Subjective and clinical assessment criteria suggestive for five clinical patterns discernible in nonspecific neck pain patients. A Delphi-survey of clinical experts

Man Ther. 2016 Dec:26:87-96. doi: 10.1016/j.math.2016.07.005. Epub 2016 Jul 21.


Background: Nonspecific neck pain patients form a heterogeneous group with different musculoskeletal impairments. Classifying nonspecific neck pain patients into subgroups based on clinical characteristics might lead to more comprehensive diagnoses and can guide effective management.

Objective: To establish consensus among a group of experts regarding the clinical criteria suggestive of a clinical dominance of 'articular', 'myofascial', 'neural', 'central' and 'sensorimotor control' dysfunction patterns distinguishable in patients with nonspecific neck pain.

Study design: Delphi study.

Methods: A focus group with 10 academic experts was organized to elaborate on the different dysfunction patterns discernible in neck pain patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 distinct dysfunction patterns resulting from the focus group.

Results: A total of 21 musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating neck pain patients completed the 3-round Delphi-survey. Respectively, 33 (response rate, 100.0%), 27 (81.8%) and 21 (63.6%) respondents replied to rounds 1, 2 and 3. Eighteen 'articular', 16 'myofascial', 20 'neural', 18 'central' and 10 'sensorimotor control' clinical indicators reached a predefined ≥80% consensus level.

Conclusion: These indicators suggestive of a clinical dominance of 'articular', 'myofascial', 'neural', 'central', and 'sensorimotor control' dysfunction patterns may help clinicians to assess and diagnose patients with nonspecific neck pain. Future validity testing is needed to determine how these criteria may help to improve the outcome of physical therapy interventions in nonspecific neck pain patients.

Keywords: Cervical spine; Clinical patterns; Clinical reasoning; Consensus.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Belgium
  • Delphi Technique
  • Diagnostic Techniques and Procedures / standards*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neck / physiopathology*
  • Neck Pain / classification*
  • Neck Pain / diagnosis*
  • Netherlands
  • Physical Examination / standards*
  • Physical Therapists
  • Practice Guidelines as Topic*
  • Surveys and Questionnaires