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Evaluations and Treatment of the Cervical Spine, 2nd Edition: Summary
MODEL TREE
INTRODUCTION
Approximately 70% of the world population will have neck pain at some point in life. Thirty percent of individuals with neck pain will develop a chronic cervical condition. Cervical spine pain risk factors include psychological issues, autoimmune diseases, neuromusculoskeletal disorders, genetics, gender, and age. Clinical practice guidelines (CPGs): • Knowledge synthesis tools • Central to the knowledge to action process • Intent: Improve quality of care • Used in multiple healthcare disciplines • Based on plethora of high-quality research that is recent • Must be periodically updated • Not a protocol or regulation; not a substitute for expert medical advice The benefits of using CPGs in clinical practice include reduced length of painful episode, reduced health care costs, decreased unnecessary imaging, decreased opioid use, and decreased surgery. CLASSIFICATION OF CERVICAL PAIN • Neck pain with mobility deficits • Neck pain with movement coordination impairments; includes whiplash-associated disorder (WAD) • Neck pain with headaches • Neck pain with radiating pain Each classification is further described using time- based stages of acute, subacute, and chronic.
EXAMINATION
Subjective : • Thorough history • Systems review • Chronicity • Mechanism of injury (MOI) • PQRST: ○ P rovokes ○ Q uality (let them describe the pain) ○ R adiating ○ S everity (numerical rating scale [NRS] and visual analog scale [VAS] 0–10/10 rating is common) ○ T ime Outcome Measures Neck Disability Index (NDI): • Self-report questionnaire the client fills out to determine their level of disability • 10 questions: Pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, recreation • Total points/50 × 100 = Total score in % Patient-Specific Functional Scale (PSFS): • Self-report questionnaire the client fills out to quantify activity limitation • Form is blank initially; clients are to select five activities they are unable to perform or are having difficulty with due to their condition • Clients rate each activity from 0 (unable to perform) to 10 (able to perform at the same level as before the condition/injury) 36-Item Short Form Survey (SF-36): • Self-report questionnaire the client fills out to determine quality of life Neck Pain and Disability Scale (NPDS): • Self-report questionnaire the client fills out to determine their level of pain and disability • Questionnaire covers neck movements, pain intensity, emotion, cognition, and interference with daily life activities
INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY, AND HEALTH (ICF) MODEL LEARNING TIP! Uses: • Promotes a biopsychosocial model • Rooted in client-centered care • Facilitates a comprehensive description of a person’s health
• Facilitates societal participation • Standardized yet individualized assessment of medical needs
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