Validity and reliability of guidelines for neck pain treatment in primary health care. A nationwide empirical analysis in Spain.
OBJECTIVE
To assess the reliability and validity of existing clinical guidelines on neck-pain physiotherapy treatment and follow-up in Spain.


METHODS
We identified existing guidelines through a nationwide census and listed their recommendations, grouped according to the main steps of the process flow-chart. To assess reliability we analysed the variability of statements. To analyse validity we assessed the type of scientific evidence supporting the recommendations, and we compared them with a list of evidence-based recommendations that was elaborated for this study.


METHODS
Primary health care centres (n = 24) with guidelines for neck-pain treatment and follow-up.


METHODS
We quantified the number of recommendations, the proportion of valid statements, the frequencies of non-evidence-based recommendations, and the absence of the evidence-based recommendations we had identified.


RESULTS
The 34 identified guidelines contained 325 recommendations, with great variation between guidelines with respect to the number, type (for up to 26 different clinical decisions), and content of the recommendations they provided. Direct assessment of the scientific evidence was not possible because no specific reference was given to support any recommendation. When compared with our list, only 20.9% of the recommendations could be considered evidence-based. No guideline contained all the eight evidence-based recommendations we identified.


CONCLUSIONS
The results question the guidelines' reliability and validity, and their usefulness in ensuring quality. We conclude that guidelines should be reviewed and re-designed with greater scientific rigour.
Saturno
Pedro J
PJ
Department of Public Health and Preventive Medicine, University of Murcia, Murcia, Spain. psaturno@um.es
Medina
Francesc
F
Valera
Fermin
F
Montilla
Joaquina
J
Escolar
Pilar
P
Gascón
Juan J
JJ
D003266:Continuity of Patient Care / Q000592:standards; D003657:Decision Making; D019317:Evidence-Based Medicine; D005500:Follow-Up Studies; D006801:Humans; D019547:Neck Pain / Q000534:rehabilitation*; D009819:Office Visits; D010043:Outcome and Process Assessment, Health Care; D018710:Pain Clinics / Q000592:standards*; D010353:Patient Education as Topic / Q000592:standards; D026741:Physical Therapy Modalities / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*