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European Spine Journal

, Volume 25, Issue 7, pp 2000–2022 | Cite as

Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

  • Pierre CôtéEmail author
  • Jessica J. Wong
  • Deborah Sutton
  • Heather M. Shearer
  • Silvano Mior
  • Kristi Randhawa
  • Arthur Ameis
  • Linda J. Carroll
  • Margareta Nordin
  • Hainan Yu
  • Gail M. Lindsay
  • Danielle Southerst
  • Sharanya Varatharajan
  • Craig Jacobs
  • Maja Stupar
  • Anne Taylor-Vaisey
  • Gabrielle van der Velde
  • Douglas P. Gross
  • Robert J. Brison
  • Mike Paulden
  • Carlo Ammendolia
  • J. David Cassidy
  • Patrick Loisel
  • Shawn Marshall
  • Richard N. Bohay
  • John Stapleton
  • Michel Lacerte
  • Murray Krahn
  • Roger Salhany
Review Article

Abstract

Purpose

To develop an evidence-based guideline for the management of grades I–III neck pain and associated disorders (NAD).

Methods

This guideline is based on recent systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences (obtained from qualitative research) when formulating recommendations. Target audience includes clinicians; target population is adults with grades I–III NAD <6 months duration.

Recommendation 1

Clinicians should rule out major structural or other pathologies as the cause of NAD. Once major pathology has been ruled out, clinicians should classify NAD as grade I, II, or III.

Recommendation 2

Clinicians should assess prognostic factors for delayed recovery from NAD.

Recommendation 3

Clinicians should educate and reassure patients about the benign and self-limited nature of the typical course of NAD grades I–III and the importance of maintaining activity and movement. Patients with worsening symptoms and those who develop new physical or psychological symptoms should be referred to a physician for further evaluation at any time during their care.

Recommendation 4

For NAD grades I–II ≤3 months duration, clinicians may consider structured patient education in combination with: range of motion exercise, multimodal care (range of motion exercise with manipulation or mobilization), or muscle relaxants. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, strain-counterstrain therapy, relaxation massage, cervical collar, electroacupuncture, electrotherapy, or clinic-based heat.

Recommendation 5

For NAD grades I–II >3 months duration, clinicians may consider structured patient education in combination with: range of motion and strengthening exercises, qigong, yoga, multimodal care (exercise with manipulation or mobilization), clinical massage, low-level laser therapy, or non-steroidal anti-inflammatory drugs. In view of evidence of no effectiveness, clinicians should 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.

Recommendation 6

For NAD grade III ≤3 months duration, clinicians may consider supervised strengthening exercises in addition to structured patient education. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, cervical collar, low-level laser therapy, or traction.

Recommendation 7

For NAD grade III >3 months duration, clinicians should not offer a cervical collar. Patients who continue to experience neurological signs and disability more than 3 months after injury should be referred to a physician for investigation and management.

Recommendation 8

Clinicians should reassess the patient at every visit to determine if additional care is necessary, the condition is worsening, or the patient has recovered. Patients reporting significant recovery should be discharged.

Keywords

Clinical practice guideline Neck pain Treatment Management Practice guideline Therapies Therapy Disease management Whiplash 

Notes

Acknowledgments

The authors would like to acknowledge the invaluable contributions to this guideline from: Lynn Anderson, Poonam Cardoso, Brenda Gamble, Willie Handler, Vivii Riis, Paula Stern, Thepikaa Varatharajan, Angela Verven, and Leslie Verville.

Compliance with ethical standards

Funding

The development of this clinical practice guideline was funded by the Ministry of Finance and the Financial Services Commission of Ontario (OSS_00267175). The Ministry of Finance and Financial Services Commission of Ontario were not involved in the design, conduct, or interpretation of the research that informed the development of the care pathways included in this report. The development of the guideline by the Guideline Expert Panel was not influenced by the Ministry of Finance or Financial Services Commission of Ontario; the views and interests of the funding body did not influence the final recommendations. All individuals involved in the project declared any competing interests. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program to Dr. Pierre Côté, Canada Research Chair in Disability Prevention and Rehabilitation at the University of Ontario Institute of Technology, and funding from Alberta Innovates—Health Solutions to Dr. Linda Carroll, Health Senior Scholar.

Conflict of interest

Dr. Brison reports no commercial interest; a university role that incorporates research activities related to guideline development. Dr. Lacerte reports an active clinical practice and conducting medicolegal assessments or reports for plaintiff lawyers and occasionally independent medical examinations for lawyers and insurers; Consultancies: Drs. Ameis and Lacerte reports non-paid consultancy for the Catastrophic Impairment Expert Panel; Honoraria: Drs. Gross and Bohay report honoraria during the conduct of this study; Grants: Dr. Côté reports grants from Ontario Ministry of Finance and Financial Services Commission of Ontario during the conduct of this study; grants from Aviva Canada outside the submitted work. Dr. Gross reports grants from Workers' Compensation Board of Alberta, grants from Workers' Compensation Board of Manitoba, outside the submitted work; Other: Drs. Brison and Marshall report participation in guideline development. Dr. Côté reports funding from Canada Research Chair Program - Canadian Institutes of Health Research during the conduct of this study; personal fees from National Judicial Institute, Société des experts en évaluation médico-légale du Québec, and European Spine Society, outside the submitted work. Dr. Ameis reports his past role as medical director and current consultant to Granite Health Service. For the remaining authors, no conflicts were declared.

Supplementary material

586_2016_4467_MOESM1_ESM.docx (292 kb)
Supplementary material 1 (DOCX 293 kb)

References

  1. 1.
    Hogg-Johnson S, van der Velde G, Carroll LJ, Holm LW, Cassidy JD, Guzman J et al (2009) The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. J Manip Physiol Ther 32(2 Suppl):S46–S60CrossRefGoogle Scholar
  2. 2.
    Côté P, Cassidy JD, Carroll L (1998) The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976) 23(15):1689–1698CrossRefGoogle Scholar
  3. 3.
    Côté P, Cassidy JD, Carroll LJ, Kristman V (2004) The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain 112(3):267–273PubMedCrossRefGoogle Scholar
  4. 4.
    Fejer R, Kyvik KO, Hartvigsen J (2006) The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J 15(6):834–848PubMedCrossRefGoogle Scholar
  5. 5.
    Borghouts JA, Koes BW, Vondeling H, Bouter LM (1999) Cost-of-illness of neck pain in The Netherlands in 1996. Pain 80(3):629–636PubMedCrossRefGoogle Scholar
  6. 6.
    Hincapie CA, Cassidy JD, Côté P, Carroll LJ, Guzman J (2010) Whiplash injury is more than neck pain: a population-based study of pain localization after traffic injury. J Occup Environ Med 52(4):434–440PubMedCrossRefGoogle Scholar
  7. 7.
    Riddle DL, Schappert SM (2007) Volume and characteristics of inpatient and ambulatory medical care for neck pain in the United States: data from three national surveys. Spine (Phila Pa 1976) 32(1):132–140 (discussion 41) CrossRefGoogle Scholar
  8. 8.
    Hoy D, March L, Woolf A, Blyth F, Brooks P, Smith E et al (2014) The global burden of neck pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis 73(7):1309–1315PubMedCrossRefGoogle Scholar
  9. 9.
    Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S et al (1995) Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management. Spine (Phila Pa 1976) 20(8 Suppl):1S–73SGoogle Scholar
  10. 10.
    Cassidy JD, Carroll LJ, Côté P, Lemstra M, Berglund A, Nygren A (2000) Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N Engl J Med 342(16):1179–1186PubMedCrossRefGoogle Scholar
  11. 11.
    Carroll LJ, Hogg-Johnson S, van der Velde G, Haldeman S, Holm LW, Carragee EJ et al (2008) Course and prognostic factors for neck pain in the general population: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976) 33(4 Suppl):S75–S82CrossRefGoogle Scholar
  12. 12.
    Ackland HM, Wolfe R, Cameron PA, Cooper DJ, Malham GM, Varma DK et al (2012) Health resource utilisation costs in acute patients with persistent midline cervical tenderness following road trauma. Injury 43(11):1908–1916PubMedCrossRefGoogle Scholar
  13. 13.
    Wong JJ, Côté P, Shearer HM, Carroll LJ, Yu H, Varatharajan S et al (2014) Clinical practice guidelines for the management of conditions related to traffic collisions: a systematic review by the OPTIMa Collaboration. Disabil Rehabil 37(6):471–489PubMedCrossRefGoogle Scholar
  14. 14.
    Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J et al (2008) Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976) 33(4 Suppl):S123–S152CrossRefGoogle Scholar
  15. 15.
    Southerst D, Nordin MC, Côté P, Shearer HM, Varatharajan S, Yu H et al (2014) Is exercise effective for the management of neck pain and associated disorders or whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine J. doi: 10.1016/j.spinee.2014.02.014 Google Scholar
  16. 16.
    Sutton DA, Côté P, Wong JJ, Varatharajan S, Randhawa KA, Yu H et al (2014) Is multimodal care effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine J. doi: 10.1016/j.spinee.2014.06.019 Google Scholar
  17. 17.
    Yu H, Côté P, Southerst D, Wong JJ, Varatharajan S, Shearer HM et al (2014) 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. Spine J. doi: 10.1016/j.spinee.2014.03.039
  18. 18.
    Wong JJ, Côté P, Ameis A, Varatharajan S, Varatharajan T, Shearer HM et al (2015) Are non-steroidal anti-inflammatory drugs effective for the management of neck pain and associated disorders, whiplash-associated disorders, or non-specific low back pain? A systematic review of systematic reviews by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J 25(1):34–61Google Scholar
  19. 19.
    Shearer HM, Carroll LJ, Wong JJ, Côté P, Varatharajan S, Southerst D, Randhawa K, Yu H, Mior S, van der Velde G, Nordin M, Stupar M, Taylor-Vaisey A. (2015) Are psychological interventions effective for the management of neck pain and whiplash associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine J. doi: 10.1016/j.spinee.2015.08.011
  20. 20.
    Varatharajan T, Varatharajan S, Côté P, Ameis A, Wong JJ, Southerst D et al (2014) Decision determinants and evidence table for neck pain and associated disorders and non-specific low back pain: muscle relaxants and analgesics. Report to the Financial Services Commission of OntarioGoogle Scholar
  21. 21.
    Wong JJ, Shearer HM, Mior S, Jacobs C, Côté P, Randhawa K et al (2015) Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa Collaboration. Spine J. doi:  10.1016/j.spinee.2015.08.024
  22. 22.
    van der Velde G, Yu H, Paulden M, Côté P, Varatharajan S, Shearer HM et al (2015) Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine J. doi: 10.1016/j.spinee.2015.08.025 Google Scholar
  23. 23.
    International Prospective Register of Systematic Reviews (PROSPERO) (2015). www.crd.york.ac.uk/PROSPERO/
  24. 24.
    Guzman J, Hurwitz EL, Carroll LJ, Haldeman S, Côté P, Carragee EJ et al (2008) A new conceptual model of neck pain: linking onset, course, and care: the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976) 33(4 Suppl):S14–S23CrossRefGoogle Scholar
  25. 25.
    Harbour R, Miller J (2001) A new system for grading recommendations in evidence based guidelines. BMJ 323(7308):334–336PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Slavin RE (1995) Best evidence synthesis: an intelligent alternative to meta-analysis. J Clin Epidemiol 48(1):9–18PubMedCrossRefGoogle Scholar
  27. 27.
    Carroll LJ, Jones DC, Ozegovic D, Cassidy JD (2012) How well are you recovering? The association between a simple question about recovery and patient reports of pain intensity and pain disability in whiplash-associated disorders. Disabil Rehabil 34(1):45–52PubMedCrossRefGoogle Scholar
  28. 28.
    Lauche R, Langhorst J, Dobos GJ, Cramer H (2013) Clinically meaningful differences in pain, disability and quality of life for chronic nonspecific neck pain—a reanalysis of 4 randomized controlled trials of cupping therapy. Complement Ther Med 21(4):342–347PubMedCrossRefGoogle Scholar
  29. 29.
    Dunn AS, Passmore SR, Burke J, Chicoine D (2009) A cross-sectional analysis of clinical outcomes following chiropractic care in veterans with and without post-traumatic stress disorder. Mil Med 174(6):578–583PubMedCrossRefGoogle Scholar
  30. 30.
    McCarthy MJ, Grevitt MP, Silcocks P, Hobbs G (2007) The reliability of the Vernon and Mior neck disability index, and its validity compared with the short form-36 health survey questionnaire. Eur Spine J 16(12):2111–2117PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Johnson AP, Sikich NJ, Evans G, Evans W, Giacomini M, Glendining M et al (2009) Health technology assessment: a comprehensive framework for evidence-based recommendations in Ontario. Int J Technol Assess Health Care 25(2):141–150PubMedCrossRefGoogle Scholar
  32. 32.
    Lindsay GM, Mior SA, Côté P, Carroll LJ, Shearer HM (2015) Patients’ experiences with vehicle collision injuries to inform the development of clinical practice guidelines: a narrative inquiry. J Manip Physiol Ther. doi: 10.1016/j.jmpt.2016.01.005 Google Scholar
  33. 33.
    National Institute for Health and Care Excellence (NICE) (2009) Developing NICE guidelines: the manualGoogle Scholar
  34. 34.
    Kung J, Miller RR, Mackowiak PA (2012) Failure of clinical practice guidelines to meet Institute of Medicine standards: two more decades of little, if any, progress. Arch Intern Med 172(21):1628–1633PubMedCrossRefGoogle Scholar
  35. 35.
    Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ et al (2001) The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 286(15):1841–1848PubMedCrossRefGoogle Scholar
  36. 36.
    Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P et al (2007) Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 147(7):478–491PubMedCrossRefGoogle Scholar
  37. 37.
    Downie A, Williams CM, Henschke N, Hancock MJ, Ostelo RW, de Vet HC et al (2013) Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ 347:f7095PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Nordin M, Carragee EJ, Hogg-Johnson S, Weiner SS, Hurwitz EL, Peloso PM et al (2008) Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976) 33(4 Suppl):S101–S122CrossRefGoogle Scholar
  39. 39.
    Carroll LJ, Hogg-Johnson S, Côté P, van der Velde G, Holm LW, Carragee EJ et al (2008) Course and prognostic factors for neck pain in workers: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976) 33(4 Suppl):S93–S100CrossRefGoogle Scholar
  40. 40.
    Carroll LJ, Côté P, Southerst D, Shearer HM, Varatharajan S, Wong JJ et al (2015) The course of recovery of WAD I–III: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Report to the Financial Services Commission of OntarioGoogle Scholar
  41. 41.
    Carroll LJ, Côté P, Southerst D, Shearer HM, Varatharajan S, Wong JJ et al (2015) Predictors of recovery, clinical and administrative outcomes of whiplash-associated disorders: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Report to the Financial Services Commission of OntarioGoogle Scholar
  42. 42.
    Carroll LJ, Holm LW, Hogg-Johnson S, Côté P, Cassidy JD, Haldeman S et al (2009) Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. J Manip Physiol Ther 32(2 Suppl):S97–S107CrossRefGoogle Scholar
  43. 43.
    Côté P, Hogg-Johnson S, Cassidy JD, Carroll L, Frank JW, Bombardier C (2007) Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result? Arthritis Rheum 57(5):861–868PubMedCrossRefGoogle Scholar
  44. 44.
    Côté P, Hogg-Johnson S, Cassidy JD, Carroll L, Frank JW, Bombardier C (2005) Initial patterns of clinical care and recovery from whiplash injuries: a population-based cohort study. Arch Intern Med 165(19):2257–2263PubMedCrossRefGoogle Scholar
  45. 45.
    Stiggelbout AM, Van der Weijden T, De Wit MP, Frosch D, Legare F, Montori VM et al (2012) Shared decision making: really putting patients at the centre of healthcare. BMJ 344:e256PubMedCrossRefGoogle Scholar
  46. 46.
    Lamb SE, Williams MA, Williamson EM, Gates S, Withers EJ, Mt-Isa S et al (2012) Managing Injuries of the Neck Trial (MINT): a randomised controlled trial of treatments for whiplash injuries. Health Technol Assess 16(49):iii–iv, 1–141Google Scholar
  47. 47.
    Brison RJ, Hartling L, Dostaler S, Leger A, Rowe BH, Stiell I et al (2005) A randomized controlled trial of an educational intervention to prevent the chronic pain of whiplash associated disorders following rear-end motor vehicle collisions. Spine (Phila Pa 1976) 30(16):1799–1807CrossRefGoogle Scholar
  48. 48.
    Oliveira A, Gevirtz R, Hubbard D (2006) A psycho-educational video used in the emergency department provides effective treatment for whiplash injuries. Spine (Phila Pa 1976) 31(15):1652–1657CrossRefGoogle Scholar
  49. 49.
    Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH (2012) Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med 156(1 Pt 1):1–10PubMedCrossRefGoogle Scholar
  50. 50.
    Cleland JA, Mintken PE, Carpenter K, Fritz JM, Glynn P, Whitman J et al (2010) Examination of a clinical prediction rule to identify patients with neck pain likely to benefit from thoracic spine thrust manipulation and a general cervical range of motion exercise: multi-center randomized clinical trial. Phys Ther 90(9):1239–1250PubMedCrossRefGoogle Scholar
  51. 51.
    Escortell-Mayor E, Riesgo-Fuertes R, Garrido-Elustondo S, Asunsolo-Del Barco A, Diaz-Pulido B, Blanco-Diaz M et al (2011) Primary care randomized clinical trial: manual therapy effectiveness in comparison with TENS in patients with neck pain. Man Ther 16(1):66–73PubMedCrossRefGoogle Scholar
  52. 52.
    Gustavsson C, Denison E, von Koch L (2010) Self-management of persistent neck pain: a randomized controlled trial of a multi-component group intervention in primary health care. Eur J Pain 14(6):630.e1–.e11CrossRefGoogle Scholar
  53. 53.
    Gustavsson C, Denison E, von Koch L (2011) Self-management of persistent neck pain: two-year follow-up of a randomized controlled trial of a multicomponent group intervention in primary health care. Spine (Phila Pa 1976) 36(25):2105–2115CrossRefGoogle Scholar
  54. 54.
    Hoving JL, de Vet HC, Koes BW, Mameren H, Deville WL, van der Windt DA et al (2006) Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain: long-term results from a pragmatic randomized clinical trial. Clin J Pain 22(4):370–377PubMedCrossRefGoogle Scholar
  55. 55.
    Hoving JL, Koes BW, de Vet HC, van der Windt DA, Assendelft WJ, van Mameren H et al (2002) Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial. Ann Intern Med 136(10):713–722PubMedCrossRefGoogle Scholar
  56. 56.
    Jull G, Sterling M, Kenardy J, Beller E (2007) Does the presence of sensory hypersensitivity influence outcomes of physical rehabilitation for chronic whiplash? A preliminary RCT. Pain 129(1–2):28–34PubMedCrossRefGoogle Scholar
  57. 57.
    Klaber Moffett JA, Jackson DA, Richmond S, Hahn S, Coulton S, Farrin A et al (2005) Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients’ preference. BMJ 330(7482):75PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    McReynolds TM, Sheridan BJ (2005) Intramuscular ketorolac versus osteopathic manipulative treatment in the management of acute neck pain in the emergency department: a randomized clinical trial. J Am Osteopath Assoc 105(2):57–68PubMedGoogle Scholar
  59. 59.
    Pool JJ, Ostelo RW, Knol DL, Vlaeyen JW, Bouter LM, de Vet HC (2010) Is a behavioral graded activity program more effective than manual therapy in patients with subacute neck pain? Results of a randomized clinical trial. Spine (Phila Pa 1976) 35(10):1017–1024CrossRefGoogle Scholar
  60. 60.
    Scholten-Peeters GG, Neeleman-van der Steen CW, van der Windt DA, Hendriks EJ, Verhagen AP, Oostendorp RA (2006) Education by general practitioners or education and exercises by physiotherapists for patients with whiplash-associated disorders? A randomized clinical trial. Spine (Phila Pa 1976) 31(7):723–731CrossRefGoogle Scholar
  61. 61.
    Skillgate E, Bohman T, Holm LW, Vingard E, Alfredsson L (2010) The long-term effects of naprapathic manual therapy on back and neck pain—results from a pragmatic randomized controlled trial. BMC Musculoskelet Disord 11:26PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Skillgate E, Vingard E, Alfredsson L (2007) Naprapathic manual therapy or evidence-based care for back and neck pain: a randomized, controlled trial. Clin J Pain 23(5):431–439PubMedCrossRefGoogle Scholar
  63. 63.
    Taimela S, Takala EP, Asklof T, Seppala K, Parviainen S (2000) Active treatment of chronic neck pain: a prospective randomized intervention. Spine (Phila Pa 1976) 25(8):1021–1027CrossRefGoogle Scholar
  64. 64.
    Walker MJ, Boyles RE, Young BA, Strunce JB, Garber MB, Whitman JM et al (2008) The effectiveness of manual physical therapy and exercise for mechanical neck pain: a randomized clinical trial. Spine (Phila Pa 1976) 33(22):2371–2378CrossRefGoogle Scholar
  65. 65.
    Korthals-de Bos IB, Hoving JL, van Tulder MW, Rutten-van Molken MP, Ader HJ, de Vet HC et al (2003) Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ 326(7395):911PubMedCrossRefGoogle Scholar
  66. 66.
    Nagrale AV, Glynn P, Joshi A, Ramteke G (2010) The efficacy of an integrated neuromuscular inhibition technique on upper trapezius trigger points in subjects with non-specific neck pain: a randomized controlled trial. J Man Manip Ther 18(1):37–43PubMedPubMedCentralCrossRefGoogle Scholar
  67. 67.
    Klein R, Bareis A, Schneider A, Linde K (2013) Strain-counterstrain to treat restrictions of the mobility of the cervical spine in patients with neck pain: a sham-controlled randomized trial. Complement Ther Med 21(1):1–7PubMedCrossRefGoogle Scholar
  68. 68.
    Irnich D, Behrens N, Molzen H, Konig A, Gleditsch J, Krauss M et al (2001) Randomised trial of acupuncture compared with conventional massage and “sham” laser acupuncture for treatment of chronic neck pain. BMJ 322(7302):1574–1578PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Persson LC, Moritz U, Brandt L, Carlsson CA (1997) Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar. A prospective, controlled study. Eur Spine J 6(4):256–266PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Borchgrevink GE, Kaasa A, McDonagh D, Stiles TC, Haraldseth O, Lereim I (1998) Acute treatment of whiplash neck sprain injuries. A randomized trial of treatment during the first 14 days after a car accident. Spine (Phila Pa 1976) 23(1):25–31CrossRefGoogle Scholar
  71. 71.
    Gennis P, Miller L, Gallagher EJ, Giglio J, Carter W, Nathanson N (1996) The effect of soft cervical collars on persistent neck pain in patients with whiplash injury. Acad Emerg Med 3(6):568–573PubMedCrossRefGoogle Scholar
  72. 72.
    Kongsted A, Qerama E, Kasch H, Bendix T, Bach FW, Korsholm L et al (2007) Neck collar, “act-as-usual” or active mobilization for whiplash injury? A randomized parallel-group trial. Spine (Phila Pa 1976) 32(6):618–626CrossRefGoogle Scholar
  73. 73.
    Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Yu F, Adams AH (2002) A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: clinical outcomes from the UCLA neck-pain study. Am J Public Health 92(10):1634–1641PubMedPubMedCentralCrossRefGoogle Scholar
  74. 74.
    Cameron ID, Wang E, Sindhusake D (2011) A randomized trial comparing acupuncture and simulated acupuncture for subacute and chronic whiplash. Spine (Phila Pa 1976) 36(26):E1659–E1665CrossRefGoogle Scholar
  75. 75.
    Vargas-Schaffer G (2010) Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician 56(6):514–517, e202-5Google Scholar
  76. 76.
    Williams CM, Maher CG, Latimer J, McLachlan AJ, Hancock MJ, Day RO et al (2014) Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet 384(9954):1586–1596PubMedCrossRefGoogle Scholar
  77. 77.
    Friedman BW, Dym AA, Davitt M, Holden L, Solorzano C, Esses D et al (2015) Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA 314(15):1572–1580PubMedCrossRefGoogle Scholar
  78. 78.
    van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM (2003) Muscle relaxants for nonspecific low back pain: a systematic review within the framework of the Cochrane Collaboration. Spine (Phila Pa 1976) 28(17):1978–1992CrossRefGoogle Scholar
  79. 79.
    Stewart MJ, Maher CG, Refshauge KM, Herbert RD, Bogduk N, Nicholas M (2007) Randomized controlled trial of exercise for chronic whiplash-associated disorders. Pain 128(1–2):59–68PubMedCrossRefGoogle Scholar
  80. 80.
    Rendant D, Pach D, Ludtke R, Reisshauer A, Mietzner A, Willich SN et al (2011) Qigong versus exercise versus no therapy for patients with chronic neck pain: a randomized controlled trial. Spine (Phila Pa 1976) 36(6):419–427CrossRefGoogle Scholar
  81. 81.
    von Trott P, Wiedemann AM, Ludtke R, Reishauer A, Willich SN, Witt CM (2009) Qigong and exercise therapy for elderly patients with chronic neck pain (QIBANE): a randomized controlled study. J Pain 10(5):501–508CrossRefGoogle Scholar
  82. 82.
    Michalsen A, Traitteur H, Ludtke R, Brunnhuber S, Meier L, Jeitler M et al (2012) Yoga for chronic neck pain: a pilot randomized controlled clinical trial. J Pain 13(11):1122–1130PubMedCrossRefGoogle Scholar
  83. 83.
    Salo P, Ylonen-Kayra N, Hakkinen A, Kautiainen H, Malkia E, Ylinen J (2012) Effects of long-term home-based exercise on health-related quality of life in patients with chronic neck pain: a randomized study with a 1-year follow-up. Disabil Rehabil 34(23):1971–1977PubMedCrossRefGoogle Scholar
  84. 84.
    Hakkinen A, Kautiainen H, Hannonen P, Ylinen J (2008) Strength training and stretching versus stretching only in the treatment of patients with chronic neck pain: a randomized one-year follow-up study. Clin Rehabil 22(7):592–600PubMedCrossRefGoogle Scholar
  85. 85.
    Sherman KJ, Cherkin DC, Hawkes RJ, Miglioretti DL, Deyo RA (2009) Randomized trial of therapeutic massage for chronic neck pain. Clin J Pain 25(3):233–238PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Chow RT, Heller GZ, Barnsley L (2006) The effect of 300 mW, 830 nm laser on chronic neck pain: a double-blind, randomized, placebo-controlled study. Pain 124(1–2):201–210PubMedCrossRefGoogle Scholar
  87. 87.
    Dundar U, Evcik D, Samli F, Pusak H, Kavuncu V (2007) The effect of gallium arsenide aluminum laser therapy in the management of cervical myofascial pain syndrome: a double blind, placebo-controlled study. Clin Rheumatol 26(6):930–934PubMedCrossRefGoogle Scholar
  88. 88.
    Gur A, Sarac AJ, Cevik R, Altindag O, Sarac S (2004) Efficacy of 904 nm gallium arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomize-controlled trial. Lasers Surg Med 35(3):229–235PubMedCrossRefGoogle Scholar
  89. 89.
    Ozdemir F, Birtane M, Kokino S (2001) The clinical efficacy of low-power laser therapy on pain and function in cervical osteoarthritis. Clin Rheumatol 20(3):181–184PubMedCrossRefGoogle Scholar
  90. 90.
    Thorsen H, Gam AN, Svensson BH, Jess M, Jensen MK, Piculell I et al (1992) Low level laser therapy for myofascial pain in the neck and shoulder girdle. A double-blind, cross-over study. Scand J Rheumatol 21(3):139–141PubMedCrossRefGoogle Scholar
  91. 91.
    Ceccherelli F, Altafini L, Lo Castro G, Avila A, Ambrosio F, Giron GP (1989) Diode laser in cervical myofascial pain: a double-blind study versus placebo. Clin J Pain 5(4):301–304PubMedCrossRefGoogle Scholar
  92. 92.
    Smania N, Corato E, Fiaschi A, Pietropoli P, Aglioti SM, Tinazzi M (2005) Repetitive magnetic stimulation: a novel therapeutic approach for myofascial pain syndrome. J Neurol 252(3):307–314PubMedCrossRefGoogle Scholar
  93. 93.
    Dziedzic K, Hill J, Lewis M, Sim J, Daniels J, Hay EM (2005) Effectiveness of manual therapy or pulsed shortwave diathermy in addition to advice and exercise for neck disorders: a pragmatic randomized controlled trial in physical therapy clinics. Arthritis Rheum 53(2):214–222PubMedCrossRefGoogle Scholar
  94. 94.
    Lewis M, James M, Stokes E, Hill J, Sim J, Hay E et al (2007) An economic evaluation of three physiotherapy treatments for non-specific neck disorders alongside a randomized trial. Rheumatology (Oxford) 46(11):1701–1708CrossRefGoogle Scholar
  95. 95.
    Viljanen M, Malmivaara A, Uitti J, Rinne M, Palmroos P, Laippala P (2003) Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomised controlled trial. BMJ 327(7413):475PubMedPubMedCentralCrossRefGoogle Scholar
  96. 96.
    Wheeler AH, Goolkasian P, Gretz SS (2001) Botulinum toxin A for the treatment of chronic neck pain. Pain 94(3):255–260PubMedCrossRefGoogle Scholar
  97. 97.
    Langevin P, Peloso PM, Lowcock J, Nolan M, Weber J, Gross A et al (2011) Botulinum toxin for subacute/chronic neck pain. Cochrane Database Syst Rev 7:Cd008626PubMedGoogle Scholar
  98. 98.
    Andersen LL, Saervoll CA, Mortensen OS, Poulsen OM, Hannerz H, Zebis MK (2011) Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. Pain 152(2):440–446PubMedCrossRefGoogle Scholar
  99. 99.
    Kongsted A, Qerama E, Kasch H, Bach FW, Korsholm L, Jensen TS et al (2008) Education of patients after whiplash injury: is oral advice any better than a pamphlet? Spine (Phila Pa 1976) 33(22):E843–E848CrossRefGoogle Scholar
  100. 100.
    Kuijper B, Tans JT, Beelen A, Nollet F, de Visser M (2009) Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial. BMJ 339:b3883PubMedPubMedCentralCrossRefGoogle Scholar
  101. 101.
    Cassidy JD (2009) Mobilisation or immobilisation for cervical radiculopathy? BMJ 339:b3952PubMedCrossRefGoogle Scholar
  102. 102.
    Young IA, Michener LA, Cleland JA, Aguilera AJ, Snyder AR (2009) Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Phys Ther 89(7):632–642PubMedCrossRefGoogle Scholar
  103. 103.
    Konstantinovic LM, Cutovic MR, Milovanovic AN, Jovic SJ, Dragin AS, Letic M et al (2010) Low-level laser therapy for acute neck pain with radiculopathy: a double-blind placebo-controlled randomized study. Pain Med 11(8):1169–1178PubMedCrossRefGoogle Scholar
  104. 104.
    Carroll LJ, Lis A, Weiser S, Torti J (2015) How well do you expect to recover, and what does recovery mean, anyway? Qualitative study of expectations after a musculoskeletal injury. Phys Ther. doi: 10.2522/ptj.20150229
  105. 105.
    Cassidy JD, Carroll LJ, Côté P, Frank J (2007) Does multidisciplinary rehabilitation benefit whiplash recovery? Results of a population-based incidence cohort study. Spine (Phila Pa 1976) 32(1):126–131CrossRefGoogle Scholar
  106. 106.
    Fischer D, Stewart AL, Bloch DA, Lorig K, Laurent D, Holman H (1999) Capturing the patient’s view of change as a clinical outcome measure. JAMA 282(12):1157–1162PubMedCrossRefGoogle Scholar
  107. 107.
    Ngo T, Stupar M, Côté P, Boyle E, Shearer H (2010) A study of the test–retest reliability of the self-perceived general recovery and self-perceived change in neck pain questions in patients with recent whiplash-associated disorders. Eur Spine J 19(6):957–962PubMedPubMedCentralCrossRefGoogle Scholar
  108. 108.
    Ozegovic D, Carroll LJ, Cassidy JD (2009) Does expecting mean achieving? The association between expecting to return to work and recovery in whiplash associated disorders: a population-based prospective cohort study. Eur Spine J 18(6):893–899PubMedPubMedCentralCrossRefGoogle Scholar
  109. 109.
    Anis AH, Stiell IG, Stewart DG, Laupacis A (1995) Cost-effectiveness analysis of the Ottawa Ankle Rules. Ann Emerg Med 26(4):422–428PubMedCrossRefGoogle Scholar
  110. 110.
    Nichol G, Stiell IG, Wells GA, Juergensen LS, Laupacis A (1999) An economic analysis of the Ottawa knee rule. Ann Emerg Med 34(4 Pt 1):438–447PubMedCrossRefGoogle Scholar
  111. 111.
    South Australian Centre for Trauma and Injury Recovery (TRACsa) (2008) Clinical guidelines for best practice management of acute and chronic whiplash-associated disorders. TRACsa, AdelaideGoogle Scholar
  112. 112.
    Motor Accidents Authority (2007) Guidelines for the management of acute whiplash associated disorders for health professionals. Motor Accidents Authority, SydneyGoogle Scholar
  113. 113.
    Chartered Society of Physiotherapists (2004) Clinical guidelines for the physiotherapy management of whiplash associated disorder. Chartered Society of Physiotherapists, LondonGoogle Scholar
  114. 114.
    Philadelphia Panel (2001) Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for neck pain. Phys Ther 81(10):1701–1717Google Scholar
  115. 115.
    Childs JD, Cleland JA, Elliott JM, Teyhen DS, Wainner RS, Whitman JM et al (2008) Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther 38(9):A1–A34PubMedCrossRefGoogle Scholar
  116. 116.
    Scholten-Peeters GG, Bekkering GE, Verhagen AP, van Der Windt DA, Lanser K, Hendriks EJ et al (2002) Clinical practice guideline for the physiotherapy of patients with whiplash-associated disorders. Spine (Phila Pa 1976) 27(4):412–422CrossRefGoogle Scholar
  117. 117.
    Berry H, Liyanage SP, Durance RA, Goode JD, Swannell AJ (1981) A double-blind study of benorylate and chlormezanone in musculoskeletal disease. Rheumatol Rehabil 20(1):46–49PubMedCrossRefGoogle Scholar
  118. 118.
    Zylbergold RS, Piper MC (1985) Cervical spine disorders. A comparison of three types of traction. Spine (Phila Pa 1976) 10(10):867–871CrossRefGoogle Scholar
  119. 119.
  120. 120.
    Côté P, Shearer H, Ameis A, Carroll L, Mior M, Nordin M, The OPTIMa Collaboration (2015) Enabling recovery from common traffic injuries: A focus on the injured person. UOIT-CMCC Centre for the Study of Disability Prevention and RehabilitationGoogle Scholar
  121. 121.
    Sterling M, Vicenzino B, Souvlis T, Connelly LB (2015) Dry-needling and exercise for chronic whiplash-associated disorders: a randomized single-blind placebo-controlled trial. Pain 156(4):635–643PubMedCrossRefGoogle Scholar
  122. 122.
    Llamas-Ramos R, Pecos-Martin D, Gallego-Izquierdo T, Llamas-Ramos I, Plaza-Manzano G, Ortega-Santiago R et al (2014) Comparison of the short-term outcomes between trigger point dry needling and trigger point manual therapy for the management of chronic mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 44(11):852–861PubMedCrossRefGoogle Scholar
  123. 123.
    Jeitler M, Brunnhuber S, Meier L, Ludtke R, Bussing A, Kessler C et al (2015) Effectiveness of jyoti meditation for patients with chronic neck pain and psychological distress—a randomized controlled clinical trial. J Pain 16(1):77–86PubMedCrossRefGoogle Scholar
  124. 124.
    Khan M, Soomro RR, Ali SS (2014) The effectiveness of isometric exercises as compared to general exercises in the management of chronic non-specific neck pain. Pak J Pharm Sci 27(5 Suppl):1719–1722PubMedGoogle Scholar
  125. 125.
    Maiers M, Bronfort G, Evans R, Hartvigsen J, Svendsen K, Bracha Y et al (2014) Spinal manipulative therapy and exercise for seniors with chronic neck pain. Spine (Phila Pa 1976) 14(9):1879–1889Google Scholar
  126. 126.
    McLean SM, Klaber Moffett JA, Sharp DM, Gardiner E (2013) A randomised controlled trial comparing graded exercise treatment and usual physiotherapy for patients with non-specific neck pain (the GET UP neck pain trial). Man Ther 18(3):199–205PubMedCrossRefGoogle Scholar
  127. 127.
    Akhter S, Khan M, Ali SS, Soomro RR (2014) Role of manual therapy with exercise regime versus exercise regime alone in the management of non-specific chronic neck pain. Pak J Pharm Sci 27(6 Suppl):2125–2128PubMedGoogle Scholar
  128. 128.
    Lin JH, Shen T, Chung RC, Chiu TT (2013) The effectiveness of Long’s manipulation on patients with chronic mechanical neck pain: a randomized controlled trial. Man Ther 18(4):308–315PubMedCrossRefGoogle Scholar
  129. 129.
    Andrade Ortega JA, Ceron Fernandez E, Garcia Llorent R, Ribeiro Gonzalez M, Delgado Martinez AD (2014) Microwave diathermy for treating nonspecific chronic neck pain: a randomized controlled trial. Spine (Phila Pa 1976) 14(8):1712–1721Google Scholar
  130. 130.
    Sherman KJ, Cook AJ, Wellman RD, Hawkes RJ, Kahn JR, Deyo RA et al (2014) Five-week outcomes from a dosing trial of therapeutic massage for chronic neck pain. Ann Fam Med 12(2):112–120PubMedPubMedCentralCrossRefGoogle Scholar
  131. 131.
    Jull G, Kenardy J, Hendrikz J, Cohen M, Sterling M (2013) Management of acute whiplash: a randomized controlled trial of multidisciplinary stratified treatments. Pain 154(9):1798–1806PubMedCrossRefGoogle Scholar
  132. 132.
    Robinson JP, Theodore BR, Dansie EJ, Wilson HD, Turk DC (2013) The role of fear of movement in subacute whiplash-associated disorders grades I and II. Pain 154(3):393–401PubMedCrossRefGoogle Scholar
  133. 133.
    Zhang SP, Chiu TT, Chiu SN (2013) Long-term efficacy of electroacupuncture for chronic neck pain: a randomised controlled trial. Hong Kong Med J 19(Suppl 9):36–39PubMedGoogle Scholar
  134. 134.
    Andersen CH, Andersen LL, Pedersen MT, Mortensen P, Karstad K, Mortensen OS et al (2013) Dose-response of strengthening exercise for treatment of severe neck pain in women. J Strength Cond Res 27(12):3322–3328PubMedCrossRefGoogle Scholar
  135. 135.
    Michaleff ZA, Maher CG, Lin CW, Rebbeck T, Jull G, Latimer J et al (2014) Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial. Lancet 384(9938):133–141PubMedCrossRefGoogle Scholar
  136. 136.
    Desai MJ, Shkolnikova T, Nava A, Inwald D (2014) A critical appraisal of the evidence for botulinum toxin type A in the treatment for cervico-thoracic myofascial pain syndrome. Pain Pract 14(2):185–195PubMedCrossRefGoogle Scholar
  137. 137.
    Rudolfsson T, Djupsjobacka M, Hager C, Bjorklund M (2014) Effects of neck coordination exercise on sensorimotor function in chronic neck pain: a randomized controlled trial. J Rehabil Med 46(9):908–914PubMedCrossRefGoogle Scholar
  138. 138.
    Ceccherelli F, Marino E, Caliendo A, Dezzoni R, Roveri A, Gagliardi G (2014) 3,5,11 needles: looking for the perfect number of needles—a randomized and controlled study. Acupunct Electrother Res 39(3–4):241–258PubMedCrossRefGoogle Scholar
  139. 139.
    Gram B, Andersen C, Zebis MK, Bredahl T, Pedersen MT, Mortensen OS et al (2014) Effect of training supervision on effectiveness of strength training for reducing neck/shoulder pain and headache in office workers: cluster randomized controlled trial. Biomed Res Int 2014:693013. doi: http://dx.doi.org/10.1155/2014/693013 PubMedPubMedCentralCrossRefGoogle Scholar
  140. 140.
    Scottish Intercollegiate Guidelines Network. Critical appraisal: notes and checklists (systematic reviews and meta-analyses). http://www.sign.ac.uk/methodology/checklists.html

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Pierre Côté
    • 1
    • 2
    Email author
  • Jessica J. Wong
    • 2
    • 3
  • Deborah Sutton
    • 2
    • 3
  • Heather M. Shearer
    • 2
    • 3
  • Silvano Mior
    • 3
    • 4
  • Kristi Randhawa
    • 2
    • 3
    • 5
  • Arthur Ameis
    • 6
  • Linda J. Carroll
    • 7
  • Margareta Nordin
    • 8
    • 9
  • Hainan Yu
    • 2
    • 3
  • Gail M. Lindsay
    • 4
  • Danielle Southerst
    • 10
  • Sharanya Varatharajan
    • 2
    • 3
    • 5
  • Craig Jacobs
    • 2
    • 11
  • Maja Stupar
    • 2
  • Anne Taylor-Vaisey
    • 2
  • Gabrielle van der Velde
    • 12
    • 13
    • 14
  • Douglas P. Gross
    • 15
    • 16
  • Robert J. Brison
    • 17
    • 18
  • Mike Paulden
    • 19
  • Carlo Ammendolia
    • 14
    • 20
  • J. David Cassidy
    • 21
    • 22
  • Patrick Loisel
    • 3
    • 23
  • Shawn Marshall
    • 24
  • Richard N. Bohay
    • 25
  • John Stapleton
    • 26
  • Michel Lacerte
    • 27
    • 28
  • Murray Krahn
    • 20
  • Roger Salhany
    • 29
  1. 1.Canada Research Chair in Disability Prevention and RehabilitationUniversity of Ontario Institute of Technology (UOIT)OshawaCanada
  2. 2.UOIT-CMCC Centre for the Study of Disability Prevention and RehabilitationUniversity of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC)TorontoCanada
  3. 3.Graduate Education and Research ProgramsCanadian Memorial Chiropractic College (CMCC)TorontoCanada
  4. 4.Faculty of Health SciencesUniversity of Ontario Institute of Technology (UOIT)OshawaCanada
  5. 5.Undergraduate EducationCanadian Memorial Chiropractic College (CMCC)TorontoCanada
  6. 6.Certification Program in Insurance Medicine and Medico-legal Expertise, Faculty of MedicineUniversity of MontrealMontrealCanada
  7. 7.Injury Prevention Centre and School of Public HealthUniversity of AlbertaEdmontonCanada
  8. 8.Department of Orthopedic Surgery, Occupational and Industrial Orthopedic Center, NYU School of MedicineNew York UniversityNew YorkUSA
  9. 9.Department of Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of MedicineNew York UniversityNew YorkUSA
  10. 10.Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai HospitalJoseph and Wolf Lebovic Health ComplexTorontoCanada
  11. 11.Division of Clinical EducationCanadian Memorial Chiropractic College (CMCC)TorontoCanada
  12. 12.Toronto Health Economics and Technology Assessment (THETA) CollaborativeTorontoCanada
  13. 13.Leslie Dan Faculty of PharmacyUniversity of TorontoTorontoCanada
  14. 14.Institute for Work and HealthTorontoCanada
  15. 15.Department of Physical TherapyUniversity of AlbertaEdmontonCanada
  16. 16.Rehabilitation Research CentreUniversity of AlbertaEdmontonCanada
  17. 17.Clinical ResearchKingston General HospitalKingstonCanada
  18. 18.Department of Emergency Medicine, School of MedicineQueen’s UniversityKingstonCanada
  19. 19.Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  20. 20.Institute for Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  21. 21.University of Southern DenmarkOdense MDenmark
  22. 22.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  23. 23.Division of Occupational and Environmental Health, Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  24. 24.University of OttawaOttawaCanada
  25. 25.Schulich School of Medicine and DentistryWestern UniversityLondonCanada
  26. 26.Open Policy OntarioTorontoCanada
  27. 27.Université de MontréalMontrealCanada
  28. 28.Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and DentistryWestern UniversityLondonCanada
  29. 29.TorontoCanada

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