Validity and reliability of guidelines for neck pain treatment in primary health care. A nationwide empirical analysis in Spain

OBJECTIVES: To assess the reliability and validity of existing clinical guidelines on neck-pain physiotherapy treatment and follow-up in Spain. DESIGN: We identified existing guidelines through a nationwide census and listed their recommendations, grouped according to the main steps of the process flow-chart. To assess reliability we analysed the variability of statements. To analyse validity we assessed the type of scientific evidence supporting the recommendations, and we compared them with a list of evidence-based recommendations that was elaborated for this study. SETTING AND PARTICIPANTS: Primary health care centres (n = 24) with guidelines for neck-pain treatment and follow-up. MAIN OUTCOME MEASURES: We quantified the number of recommendations, the proportion of valid statements, the frequencies of non-evidence-based recommendations, and the absence of the evidence-based recommendations we had identified. RESULTS: The 34 identified guidelines contained 325 recommendations, with great variation between guidelines with respect to the number, type (for up to 26 different clinical decisions), and content of the recommendations they provided. Direct assessment of the scientific evidence was not possible because no specific reference was given to support any recommendation. When compared with our list, only 20.9% of the recommendations could be considered evidence-based. No guideline contained all the eight evidence-based recommendations we identified. CONCLUSIONS: The results question the guidelines' reliability and validity, and their usefulness in ensuring quality. We conclude that guidelines should be reviewed and re-designed with greater scientific rigour.