A questionnaire survey of the management and classification of patients presenting with neck pain to osteopathic and physiotherapy practices
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Background: Little is known about the management practices of Australian and New Zealand osteopaths and physiotherapists for patients with neck pain. By assessing the practice patterns of practitioners using a case-by-case approach it is possible to investigate the extent to which practitioners may be in alignment with best-practice guidelines. By identifying a practice-research gap it is possible to tailor educational and research efforts to improve management practices where necessary. Aim: To survey the management approaches of Australian and New Zealand osteopaths and physiotherapists for patients with neck pain and describe their alignment with evidence-based practice. Methods: A web-based questionnaire was administered from September 2012 to April 2013 to survey the intervention utilisation, and consistency with a treatment-based classification scheme amongst Australian and New Zealand osteopaths and physiotherapists treating patients with neck pain. Results: The highest proportion of respondent practitioners (n=48) was from New Zealand (52%, n=25). Osteopaths accounted for 54% of the respondents and physiotherapists 46%. In the patient subset (n=109), osteopaths reported on n=51 patient interactions, and physiotherapists on n=58. The most frequently occurring age bracket for patients was 36-45 years (29%), and the patient subset was predominantly female (62%). The most frequently reported presenting complaint was neck pain and headache (35%). Odds ratio (OR) and Chi square (X2) analysis was performed to allow comparisons to be made between practitioner groups. Analysis indicated that both practitioner groups employed a multimodal approach in their management of patients with neck pain, with the interventions selected consistent with supporting evidence. Analysis of the classification subgroups showed a lack of evidence supporting practitioners applying a treatment-based classification system. Some of the interventions applied lacked evidential support in the literature. Osteopaths often applied a regional approach for the treatment of patients with neck pain, applying interventions more frequently than physiotherapists to the thoracic region as well as the cervical region. Conclusion: The two groups of practitioners demonstrated a multimodal approach to their management of patients with neck pain and did not appear to apply groupings of interventions that were consistent with a treatment-based classification system. In addition, there were differences between osteopaths and physiotherapists in the frequency of utilisation of spinal manipulation, and the anatomical regions addressed.