Evaluation of the Application of Clinical Practice Guideline Recommendations on the Classification of Patients With Neck Pain

Abstract

Background: Clinical practice guidelines (CPGs) are developed to synthesize evidence into recommendations for clinical practice. Minimal evidence exists on the evaluation practice of physical therapists in the treatment of patients with neck pain. Purpose: We sought to describe (1) the extent to which clinicians perform the Neck Pain CPG-recommended examination measures and (2) the percentage of patients properly classified. Methods: We retrospectively analyzed the electronic health records of 397 patients with neck pain at an ambulatory care setting in an academic medical center. The frequency of physical therapists’ evaluation measures, subjective findings, positive examination results, and the percentage of patients properly classified into impairment-based categories (IBCs) were recorded. Descriptive statistics and χ² tests were used to assess patient demographics and compare classification accuracy across IBCs. Results: Of the 397 patients, 56% were classified into an IBC. The most common IBC was neck pain with mobility deficits (24%), followed by neck pain with radiating pain (17%), neck pain with movement coordination impairments (NPMCIs) (8%), and neck pain with headache (6%). Neck pain with movement coordination impairment had the lowest percentage of proper classifications. Classification accuracy was highest when subjective and objective findings were combined and varied between IBCs. Conclusion: Our findings suggest that physical therapists evaluating patients with neck pain may have increased classification accuracy when subjective and objective findings are considered. Decreased classification accuracy was demonstrated in the NPMCI category, highlighting opportunities for further education and research.