Does structured patient education improve the recovery and clinical outcomes of patients with neck pain? A systematic review from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
In 2008, the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders recommended patient education for the management of neck pain. However, the effectiveness of education interventions has recently been challenged.



To update the findings of the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders and evaluate the effectiveness of structured patient education for the management of patients with whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD).



Systematic review of the literature and best-evidence synthesis.



Randomized controlled trials that compared structured patient education with other conservative interventions.



Self-rated recovery, functional recovery (eg, disability, return to activities, work, or school), pain intensity, health-related quality of life, psychological outcomes such as depression or fear, or adverse effects.



We systematically searched eight electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Central Register of Controlled Trials, DARE, PubMed, and ICL) from 2000 to 2012. Randomized controlled trials, cohort studies, and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Scientifically admissible studies were summarized in evidence tables and synthesized following best-evidence synthesis principles.



We retrieved 4,477 articles. Of those, nine were eligible for critical appraisal and six were scientifically admissible. Four admissible articles investigated patients with WAD and two targeted patients with NAD. All structured patient education interventions included advice on activation or exercises delivered orally combined with written information or as written information alone. Overall, as a therapeutic intervention, structured patient education was equal or less effective than other conservative treatments including massage, supervised exercise, and physiotherapy. However, structured patient education may provide small benefits when combined with physiotherapy. Either mode of delivery (ie, oral or written education) provides similar results in patients with recent WAD.



This review adds to the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders by defining more specifically the role of structured patient education in the management of WAD and NAD. Results suggest that structured patient education alone cannot be expected to yield large benefits in clinical effectiveness compared with other conservative interventions for patients with WAD or NAD. Moreover, structured patient education may be of benefit during the recovery of patients with WAD when used as an adjunct therapy to physiotherapy or emergency room care. These benefits are small and short lived.
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada; Division of Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada. Electronic address: hainan.yu@uoit.ca.
Hainan
H
Yu
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada; Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St N, Science building, Room 3000, Oshawa, Ontario L1H 7K4, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St N, Science building, Room 3000, Oshawa, Ontario L1H 7K4, Canada.
Pierre
P
Côté
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada; Division of Undergraduate Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada.
Danielle
D
Southerst
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada; Division of Undergraduate Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada.
Jessica J
JJ
Wong
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada; Division of Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada.
Sharanya
S
Varatharajan
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada; Division of Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada.
Heather M
HM
Shearer
Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, University of Alberta, Edmonton, Alberta T6G 2G4, Canada.
Douglas P
DP
Gross
Toronto Health Economics and Technology Assessment (THETA) Collaborative, Leslie Dan Pharmacy Building, University of Toronto, 6th Floor, Room 658, 144 College St, Toronto, Ontario M5S 3M2, Canada; Faculty of Pharmacy, Leslie Dan Pharmacy Building, University of Toronto, 2nd Floor, 144 College St, Toronto, Ontario M5S 3M2, Canada; Institute for Work and Health, 481 University Ave, Suite 800, Toronto, Ontario M5G 2E9, Canada.
Gabrielle M
GM
van der Velde
School of Public Health, University of Alberta, 4075 Research Transition Facility, 8308 - 114 St, Edmonton, Alberta T6G 2E1, Canada.
Linda J
LJ
Carroll
Division of Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe St N, Science building, Room 3000, Oshawa, Ontario L1H 7K4, Canada.
Silvano A
SA
Mior
Certification Program in Insurance Medicine and Medico-legal Expertise, Faculty of Medicine, University of Montreal, N-414, Roger-Gaudry Building, 2900, Boulevard Edouard-Montpetit, Montreal, Quebec H3T 1J4, Canada.
Arthur
A
Ameis
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada; Division of Clinical Education, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada.
Craig L
CL
Jacobs
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie St, Toronto, Ontario M2H 3J1, Canada.
Anne L
AL
Taylor-Vaisey
D000328:Adult; D002648:Child; D006801:Humans; D019547:Neck Pain / Q000209:etiology / Q000534:rehabilitation*; D010353:Patient Education as Topic / Q000379:methods*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D000078202:Systematic Reviews as Topic; D014911:Whiplash Injuries / Q000150:complications
Neck pain and associated disorders; Outcome; Patient education; Recovery; Systematic review; Whiplash-associated disorders