONTROL for subacute WAD, Outcome 2 disability.
7.1
7.1. Analysis
Comparison 7 ADVICE ‐ focus on pain & stress‐coping skills vs CONTROL for MND of unspecified duration, Outcome 1 pain [present].
8.1
8.1. Analysis
Comparison 8 ADVICE ‐ focus on pain & stress‐coping skills + workplace ergonomics vs EXERCISE for subacute or chronic MND, Outcome 1 Pain intensity.
9.1
9.1. Analysis
Comparison 9 Self‐care Strategies vs NO TREATMENT for acute to chronic MND, Outcome 1 pain [intensity].
9.6
9.6. Analysis
Comparison 9 Self‐care Strategies vs NO TREATMENT for acute to chronic MND, Outcome 6 additional health contacts for neck disorder.
10.1
10.1. Analysis
Comparison 10 Self‐care Strategies versus OTHER TREATMENT for chronic MND, Outcome 1 Function.
10.2
10.2. Analysis
Comparison 10 Self‐care Strategies versus OTHER TREATMENT for chronic MND, Outcome 2 Patient satisfaction.
10.3
10.3. Analysis
Comparison 10 Self‐care Strategies versus OTHER TREATMENT for chronic MND, Outcome 3 Quality of life.
See this image and copyright information in PMC

Update of

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References to other published versions of this review

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Publication types