WHEN VASCULAR NECK PATHOLOGY MASQUERADES AS MUSCULOSKELETAL HEAD AND NECK PAIN: A PROTOCOL FOR A RAPID REALIST REVIEW OF DIAGNOSTIC FAILURE IN FIRST-CONTACT COMMUNITY SETTINGS

Conflicts of interest: Steven Vogel is past president of the Society for Back Pain Research and sits on the Executive Committee of the Society. He has had no role in the evaluation or selection of this work for inclusion at the conference. Sources of funding: Osteopathic Foundation (oF); Health Sciences University Background Vascular pathologies of the neck, including craniocervical arterial dissection, vertebral artery stenosis and atherosclerotic disease, present as head and neck pain, mimicking benign musculoskeletal conditions. This diagnostic overlap contributes to delayed or missed recognition across primary care and manual therapy settings, with potentially catastrophic consequences including stroke. No strong guidance exists for clinicians to differentiate these presentations from routine musculoskeletal complaints. Safety netting material is needed. Methods A rapid realist review will be conducted in accordance with RAMESES publication standards. The review will develop programme theories explaining how, why, for whom, and in what contexts vascular pathologies of the neck are misdiagnosed when presenting as head or neck pain. Three databases (MEDLINE, CINAHL, AMED) and grey literature will be searched iteratively. Evidence will be selected based on relevance, richness and rigour, and used to develop context-mechanism-outcome configurations. Initial programme theories have been generated through scoping, and professional experience. PPIE involvement will be embedded throughout, and an international expert consensus workshop will validate and refine emerging theories. The protocol will be registered on PROSPERO prior to full database searching. Results This protocol describes planned work. PROSPERO registration is in progress. No review results are yet available. Initial programme theories include: three explanatory levels: clinician cognition (diagnostic masquerade, therapeutic confidence, curriculum knowledge deficit), patient behaviour (symptom normalisation), and healthcare system structure (referral pathway friction). Conclusion This rapid realist review will generate causal programme theories explaining diagnostic failure in vascular neck pathology presenting as head and neck pain. Findings will inform evidence-based safety-netting materials.