Journal of Rehabilitation Medicine 51-11 | Page 30

844
M. Honkanen et al.
Table II. Example of applying International Classification of Functioning Disability and Health (ICF) classification. Neck pain: functioning,
treatment and rehabilitation
Prognosis: During the preceding month 27% of Finnish men over 30 years of age and 41% of women of the same age have experienced neck pain.
The prognosis of neck pain is usually good. In the management it is essential to place emphasis on the prevention of chronic pain after serious
illnesses have been ruled out.
ICF categories
Key problems
Sensory functions and
pain
Pain may hamper all
activities of daily living
and sleeping. Vertigo may
hamper mobility
Functions related to
Difficulties in turning head
musculoskeletal organs for example when driving
and movements
Functions of mind
Low mood and anxiety
Movements
Difficulties in loading of
upper extremities, rarely in
walking. Difficulties both at
leisure and at work
Taking care of oneself Difficulties in e.g. combing,
washing oneself, clothing
Home life
Difficulties in home chores
and in shopping
Communication
Seclusion from contacts,
between persons and difficulties in hobbies
human relationships
Central parts of life
Total or partial ability to
work or study
Assessment of key
problems
(outcome measures)
Intensity of pain (VAS, NRS)
and a pain drawing as a
background for disability
classifications
Long-standing sitting
(level of evidence B)
Overweight (level of
evidence B)
Assessment of disability due Low level of physical
to neck-shoulder pain
activity
NDI-FI questionnaire (neck Psychosocial factors at
pain index)
work (level of evidence
WHODAS-2 assessment of
health and disabilities
Rehabilitation methods of
choice (a,b)
Contributing factors a Drugs of choice a
Paracetamol
Non-steroidal anti-
inflammatory drugs
(level of evidence C)
(Trigger-point injections
in chronic myofascial
pain (level of evidence
C))
C)
Nature of work (level
of evidence B)
Information and
continuation of ordinary
daily activities despite pain
Leisure-time physical
activity reduces risk for
chronic neck pain (level of
evidence C)
Support for continuing at
work (changes in work
content) and for return to
work (e.g. partial sick-leave
or work trial c )
Specific exercises for neck
and shoulder muscles to
increase muscle strength,
endurance, flexibility and
coordination (level of
evidence C)
Mobilization treatment
does not provide benefit
in comparison to usual
treatment (level of evidence
C)
In whiplash injuries an early
return to ordinary activities
is recommended (level of
evidence B)
a
Level of evidence is graded from A (high) to D (very low) (2).
b
Discrimination between treatment and rehabilitation depends on the context. In this table rehabilitation interventions mean actions, where rehabilitees’ (those
with neck pain) self-motivated activity is crucial.
c
Can be executed by a decision from occupational healthcare, Social Insurance Institution or pension fund.
NDI-FI: neck pain index; NRS: numeric rating scale; VAS: visual analogue scale; WHODAS-2: World Health Organization Disability Assessment Schedule.
chapter on rehabilitation in those CCGs where it was
not incorporated at that time (in 2012). According to
this survey, an additional 24 CCGs were suggested. Of
these 24 CCGs, 11 were considered as very important
to include rehabilitation recommendations. These 11
guidelines were on diabetes, obesity (both in adults and
in children), peripheral arterial disease, diabetic foot,
arterial hypertension, physical activity and exercise training, memory diseases, neck pain, psoriasis (skin
and joints) and urinary incontinence in women.
A total of 54 new or updated CCGs were published
in the years 2012–2014. In 31 of those, rehabilitation
and functional capacity were incorporated as a chapter,
otherwise in the text or in evidence summaries (Table
III). The number of evidence summaries on rehabilita-
tion increased by 115, from 49 to 164 (Table IV).
Table III. Text chapters or other mentions of rehabilitation and
functional capacity in Current Care Guidelines (CCGs) published
during years 2012–2017. The number of chapters is given separately
during the project in 2012–2014 and during the follow-up in
2015–2017, each year referring to those guidelines in the process
of drafting or update (before and after publication, respectively) Table IV. Number and level of evidence of rehabilitation evidence
summaries (grading A–D) in Current Care Guidelines (CCGs)
published during 2012–2017 (the development project in 2012–
2014 and the follow-up in 2015–2017)
Year
2012–2014
2012
2013
2014
Subtotal
2015–2017
2015
2016
2017
Subtotal
Total
Before CCG
publication or
update After CCG
publication or
update Rehabilitation
otherwise included a
8
3
9
20 8
4
13
25 1
3
1
5
5
4
5
14
34 6
5
9
20
45 1
1
2
4
9
a
Mentioned as a part of other text chapters (e.g. driving health instructions,
non-pharmacological treatments, self-care).
www.medicaljournals.se/jrm
Level of evidence
(A = high, B = moderate, C = low, D = very low)
Before CCG publication or After CCG publication or
update
update
Year
2012–2014
2012
2013
2014
Subtotal
2015–2017
2015
2016
2017
Subtotal
Total
A
B
C D Total A B C D Total
1
0
4 3
0
6 15
2
13 0
1
4 19
3
27
49 4
7
18 11
9
29 37
5
28 7
3
6 59
24
81
164
5
8
7 10
8
5 12
9
5 3
4
2 30
29
19
78
127 6
30
8 16
16
12 11
17
13 1
3
3 34
66
36
136
300