Clinical reasoning in unimodal interventions in patients with non-specific neck pain in daily physiotherapy practice, a Delphi study

Francois Maissan, Jan Pool, Eric Stutterheim, Harriet Wittink, Raymond Ostelo

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Neck pain is the fourth major cause of disability worldwide but sufficient evidence regarding treatment is not available. This study is a first exploratory attempt to gain insight into and consensus on the clinical reasoning of experts in patients with non-specific neck pain. Objective: First, we aimed to inventory expert opinions regarding the indication for physiotherapy when, other than neck pain, no positive signs and symptoms and no positive diagnostic tests are present. Secondly, we aimed to determine which measurement instruments are being used and when they are used to support and objectify the clinical reasoning process. Finally, we wanted to establish consensus among experts regarding the use of unimodal interventions in patients with non-specific neck pain, i.e. their sequential linear clinical reasoning. Study design: A Delphi study. Methods: A Web-based Delphi study was conducted. Fifteen experts (teachers and researchers) participated. Results: Pain alone was deemed not be an indication for physiotherapy treatment. PROMs are mainly used for evaluative purposes and physical tests for diagnostic and evaluative purposes. Eighteen different variants of sequential linear clinical reasoning were investigated within our Delphi study. Only 6 out of 18 variants of sequential linear clinical reasoning reached more than 50% consensus. Conclusion: Pain alone is not an indication for physiotherapy. Insight has been obtained into which measurement instruments are used and when they are used. Consensus about sequential linear lines of clinical reasoning was poor.

Original languageEnglish
Pages (from-to)8-16
Number of pages9
JournalMusculoskeletal Science and Practice
Volume37
DOIs
Publication statusPublished - 1 Oct 2018

Cite this

@article{5d53104e0da245ec96b23fd308b62c88,
title = "Clinical reasoning in unimodal interventions in patients with non-specific neck pain in daily physiotherapy practice, a Delphi study",
abstract = "Background: Neck pain is the fourth major cause of disability worldwide but sufficient evidence regarding treatment is not available. This study is a first exploratory attempt to gain insight into and consensus on the clinical reasoning of experts in patients with non-specific neck pain. Objective: First, we aimed to inventory expert opinions regarding the indication for physiotherapy when, other than neck pain, no positive signs and symptoms and no positive diagnostic tests are present. Secondly, we aimed to determine which measurement instruments are being used and when they are used to support and objectify the clinical reasoning process. Finally, we wanted to establish consensus among experts regarding the use of unimodal interventions in patients with non-specific neck pain, i.e. their sequential linear clinical reasoning. Study design: A Delphi study. Methods: A Web-based Delphi study was conducted. Fifteen experts (teachers and researchers) participated. Results: Pain alone was deemed not be an indication for physiotherapy treatment. PROMs are mainly used for evaluative purposes and physical tests for diagnostic and evaluative purposes. Eighteen different variants of sequential linear clinical reasoning were investigated within our Delphi study. Only 6 out of 18 variants of sequential linear clinical reasoning reached more than 50{\%} consensus. Conclusion: Pain alone is not an indication for physiotherapy. Insight has been obtained into which measurement instruments are used and when they are used. Consensus about sequential linear lines of clinical reasoning was poor.",
keywords = "Delphi study, Evidence based medicine, Non-specific neck pain, Physiotherapy",
author = "Francois Maissan and Jan Pool and Eric Stutterheim and Harriet Wittink and Raymond Ostelo",
year = "2018",
month = "10",
day = "1",
doi = "10.1016/j.msksp.2018.06.001",
language = "English",
volume = "37",
pages = "8--16",
journal = "Musculoskeletal Science and Practice",
issn = "2468-8630",
publisher = "Elsevier BV",

}

Clinical reasoning in unimodal interventions in patients with non-specific neck pain in daily physiotherapy practice, a Delphi study. / Maissan, Francois; Pool, Jan; Stutterheim, Eric; Wittink, Harriet; Ostelo, Raymond.

In: Musculoskeletal Science and Practice, Vol. 37, 01.10.2018, p. 8-16.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Clinical reasoning in unimodal interventions in patients with non-specific neck pain in daily physiotherapy practice, a Delphi study

AU - Maissan, Francois

AU - Pool, Jan

AU - Stutterheim, Eric

AU - Wittink, Harriet

AU - Ostelo, Raymond

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background: Neck pain is the fourth major cause of disability worldwide but sufficient evidence regarding treatment is not available. This study is a first exploratory attempt to gain insight into and consensus on the clinical reasoning of experts in patients with non-specific neck pain. Objective: First, we aimed to inventory expert opinions regarding the indication for physiotherapy when, other than neck pain, no positive signs and symptoms and no positive diagnostic tests are present. Secondly, we aimed to determine which measurement instruments are being used and when they are used to support and objectify the clinical reasoning process. Finally, we wanted to establish consensus among experts regarding the use of unimodal interventions in patients with non-specific neck pain, i.e. their sequential linear clinical reasoning. Study design: A Delphi study. Methods: A Web-based Delphi study was conducted. Fifteen experts (teachers and researchers) participated. Results: Pain alone was deemed not be an indication for physiotherapy treatment. PROMs are mainly used for evaluative purposes and physical tests for diagnostic and evaluative purposes. Eighteen different variants of sequential linear clinical reasoning were investigated within our Delphi study. Only 6 out of 18 variants of sequential linear clinical reasoning reached more than 50% consensus. Conclusion: Pain alone is not an indication for physiotherapy. Insight has been obtained into which measurement instruments are used and when they are used. Consensus about sequential linear lines of clinical reasoning was poor.

AB - Background: Neck pain is the fourth major cause of disability worldwide but sufficient evidence regarding treatment is not available. This study is a first exploratory attempt to gain insight into and consensus on the clinical reasoning of experts in patients with non-specific neck pain. Objective: First, we aimed to inventory expert opinions regarding the indication for physiotherapy when, other than neck pain, no positive signs and symptoms and no positive diagnostic tests are present. Secondly, we aimed to determine which measurement instruments are being used and when they are used to support and objectify the clinical reasoning process. Finally, we wanted to establish consensus among experts regarding the use of unimodal interventions in patients with non-specific neck pain, i.e. their sequential linear clinical reasoning. Study design: A Delphi study. Methods: A Web-based Delphi study was conducted. Fifteen experts (teachers and researchers) participated. Results: Pain alone was deemed not be an indication for physiotherapy treatment. PROMs are mainly used for evaluative purposes and physical tests for diagnostic and evaluative purposes. Eighteen different variants of sequential linear clinical reasoning were investigated within our Delphi study. Only 6 out of 18 variants of sequential linear clinical reasoning reached more than 50% consensus. Conclusion: Pain alone is not an indication for physiotherapy. Insight has been obtained into which measurement instruments are used and when they are used. Consensus about sequential linear lines of clinical reasoning was poor.

KW - Delphi study

KW - Evidence based medicine

KW - Non-specific neck pain

KW - Physiotherapy

UR - http://www.scopus.com/inward/record.url?scp=85048728669&partnerID=8YFLogxK

U2 - 10.1016/j.msksp.2018.06.001

DO - 10.1016/j.msksp.2018.06.001

M3 - Article

VL - 37

SP - 8

EP - 16

JO - Musculoskeletal Science and Practice

JF - Musculoskeletal Science and Practice

SN - 2468-8630

ER -