Table 3

Classification of recommendations

OALBPNeck painRotator cuff
AAOSEULAROARSINICEGlobe et al NICEDanishBelgiumBussieres et al OPTIMaNSW
Management principles
 Patient-centred care✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓
 Diagnosis: exclude serious pathology✓✓✓✓✓✓✓✓✓✓✓✓✓✓
 Diagnosis: classify neck pain grades I–IV✓✓✓✓
 Assess psychosocial factors✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓
 Routine use of radiological imagingOOOOOO
 Undertake physical examination✓✓✓✓✓✓✓✓✓✓✓✓✓✓
 Evaluation/re-evaluation and measurement✓✓✓✓✓✓✓✓✓✓
 Provide education/information✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓
 Prescribe physical activity/exercise✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓✓
 Offer self-management programmes✓✓✓✓✓✓
 Weight loss if overweight/obese✓✓✓✓✓✓
  paracetamol alone
  NSAIDS plus paracetamol
  Opioids – acute pain?O??
  Opioid – chronic pain?OO?
  Muscle relaxantsO
  Glucosamine and chondroitinOOO
  Selective serotonin reuptake inhibitorsOO
  Serotonin– norepinephrine reuptake inhibitors, tricyclic antidepressants or anticonvulsantsOO
 Passive interventions – non-invasive:
 manual therapy
  If used, use manual therapy with other modalities✓✓✓✓✓✓✓✓✓✓✓✓
  Psychological therapyO
 Passive interventions – invasive: surgery.
 Trial conservative care first before surgery.
  Knee arthroscopic lavage and debridement for OAOO
  Disc replacement for LBPOO
 Passive interventions – invasive: injections
 Intra-articular corticosteroid injection for knee OA
  Injections for LBPOO
  Epidural injection for acute and severe radicular painO
 Complementary medicine: acupunctureO?OOO?
 Facilitate continuation/resumption of work✓✓✓✓✓✓✓✓✓✓
  • ✓✓Should do; ✓ Could do; O Do not do; ?Uncertain.

  • AAOS, American Academy of Orthopedic Surgeons; EULAR, European League Against Rheumatism; LBP, low back pain; NICE, National Institute for Health and Care Excellence; NSAIDS, non-steroidal anti-inflammatory drugs; OA, osteoarthritis; OARSI, Osteoarthritis Research Society International; OPTIMa, Ontario Protocol for Traffic Injury Management Collaboration.