CCGI Best Practice Collaborators
CCGI Best Practice Collaborators
CCGI Best Practice Collaborators
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
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understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
-
understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
-
understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
Are you interested in getting involved with CCGI?
We are always looking to get people involved in our projects. No experience necessary - we provide training!
Contact us today!
Are you interested in getting involved with CCGI?
We are always looking to get people involved in our projects. No experience necessary - we provide training!
Contact us today!
Neck Pain
This tool provides information to facilitate the management of recent onset and persistent neck pain for adults.
Focused examination
1. Patient History
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Assess level of concern for major structural or other pathologies. If required, refer to an appropriate healthcare provider.
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Identify and assess other conditions and co-morbidities. Manage using appropriate care pathways.
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Address prognostic factors that may delay recovery.
Major structural or other pathologies may be suspected with certain signs and symptoms (red flags):
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Cancer (history of cancer, unexplained weight loss, nocturnal pain, age >50), vertebral infection (fever, intravenous drug use, recent infection), osteoporotic fractures (history of osteoporosis, use of corticosteroid, older age), traumatic fracture (positive Canadian C-Spine rule), myelopathy - severe/progressive neurological deficits (painful stiff neck, arm pain and weakness, sensory changes in lower extremity, motor weakness and atrophy, hyper-reflexia, spastic gait), carotid/vertebral artery dissection (sudden and intense onset of headache or neck pain), brain haemorrhage/mass lesion (sudden and intense onset headache), inflammatory arthritis (morning stiffness, swelling in multiple joints)
Examples of other conditions/co-morbidities:
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Physical conditions: back pain, headache
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Psychological conditions: depression, anxiety
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Co-morbidities: diabetes, heart disease
Examples of prognostic factors that may delay recovery:
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Symptoms of depression or anxiety, passive coping strategies, job dissatisfaction, high self-reported disability levels, disputed compensation claims, somatization
2. Physical Examination
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Assess levels of concern regarding major structural or other pathologies and grade IV NAD.
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Assess for neurological signs.
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Identify type of neck pain.
Grade I: No signs or symptoms of major structural pathology and no or minor interference with activities of daily living
Grade II: No signs or symptoms of major structural pathology but major interference with activities of daily living
Grade III: No signs or symptoms of major structural pathology but presence of neurologic signs
Grade IV: Signs and symptoms of major structural pathology
3. Management
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Offer information on nature, management, and the course of neck pain. See patient handouts below for more information to provide to patients.
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Discuss the range of effective interventions with the patient and, together, select a therapeutic intervention.
Patient Handouts
Management of recent-onset (0-3 months symptom duration) neck pain, grades I-II
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:
Consider range of motion exercise
Consider multimodal careᶧ
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combination of range of motion exercise and manipulation or mobilization
Consider a short course of muscle relaxants (as indicated)
Do not offer structured patient education alone, strain-counterstrain therapy, relaxation massage, cervical collar, electroacupuncture, electrotherapy, or clinic-based heat
Do not offer or recommend acetaminophen as a routine intervention
Management of persistent (4-6 months symptom duration) neck pain, grades I-II
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:
Consider range of motion and strengthening exercises, qigong, yoga
Consider clinical massage
Consider low-level laser therapy
Consider multimodal careᶧ
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combination of range of motion exercise and manipulation or mobilization
Consider non-steroidal anti-inflammatory drugs (NSAIDS) (as indicated)
Do not offer strengthening exercises alone, strain-counterstrain therapy, relaxation massage, relaxation therapy for pain or disability, electrotherapy, shortwave diathermy, clinic-based heat, electroacupuncture, or botulinum toxin injections
Management of recent-onset (0-3 months symptom duration) neck pain, grade III
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and the following therapeutic intervention*:
Consider supervised strengthening exercise
Do not offer structured patient education alone, cervical collar, low-level laser therapy, or traction
Management of persistent (4-6 months symptom duration) neck pain, grade III
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and the following therapeutic intervention*:
Consider referring to an appropriate healthcare provider for investigation and management for patients who continue to experience neuro-logical signs and disability more than 3 months after injury
Do not offer a cervical collar
*Interventions are recommended if guidelines used terms such as ‘recommended for consideration’ (e.g., ‘offer’, ‘consider’), ‘strongly recommended’, ‘recommended without any conditions required’, or ‘should be used’. Recommendations from low-quality evidence are not listed.
ᶧMultimodal care: treatment involving at least two distinct therapeutic modalities, provided by one or more health care disciplines.
Care Pathway for the management of neck pain, grades I and II
Care Pathway for the management of neck pain, grade III
Exercise Videos
The neck pain videos are based on the recommendations from the Clinical Practice Guideline for the Treatment of Neck Pain Associated with Whiplash and Associated Disorders (2016). Select a link below to view the patient exercise videos for neck pain.
4. Reevaluation and Discharge
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Reassess the patient at every visit to determine if: (1) additional care is necessary; (2) the condition is worsening; or (3) the patient has recovered.
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Monitor for any emerging factors that may delay recovery.
5. Referrals and Collaboration
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Refer the patient to an appropriate healthcare provider for further evaluation at any time during their care if they develop worsening symptoms and new physical or psychological symptoms.