Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management
Manual TherapiesWork Group
Pre-Conference Assignment
Your pre-conference assignment is to review the assigned questions and readings for the Manual Therapies Work Group. This worksheet is a tool for you to collect your thoughts and help generate work group discussion. Please feel free to compose additional discussion questions for the consideration of colleagues in your specific group. In addition, besides the readings for “All” work groups and the reading assignments specific to the Manual Therapies work group, you are welcome to review background resources for any of the other work groups that are posted here:
Your work group facilitator(s) will lead the group through a discussion of the assigned questions toward the goal of reaching consensus on what is known (evidence-based) and what needs to be known (knowledge gaps), prioritizing, and making recommendations for research, policy, and practice. The last portion of the work group session on November 3rd will be dedicated to summarizing the discussion, agreed upon priorities, and recommendations into a slide deckfor presentation to the entire SOTA group on November 4th.
Please use the space below to identify areas in which there is sufficient evidence to inform VA policy and practice or areas in which significant evidence gaps remain. When considering evidence gaps, the work group will also be directed to prioritize which evidence gaps are most important to be addressed in future RFAs released by HSR&D.
It is expected that there will be differences in the evidentiary support of a given manual therapy for a given musculoskeletal pain condition (e.g., acupuncture for low back pain vs. massage for knee pain), thus please be prepared to reflect these differences in our discussions. Also, whenever possible, consider what is known or not known about using manual therapies in combination with active non-pharmacological therapies for improving patient outcomes and engaging patients with self-management.
KEY QUESTIONS for the Manual Therapies Work Group:
- What manual therapies have strong evidence that they provide clinically-relevant benefits in pain intensity, pain-related function, quality of life, or other pain-related outcomes among patients with chronic musculoskeletal pain? What manual therapies have some promising evidence but need further study to fill evidence gaps? Whatmanual therapies are lower priority for investment in research and implementation?
General Comments:
Areas with Sufficient Evidence:
Areas with Research Gaps:
Priorities for Future Research to Address Evidence Gaps identified above:
- What patient characteristics might predict a positive response to a certain type of manual therapy or to manual therapy relative to other types of therapies? If the evidence is weak, what are the priorities for better evidence?
General Comments:
Areas with Sufficient Evidence:
Areas with Research Gaps:
Priorities for Future Research to Address Evidence Gaps identified above:
- Whatis the evidence fortime of initiation within an episode, effective frequency, duration, and intensity (i.e., dose) of manual therapies for improving patient and system outcomes?
General Comments:
Areas with Sufficient Evidence:
Areas with Research Gaps:
Priorities for Future Research to Address Evidence Gaps identified above:
- What are the barriers to delivery ofmanual therapy (patient/provider/facility/system) to individual patients and populations of patients? What are effective and efficient strategies for overcoming the barriers (training/education, outreach, technology/new modalities)?
General Comments:
Areas with Sufficient Evidence:
Areas with Research Gaps:
Priorities for Future Research to Address Evidence Gaps identified above:
- What is the evidence for combining or sequencing non-pharmacological treatments when treating patients with chronic pain?
General Comments:
Areas with Sufficient Evidence:
Areas with Research Gaps:
Priorities for Future Research to Address Evidence Gaps identified above:
Cross Cutting Question for all groups:
- What primary and secondary outcome domains should be included in prospective research on benefits and harms of nonpharmacological therapies for chronic musculoskeletal pain?
- What is the evidence of validity, reliability, and responsivity to change for available measures in recommended outcome domains?
- What measures should be considered for outcomes assessment in a) clinical trials, b)prospective observational studies, and c) clinical program evaluations of nonpharmacological therapies for chronic musculoskeletal pain?
- What timing is recommended for assessment of outcomes of nonpharmacological therapies for chronic musculoskeletal pain? (Do recommendations differ for different therapeutic approaches?)
General Comments:
Areas with Sufficient Evidence:
Areas with Research Gaps:
Priorities for Future Research to Address Evidence Gaps identified above: