Is it time for a population health approach to neck pain?
OBJECTIVE
Neck pain and its associated disorders (NPAD) cause significant health burden in the general population and after road traffic and occupational injury. Individual-level health care treatments have been well studied, but population-health approaches to this problem have not. We used a best-evidence synthesis to examine population-level approaches to the prevention and control of NPAD.


METHODS
The systematic review examined studies published between 1980 and 2006 that addressed the incidence, prevalence, risk factors, prevention, cost, assessment and classification, interventions, and course and prognostic factors for NPAD. Citations were screened for relevance, scientifically reviewed, and synthesized. Valid studies addressing public policies or population-level approaches to the prevention and control of NPAD were identified and used in the evidence synthesis.


RESULTS
Only 8 of the 552 scientifically admissible studies were considered relevant to a public or population health approach to preventing and controlling the burden of NPAD. For whiplash-associated disorders, active head restraints and seat backs were protective in rear-end collisions; insurance policies affected the incidence and recovery; government funding of multidisciplinary rehabilitation programs did not benefit recovery; and early intensive health care delayed recovery. In the workplace, 2 randomized trials failed to show any preventive effect for ergonomic interventions or physical training and stress management. One study documented the societal cost of neck pain.


CONCLUSIONS
There is little evidence on which to make public or population-level recommendations, despite the important public health burden and costs of NPAD. Population-level approaches to preventing and controlling NPAD should be investigated.
Cassidy
J David
JD
Centre of Research Expertise for Improved Disability Outcomes, Toronto Western Hospital, Toronto, Ontario, Canada. dcassidy@uhnresearch.ca
Côté
Pierre
P
D000062:Accidents, Occupational; D001336:Automobiles; D006804:Ergonomics; D005380:Financing, Government; D006801:Humans; D019458:Insurance Coverage; D019838:Neck Injuries / Q000150:complications / Q000517:prevention & control / Q000534:rehabilitation; D019547:Neck Pain / Q000209:etiology / Q000517:prevention & control*; D011482:Protective Devices; D011634:Public Health; D020127:Recovery of Function; D013315:Stress, Psychological / Q000150:complications / Q000517:prevention & control