Clinical findings that guide musculoskeletal physiotherapists’ decision-making in the treatment of patients with non-specific neck pain. An international e-Delphi study

OBJECTIVE: To identify clinical criteria for prioritizing manual therapy or exercise in the management of patients with nonspecific neck pain (NSNP). DESIGN: e-Delphi study (three rounds). METHODS: International researchers and clinicians involved in teaching in postgraduate musculoskeletal education were invited to participate. In Round 1, 29 participants answered open-ended questions to identify clinical features of NSNP patients, with responses content analyzed and grouped. In Rounds 2 (24) and 3 (25), experts rated these criteria using a 5-points Likert scale, aiming for consensus set at 75% agreement. RESULTS: Experts believed that manual therapy and exercise are often best used in combination but should be tailored to each patient's unique clinical presentation. They agreed on a total of 16 and 11 clinical criteria to indicate the use of manual therapy and exercise, respectively. These included movement limitations, muscle weakness, altered sensorimotor control, directional preference, pain types, and patient preferences. CONCLUSION: While international experts typically seek to combine exercise and manual therapy to manage NSNP, they agree on several criteria to guide individualized intervention. Further research should assess the reliability and effectiveness of these criteria.