Effects of long-term home-based exercise on health-related quality of life in patients with chronic neck pain: A randomized study with a 1-year follow-up

Randomised controlled trial assessing the effects of 6-week telerehabilitation exercise programme on chronic non-specific neck pain: a study protocol

Chronic non-specific neck pain is one of the most common musculoskeletal conditions affecting the work and lifestyle of those suffering from it. Physiotherapy interventions, such as strength training and stretching, have positively influenced neck pain. Patient adherence to home-based exercises is a growing concern that could be easily improved through telerehabilitation exercise programmes. This can also be a cost-effective, time-efficient and patient-suitable service. Therefore, this study aims to establish the effectiveness of telerehabilitation exercise intervention by measuring patient adherence, pain score, disability index, cervical range of motion (CROM) and cervical muscle endurance. This randomised controlled trial will include n=60 participants, aged 18-45 years, in a 6-week home-based exercise programme delivered through telerehabilitation or paper-based instructions. Outcome measures from participants will be obtained at baseline and on completion of 6 weeks. These will include the Visual Analogue Scale for Pain, Neck Disability Index questionnaire, CROM by using the CROM instrument and cervical muscle endurance through the Craniocervical Flexion Test. For baseline differences between groups, an independent samples t-test will be used. Repeated measures analysis of variance will be used for within-group and between-group analyses at three different time points (0 weeks, 3 weeks, 6 weeks). Trial registration number:NCT06076174.

Gamification of Cervical Spine Physiotherapy by Virtual Reality Software: Is This Real Rehabilitation?

Objective: Physical rehabilitation by virtual reality (VR) gamification is gaining acceptance. This study was designed to verify whether neck movements invoked by a fully immersive VR game environment may be physiotherapist-prescribed rehabilitation exercise. Methods: This was a single-visit prospective clinical trial (NCT03104647). Healthy participants put on VR headsets and entered a fully immersive game environment (VRPhysio, XRHealth, Tel Aviv, Israel) that prompted neck movement (flexion, extension, rotation, lateral bend, and combinations repeated twice in random order) accompanied by feedback encouraging correct performance. Four board-certified physiotherapists independently viewed videotapes recorded during the session, identified movements, and determined whether they were recommended as neck rehabilitation exercises. Results: Twenty (n = 20) participants (male-female ratio = 13:7; age = 38 ± 14 years old) completed the training session (16 movements per participant). All movements were identified correctly and determined to be appropriate for neck rehabilitation. No adverse events were reported. Conclusions: The VRPhysio software invoked movements identified by board-certified physiotherapists as appropriate for neck rehabilitation. The potential advantage of home-based VR gamification of cervical spine rehabilitation programs over common practice in motivating patient adherence warrants evaluation by randomized controlled trials.

The Influence of Mobile Device Type on Camera-Based Monitoring of Neck Movements for Cervical Rehabilitation

We developed a mobile application for cervical rehabilitation that uses a non-invasive camera-based head-tracker sensor for monitoring neck movements. The intended user population should be able to use the mobile application in their own mobile device, but mobile devices have different camera sensors and screen dimensions that could affect the user performance and neck movement monitoring. In this work, we studied the influence of mobile devices type on camera-based monitoring of neck movements for rehabilitation purposes. We conducted an experiment to test whether the characteristics of a mobile device affect neck movements when using the mobile application with the head-tracker. The experiment consisted of the use of our application, containing an exergame, in three mobile devices. We used wireless inertial sensors to measure the real-time neck movements performed while using the different devices. The results showed that the effect of device type on neck movements was not statistically significant. We included the sex factor in the analysis, but there was no statistically significant interaction between sex and device variables. Our mobile application proved to be device-agnostic. This will allow intended users to use the mHealth application regardless of the type of device. Thus, future work can continue with the clinical evaluation of the developed application to analyse the hypothesis that the use of the exergame will improve therapeutic adherence in cervical rehabilitation.

Influence of adding strain-counterstrain to standard therapy on axioscapular muscles amplitude and fatigue in mechanical neck pain: a single-blind, randomized trial

BACKGROUND

Strain-counterstrain technique (SCS) or positional release therapy is strongly recommended for patients with mechanical neck pain (MNP) because this method has excellent benefits, but the clinical significance of this method is unclear.

AIM

The aim of this study was to investigate the influence of adding the SCS technique to standard therapy on pain, pressure pain threshold, disability according to Neck Disability Index (NDI), and electrophysiological characteristics (amplitude and fatigue) of the upper part of trapezius in the axioscapular muscles of patients with mechanical neck pain.

DESIGN

Single-blind, randomized clinical trial.

SETTING

Outpatient clinic.

POPULATION

Sixty patients (19-38 years old) with mechanical neck pain participated in this study and were recruited from the outpatient clinic at the faculty of physical therapy after a referral from an orthopedist.

METHODS

Patients were randomly assigned by opaque sealed envelope to two treatment groups: group A received SCS, standard therapy in form of active range of motion, stretching exercises, and postural correction exercises (PCES), whereas group B, received standard therapy only; therapeutic sessions were performed three times/week for 4 weeks. The visual analogue scale, pressure pain threshold, NDI, upper trapezius median frequency, and root mean square were used to evaluate the patients' pretreatment and post-treatment status.

RESULTS

Multiple pairwise comparisons within each group revealed statistically significant differences in all outcome variables with favor to the SCS group.

CONCLUSIONS

The Strain-counterstrain technique combined with traditional standard therapy is an effective method more than traditional standard therapy alone for the management of patients with MNP.

CLINICAL REHABILITATION IMPACT

The present study has implications, especially for clinical decision-making about therapy of choice in MNP to reduce pain, improve function as measured through SCS technique and its impact on normal lifestyle, and to highlight the need for active intervention.

Camera-Based Monitoring of Neck Movements for Cervical Rehabilitation Mobile Applications

Vision-based interfaces are used for monitoring human motion. In particular, camera-based head-trackers interpret the movement of the user's head for interacting with devices. Neck pain is one of the most important musculoskeletal conditions in prevalence and years lived with disability. A common treatment is therapeutic exercise, which requires high motivation and adherence to treatment. In this work, we conduct an exploratory experiment to validate the use of a non-invasive camera-based head-tracker monitoring neck movements. We do it by means of an exergame for performing the rehabilitation exercises using a mobile device. The experiments performed in order to explore its feasibility were: (1) validate neck's range of motion (ROM) that the camera-based head-tracker was able to detect; (2) ensure safety application in terms of neck ROM solicitation by the mobile application. Results not only confirmed safety, in terms of ROM requirements for different preset patient profiles, according with the safety parameters previously established, but also determined the effectiveness of the camera-based head-tracker to monitor the neck movements for rehabilitation purposes.

[Therapeutic exercise as treatment for spinal chronic pain: systematic review of randomized clinical trials]

OBJECTIVE

The objective of the present review was to analyze and compare the effectiveness of different types of therapeutic exercise in people with chronic spinal pain.

METHODS

Data search was conducted using the electronic database MEDLINE. Randomized clinical trials, conducted in patients between 18 and 65 years old with chronic pain in the spine region, were included.

RESULTS

Two independent reviewers performed the analysis of methodological quality using the PEDro scale, with 13 studies finally selected. The different types of therapeutic exercise had significant effects on pain reduction, decrease of disability and improvement of the quality of life of the patients.

CONCLUSIONS

The results show that there is no modality of therapeutic exercise superior to others. The combination of different therapeutic exercise modalities could be a complete tool for the management of chronic pain in the spine.

Do behaviour change techniques increase adherence to home exercises in those with upper extremity musculoskeletal disorders? A systematic review

OBJECTIVES

To investigate whether behaviour change techniques (BCTs) can influence adherence to home exercise in people with upper extremity musculoskeletal disorders (UEMD).

DESIGN

A systematic review of randomised control trials, non-randomised control trials, case-control studies and cohort studies. Results were presented narratively. Participants were those with UEMD. The intervention was any home exercise programme, alongside a BCT designed to increase exercise adherence. Any duration of intervention was accepted. The main outcome sought was adherence to home exercise. A systematic search was performed on four online databases. Grey literature was searched.

RESULTS

The search resulted in 28,755 titles. 77 full-text articles were assessed for eligibility. Six studies were included in the qualitative synthesis. Four studies had Some Concern of Bias, whilst two studies had High Risk of Bias. Three studies found statistically significant differences in exercise adherence (p < 0.05) between the Intervention group and Control group. The BCT 'Social Support (unspecified)' was used within all studies that found significant differences in adherence levels at outcome. However, multiple BCTs were received by the Intervention groups within all studies, making it impossible to identify the effects of any single BCT upon adherence levels.

CONCLUSION

Social support may be relevant in patients' adherence levels to HEPs. However, confidence in the results is uncertain given the small number of studies found, and their High RoB. Future studies should validate their measurement and definition of adherence, as well as the number of BCTs they use, to provide reproducible evidence.

Prescription of exercises for the treatment of chronic pain along the continuum of nociplastic pain: A systematic review with meta-analysis

BACKGROUND AND OBJECTIVE

To compare different exercise prescriptions for patients with chronic pain along the continuum of nociplastic pain: fibromyalgia, chronic whiplash-associated disorders (CWAD), and chronic idiopathic neck pain (CINP).

DATABASES AND DATA TREATMENT

Randomized controlled trials comparing different exercise parameters were included. The search was performed in the databases Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and PEDro. Data on the parameters for the physical exercise programs for pain management were extracted for analysis.

RESULTS

Fifty studies with 3,562 participants were included. For fibromyalgia, both aerobic strengthening exercises were similar and better than stretching exercises alone. Exercises could be performed in 50- to 60-min supervised sessions, 2 to 3 times a week, for 13 weeks or more. For CWAD, body awareness exercises were similar to combined exercises, and there was no difference in adding sling exercises to a strengthening exercise program. The exercises could be performed in 90-min supervised sessions, twice a week, for 10 to 16 weeks. For CINP, motor control exercises and nonspecific muscle strengthening had a similar effect. Exercises could be performed in 30- to 60-min supervised sessions, 2 to 3 times a week, for 7 to 12 weeks.

CONCLUSIONS

The choice of parameters regarding exercises should emphasize global exercises in nociplastic pain conditions (such as fibromyalgia and CWAD) and specific exercises in non-nociplastic pain conditions (such as CINP) and be based on patient's preference and therapist's skills.

PROSPERO REGISTRATION NUMBER

CRD42019123271.

SIGNIFICANCE

The pain mechanism must be considered to optimize exercise prescription in patients with different chronic pain profiles. The main message of this article is that low to moderate intensity global exercises performed for a long period of treatment should be performed in patients with nociplastic pain predominance. Additionally, focused and intense exercises for a short period of treatment can be prescribed for patients with nociceptive pain predominance.

Effects of an integrated neuromuscular inhibition technique program on neck muscle strength and endurance in individuals with chronic mechanical neck pain

BACKGROUND

The aim of this study was to investigate whether the application of the integrated neuromuscular inhibition technique (INIT) combined with therapeutic exercise (TE) can provide faster and greater improvement in maximum isometric strength and isometric endurance of the neck muscles in patients with chronic mechanical neck pain (CMNP).

METHODS

In this 10-week, single-blind clinical trial, 40 participants (men and women) with CMNP were divided into two groups. The intervention group (IG) followed a TE program in combination with the INIT, while the control group (CG) followed the same TE program without the INIT technique. Changes in maximum isometric strength and isometric endurance of the neck muscles were evaluated before, during, and after the intervention, with follow-up measurements taken at 1, 3, and 6 months after the intervention. Analysis of variance with repeated measures was applied.

RESULTS

Both groups showed a significant improvement in all dependent measures after the intervention (p < .05). These changes were maintained for both groups 6 months after the intervention. However, the IG showed a greater improvement in the maximum isometric strength of neck flexion and an improved craniocervical flexion test score compared with the CG.

CONCLUSION

The combination of TE and INIT had a positive effect on neck muscle strength and endurance in individuals suffering from CMNP as compared with TE alone.

Pain, disability and adherence to home exercises in patients with chronic neck pain: long term effects of phone surveillance. A randomized controlled study

BACKGROUND

Effectiveness of phone surveillance and other communication technologies in the management of neck pain patients have been evaluated previously only at the suspension of the service.

AIM

To verify whether a phone surveillance program can improve pain, disability, and adherence to home exercises in neck pain patients, and whether the improvement achieved continues to be maintained also after suspension of the support.

DESIGN

This is a randomized controlled study.

SETTING

Outpatients of Rehabilitation Unit.

POPULATION

84 out of 100 outpatients consecutively randomized (by blocks of four) to Phone group (N.=42, performing a 6-month home-based phone surveillance program) or to Control group (N.=42, with the only recommendation to continue exercising at home without phone surveillance) were considered. The home-based phone surveillance program consisted of 12 scheduled phone calls, each performed every fortnight by a nurse-tutor with expertise in rehabilitation for the first six months of the study. At the end of phone surveillance period, Phone patients were encouraged to continue home exercises for a further 6 months period.

METHODS

Pain severity (assessed with Pain VAS), disability (Neck Disability Index), and adherence to exercises performed at home (classified as: ≥5 sessions/week, 2-4 sessions/week, occasional or no sessions) were outcome measures. Pain severity and disability were assessed at entry, at 6 and 12 months, while adherence to exercises was self-reported and recorded at 6 and 12 months. Differences between groups were analyzed with χ2 test, Student's t-test or ANOVA.

RESULTS

At 6 months, Pain VAS (P=0.013) and Neck Disability Index scores (P=0.012) were lower in Phone patients than Controls. At 12 months, Neck Disability Index scores (P=0.026) continued to be lower in Phone patients than Controls. At 6 months, 97.6% of Phone patients and 80.9% of Controls performed rehabilitation at home with a range of 2 to 7 sessions/week; while at 12 months, the respective percentages of Phone and Control patients were 92.9% and 73.8%. Adherence to home exercises was higher in Phone patients than in Controls at 6 (P=0.013) and 12 months (P=0.019).

CONCLUSIONS

In patients with chronic neck pain, the positive effects of phone surveillance on the neck disability and adherence to home exercises still persist 6 months after the suspension of the support.

CLINICAL REHABILITATION IMPACT

This knowledge can be useful for physicians to plan home rehabilitation of neck pain patients.

Health related quality of life improvement in chronic non-specific neck pain: secondary analysis from a single blinded, randomized clinical trial

BACKGROUND

Chronic non-specific neck pain is related to limited cervical mobility, impaired function, neck muscles myofascial pain syndrome, and stress at work. The aforementioned factors are strongly related and may lead to a negative impact on health-related quality of life. There are some effective conservative Physical therapy interventions for treating chronic non-specific neck pain. Currently, Deep Dry Needling is emerging as an alternative for improving symptoms and consequently, the quality of life in patients with chronic non-specific neck pain. The purpose of the study was to examine the effectiveness of Deep Dry Needling of myofascial trigger points on health-related quality of life improvement, as a secondary analysis, in people with chronic non-specific neck pain.

METHODS

A randomized parallel-group blinded controlled clinical trial was conducted at a public Primary Health Care Centre in Madrid, Spain, from January 2011 to September 2014. One hundred thirty subjects with chronic non-specific neck pain and active myofascial trigger points in neck muscles were randomly allocated into two groups. Subjects in the intervention group (n = 65) were treated with Deep Dry Needling in active myofascial trigger points plus stretching in neck muscles; Control group (n = 65) received only stretching. Both interventions lasted 2 weeks, 2 sessions per week. Health-related quality of life was measured with Short Form-36 (SF-36), in 5 assessments: at baseline, after intervention period; and at 1, 3 and 6 months after intervention.

RESULTS

For both groups, SF-36 mean values increased in all dimensions in every assessment. Significant differences (p < 0.05) were found in favor of the intervention group for all dimensions at the last assessment. For some dimensions (physical function, physical role, social function and vitality), the evidence was more consistent from the beginning.

CONCLUSIONS

Deep Dry Needling plus stretching is more effective than stretching alone for Health-related quality of life improvement, especially for physical function, physical role, social function and vitality dimensions, in people with non-specific neck pain.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN22726482 . Registered 9 October 2011.

Prediction models of health-related quality of life in different neck pain conditions: a cross-sectional study

PURPOSE

The main aim of the study was to predict the health-related quality of life (HRQoL) based on physical, functional, and psychological measures in patients with different types of neck pain (NP).

MATERIALS AND METHODS

This cross-sectional study included 202 patients from a primary health center and the physiotherapy outpatient department of a hospital. Patients were divided into four groups according to their NP characteristics: chronic (CNP), acute whiplash (WHIP), chronic NP associated with temporomandibular dysfunction (NP-TMD), or chronic NP associated with chronic primary headache (NP-PH). The following measures were performed: Short Form-12 Health Survey (SF-12), Neck Disability Index (NDI), visual analog scale (VAS), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BECK), and cervical range of movement (CROM).

RESULTS

The regression models based on the SF-12 total HRQoL for CNP and NP-TMD groups showed that only NDI was a significant predictor of the worst HRQoL (48.9% and 48.4% of the variance, respectively). In the WHIP group, the regression model showed that BECK was the only significant predictor variable for the worst HRQoL (31.7% of the variance). Finally, in the NP-PH group, the regression showed that the BECK, STAI, and VAS model predicted the worst HRQoL (75.1% of the variance).

CONCLUSION

Chronic nonspecific NP and chronic NP associated with temporomandibular dysfunction were the main predictors of neck disability. In addition, depression, anxiety, and pain were the main predictors of WHIP or primary headache associated with CNP.

Resistance training in addition to multidisciplinary rehabilitation for patients with chronic pain in the low back: Study protocol

INTRODUCTION

Chronic low back pain (LBP) is a major health problem worldwide. Multidisciplinary rehabilitation and exercise is recommended for the management of chronic LBP. However, there is a need to investigate effective exercise interventions that is available in clinics and as home-based training on a large scale. This article presents the design and rationale of the first randomized clinical trial investigating the effects of progressive resistance training with elastic bands in addition to multidisciplinary rehabilitation for patients with moderate to severe chronic LBP.

METHODS AND ANALYSIS

We aim to enroll 100 patients with chronic LBP referred to a specialized outpatient hospital clinic in Norway. Participants will be randomized equally to either; a) 3 tion including whole-body progressive resistance training using elastic bands - followed by home-based progressive resistance training for 9 weeks, or b) 3 weeks of multidisciplinary rehabilitation including general physical exercise - followed by home-based general physical exercise for 9 weeks. Questionnaires and strength tests will be collected at baseline, weeks 3 and 12, and at 6 and 12 months. The primary outcome is between-group changes in pain-related disability at week 12 assessed by the Oswestry disability index. Secondary outcomes include pain, work ability, work status, mental health, health-related quality of life, global rating of change, general health, and muscular strength and pain-related disability up to 12 months of follow-up.

DISCUSSION

This study will provide valuable information for clinicians working with patients with chronic LBP.

TRIAL REGISTRATION

ClinicalTrials.gov, number NCT02420236.

Home-Based Telemedicine in Patients with Chronic Neck Pain

OBJECTIVE

To investigate if a structured physician-directed, nurse-managed, home-based telemedicine (HBT) program, consisting of scheduled/unscheduled phone surveillance, can reduce pain in patients with chronic neck pain.

DESIGN

This is a prospective randomized controlled study conducted on outpatients. Following outpatient rehabilitation, patients (n = 100) were consecutively randomized to a 6-month HBT program (HBT group) or no HBT but only the recommendation to continue exercising at home (control group). At baseline and after 6 months, pain severity (visual analog scale) and disability (Neck Disability Index) were evaluated.

RESULTS

At 6 months, neck pain and disability declined in both groups (P < 0.001 for both groups, both parameters), but the decline was significantly more marked in the HBT group (P = 0.001, both parameters). At 6 months, 87.2% of HBT patients and 65.9% of control subjects were performing home exercises (in the range of 2-7 exercise sessions/wk). Pain and disability scores were correlated to participation in the HBT program, patients' perception of HBT, and adherence to home exercises.

CONCLUSIONS

Home-based telemedicine may be a useful additional tool to help physicians in the management of chronic neck pain.

Is exercise effective for the management of neck pain and associated disorders or whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

BACKGROUND CONTEXT

In 2008, the Neck Pain Task Force (NPTF) recommended exercise for the management of neck pain and whiplash-associated disorders (WAD). However, no evidence was available on the effectiveness of exercise for Grade III neck pain or WAD. Moreover, limited evidence was available to contrast the effectiveness of various types of exercises.

PURPOSE

To update the findings of the NPTF on the effectiveness of exercise for the management of neck pain and WAD grades I to III.

STUDY DESIGN/SETTING

Systematic review and best evidence synthesis.

SAMPLE

Studies comparing the effectiveness of exercise to other conservative interventions or no intervention.

OUTCOME MEASURES

Outcomes of interest included self-rated recovery, functional recovery, pain intensity, health-related quality of life, psychological outcomes, and/or adverse events.

METHODS

We searched eight electronic databases from 2000 to 2013. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. The results of scientifically admissible studies were synthesized following best-evidence synthesis principles.

RESULTS

We retrieved 4,761 articles, and 21 randomized controlled trials (RCTs) were critically appraised. Ten RCTs were scientifically admissible: nine investigated neck pain and one addressed WAD. For the management of recent neck pain Grade I/II, unsupervised range-of-motion exercises, nonsteroidal anti-inflammatory drugs and acetaminophen, or manual therapy lead to similar outcomes. For recent neck pain Grade III, supervised graded strengthening is more effective than advice but leads to similar short-term outcomes as a cervical collar. For persistent neck pain and WAD Grade I/II, supervised qigong and combined strengthening, range-of-motion, and flexibility exercises are more effective than wait list. Additionally, supervised Iyengar yoga is more effective than home exercise. Finally, supervised high-dose strengthening is not superior to home exercises or advice.

CONCLUSIONS

We found evidence that supervised qigong, Iyengar yoga, and combined programs including strengthening, range of motion, and flexibility are effective for the management of persistent neck pain. We did not find evidence that one supervised exercise program is superior to another. Overall, most studies reported small effect sizes suggesting that a small clinical effect can be expected with the use of exercise alone.

Feasibility of a Smartphone-Based Exercise Program for Office Workers With Neck Pain: An Individualized Approach Using a Self-Classification Algorithm

OBJECTIVE

To explore the feasibility of a newly developed smartphone-based exercise program with an embedded self-classification algorithm for office workers with neck pain, by examining its effect on the pain intensity, functional disability, quality of life, fear avoidance, and cervical range of motion (ROM).

DESIGN

Single-group, repeated-measures design.

SETTING

The laboratory and participants' home and work environments.

PARTICIPANTS

Offices workers with neck pain (N=23; mean age ± SD, 28.13±2.97y; 13 men).

INTERVENTION

Participants were classified as having 1 of 4 types of neck pain through a self-classification algorithm implemented as a smartphone application, and conducted corresponding exercise programs for 10 to 12min/d, 3d/wk, for 8 weeks.

MAIN OUTCOME MEASURES

The visual analog scale (VAS), Neck Disability Index (NDI), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Fear-Avoidance Beliefs Questionnaire (FABQ), and cervical ROM were measured at baseline and postintervention.

RESULTS

The VAS (P<.001) and NDI score (P<.001) indicated significant improvements in pain intensity and functional disability. Quality of life showed significant improvements in the physical functioning (P=.007), bodily pain (P=.018), general health (P=.022), vitality (P=.046), and physical component scores (P=.002) of the SF-36. The FABQ, cervical ROM, and mental component score of the SF-36 showed no significant improvements.

CONCLUSIONS

The smartphone-based exercise program with an embedded self-classification algorithm improves the pain intensity and perceived physical health of office workers with neck pain, although not enough to affect their mental and emotional states.

Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain? A randomised control trial with a 4-month follow up

AIM

To investigate the effect of combining pain education, specific exercises and graded physical activity training (exercise) compared with pain education alone (control) on physical health-related quality of life (HR-QoL) in chronic neck pain patients.

METHODS

A multicentre randomised controlled trial of 200 neck pain patients receiving pain education. The exercise group received additional exercises for neck/shoulder, balance and oculomotor function, plus graded physical activity training. Patient-reported outcome measures (Short Form-36 Physical and Mental component summary scores, EuroQol-5D, Beck Depression Inventory-II, Neck Disability Index, Pain Bothersomeness, Patient-Specific Functioning Scale, Tampa Scale of Kinesiophobia, Global Perceived Effect) and clinical tests (Aastrand Physical Fitness, cervical Range of Motion, Pressure Pain Threshold at infraspinatus, tibialis anterior and cervical spine, Cranio-cervical Flexion, Cervical Extension muscle function, and oculomotion) were recorded at baseline and after 4 months.

RESULTS

The exercise group showed statistically significant improvement in physical HR-QoL, mental HR-QoL, depression, cervical pressure pain threshold, cervical extension movement, muscle function, and oculomotion. Per protocol analyses confirmed these results with additional significant improvements in the exercise group compared with controls.

CONCLUSIONS

This multimodal intervention may be an effective intervention for chronic neck pain patients.

TRIAL REGISTRATION

The trial was registered on www.ClinicalTrials.govNCT01431261 and at the Regional Scientific Ethics Committee of Southern Denmark S-20100069.

Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

PURPOSE

To develop an evidence-based guideline for the management of grades I-III neck pain and associated disorders (NAD).

METHODS

This guideline is based on recent systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences (obtained from qualitative research) when formulating recommendations. Target audience includes clinicians; target population is adults with grades I-III NAD <6 months duration.

RECOMMENDATION 1

Clinicians should rule out major structural or other pathologies as the cause of NAD. Once major pathology has been ruled out, clinicians should classify NAD as grade I, II, or III.

RECOMMENDATION 2

Clinicians should assess prognostic factors for delayed recovery from NAD.

RECOMMENDATION 3

Clinicians should educate and reassure patients about the benign and self-limited nature of the typical course of NAD grades I-III and the importance of maintaining activity and movement. Patients with worsening symptoms and those who develop new physical or psychological symptoms should be referred to a physician for further evaluation at any time during their care.

RECOMMENDATION 4

For NAD grades I-II ≤3 months duration, clinicians may consider structured patient education in combination with: range of motion exercise, multimodal care (range of motion exercise with manipulation or mobilization), or muscle relaxants. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, strain-counterstrain therapy, relaxation massage, cervical collar, electroacupuncture, electrotherapy, or clinic-based heat.

RECOMMENDATION 5

For NAD grades I-II >3 months duration, clinicians may consider structured patient education in combination with: range of motion and strengthening exercises, qigong, yoga, multimodal care (exercise with manipulation or mobilization), clinical massage, low-level laser therapy, or non-steroidal anti-inflammatory drugs. In view of evidence of no effectiveness, clinicians should not offer strengthening exercises alone, strain-counterstrain therapy, relaxation massage, relaxation therapy for pain or disability, electrotherapy, shortwave diathermy, clinic-based heat, electroacupuncture, or botulinum toxin injections.

RECOMMENDATION 6

For NAD grade III ≤3 months duration, clinicians may consider supervised strengthening exercises in addition to structured patient education. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, cervical collar, low-level laser therapy, or traction. RECOMMENDATION 7: For NAD grade III >3 months duration, clinicians should not offer a cervical collar. Patients who continue to experience neurological signs and disability more than 3 months after injury should be referred to a physician for investigation and management. RECOMMENDATION 8: Clinicians should reassess the patient at every visit to determine if additional care is necessary, the condition is worsening, or the patient has recovered. Patients reporting significant recovery should be discharged.

A Comparison of the Effects of Stabilization Exercises Plus Manual Therapy to Those of Stabilization Exercises Alone in Patients With Nonspecific Mechanical Neck Pain: A Randomized Clinical Trial

STUDY DESIGN

Randomized clinical trial.

BACKGROUND

Little is known about the efficacy of providing manual therapy in addition to cervical and scapulothoracic stabilization exercises in people with mechanical neck pain (MNP). Objectives To compare the effects of stabilization exercises plus manual therapy to those of stabilization exercises alone on disability, pain, range of motion (ROM), and quality of life in patients with MNP.

METHODS

One hundred two patients with MNP (18-65 years of age) were recruited and randomly allocated into 2 groups: stabilization exercise without (n = 51) and with (n = 51) manual therapy. The program was carried out 3 days per week for 4 weeks. The Neck Disability Index, visual analog pain scale, digital algometry of pressure pain threshold, goniometric measurements, and Medical Outcomes Study 36-Item Short-Form Health Survey were used to assess participants at baseline and after 4 weeks.

RESULTS

Improvements in Neck Disability Index score, night pain, rotation ROM, and the Medical Outcomes Study 36-Item Short-Form Health Survey score were greater in the group that received stabilization exercise with manual therapy compared to the group that only received stabilization exercise. Between-group differences (95% confidence interval) were 2.2 (0.1, 4.3) points for the Neck Disability Index, 1.1 (0.0, 2.3) cm for pain at night measured on the visual analog scale, -4.3° (-8.1°, -0.5°) and -5.0° (-8.2°, -1.7°) for right and left rotation ROM, respectively, and -2.9 (-5.4, -0.4) points and -3.1 (-6.2, 0.0) points for the Medical Outcomes Study 36-Item Short-Form Health Survey physical and mental components, respectively. Changes in resting and activity pain, pressure pain threshold, and cervical extension or lateral flexion ROM did not differ significantly between the groups. Pressure pain threshold increased only in those who received stabilization exercise with manual therapy (P<.05).

CONCLUSION

The results of this study suggest that stabilization exercises with manual therapy may be superior to stabilization exercises alone for improving disability, pain intensity at night, cervical rotation motion, and quality of life in patients with MNP.

LEVEL OF EVIDENCE

Therapy, level 1b.

Cognitive-behavioural treatment for subacute and chronic neck pain

EDITORIAL NOTE

EXPRESSION OF CONCERN - Professor Marco Monticone has acted as the first author of this Cochrane review. Readers should be informed that multiple randomized controlled trials authored by Professor Monticone have been scrutinized because of potential research integrity issues, including irregularities in the data (doi:10.1097/j.pain.0000000000002659). One of the trials suspected of research integrity issues is included in this Cochrane review (doi:10.1007/s00586-012-2287-y). The Cochrane editorial team has concerns about the trustworthiness of the trial data and is applying Cochrane's policy on managing potentially problematic studies (https://www.cochranelibrary.com/cdsr/editorial-policies#problematic-studies). No major differences to the conclusions of this review were found after performing a sensitivity analysis on the main outcomes, whether the potentially problematic trial was included or excluded. Cochrane will take further action as needed on this review once additional investigations into the potentially problematic trial are concluded. In the meantime, a new version of this review topic is underway with a new author team. The new review will supersede this review.

BACKGROUND

Although research on non-surgical treatments for neck pain (NP) is progressing, there remains uncertainty about the efficacy of cognitive-behavioural therapy (CBT) for this population. Addressing cognitive and behavioural factors might reduce the clinical burden and the costs of NP in society.

OBJECTIVES

To assess the effects of CBT among individuals with subacute and chronic NP. Specifically, the following comparisons were investigated: (1) cognitive-behavioural therapy versus placebo, no treatment, or waiting list controls; (2) cognitive-behavioural therapy versus other types of interventions; (3) cognitive-behavioural therapy in addition to another intervention (e.g. physiotherapy) versus the other intervention alone.

SEARCH METHODS

We searched CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, SCOPUS, Web of Science, and PubMed, as well as ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform up to November 2014. Reference lists and citations of identified trials and relevant systematic reviews were screened.

SELECTION CRITERIA

We included randomised controlled trials that assessed the use of CBT in adults with subacute and chronic NP.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the risk of bias in each study and extracted the data. If sufficient homogeneity existed among studies in the pre-defined comparisons, a meta-analysis was performed. We determined the quality of the evidence for each comparison with the GRADE approach.

MAIN RESULTS

We included 10 randomised trials (836 participants) in this review. Four trials (40%) had low risk of bias, the remaining 60% of trials had a high risk of bias.The quality of the evidence for the effects of CBT on patients with chronic NP was from very low to moderate. There was low quality evidence that CBT was better than no treatment for improving pain (standard mean difference (SMD) -0.58, 95% confidence interval (CI) -1.01 to -0.16), disability (SMD -0.61, 95% CI -1.21 to -0.01), and quality of life (SMD -0.93, 95% CI -1.54 to -0.31) at short-term follow-up, while there was from very low to low quality evidence of no effect on various psychological indicators at short-term follow-up. Both at short- and intermediate-term follow-up, CBT did not affect pain (SMD -0.06, 95% CI -0.33 to 0.21, low quality, at short-term follow-up; MD -0.89, 95% CI -2.73 to 0.94, low quality, at intermediate-term follow-up) or disability (SMD -0.10, 95% CI -0.40 to 0.20, moderate quality, at short-term follow-up; SMD -0.24, 95% CI-0.54 to 0.07, moderate quality, at intermediate-term follow-up) compared to other types of interventions. There was moderate quality evidence that CBT was better than other interventions for improving kinesiophobia at intermediate-term follow-up (SMD -0.39, 95% CI -0.69 to -0.08, I(2) = 0%). Finally, there was very low quality evidence that CBT in addition to another intervention did not differ from the other intervention alone in terms of effect on pain (SMD -0.36, 95% CI -0.73 to 0.02) and disability (SMD -0.10, 95% CI -0.56 to 0.36) at short-term follow-up.For patients with subacute NP, there was low quality evidence that CBT was better than other interventions at reducing pain at short-term follow-up (SMD -0.24, 95% CI -0.48 to 0.00), while no difference was found in terms of effect on disability (SMD -0.12, 95% CI -0.36 to 0.12) and kinesiophobia.None of the included studies reported on adverse effects.

AUTHORS' CONCLUSIONS

With regard to chronic neck pain, CBT was found to be statistically significantly more effective for short-term pain reduction only when compared to no treatment, but these effects could not be considered clinically meaningful. When comparing both CBT to other types of interventions and CBT in addition to another intervention to the other intervention alone, no differences were found. For patients with subacute NP, CBT was significantly better than other types of interventions at reducing pain at short-term follow-up, while no difference was found for disability and kinesiophobia. Further research is recommended to investigate the long-term benefits and risks of CBT including for the different subgroups of subjects with NP.

Long-term effects of therapeutic exercise on nonspecific chronic neck pain: a literature review

[Purpose] Nonspecific neck pain is a common musculoskeletal disease. Therapeutic exercise has been shown to improve pain and disability in short-term and midterm follow-ups. This study performed a literature review of the long-term effects of therapeutic exercise on subjects with nonspecific chronic neck pain. [Subjects and Methods] The databases of the CINAHL, MEDLINE, PEDro and PubMed were used. Randomized controlled trials (RCT) published from January 2000 to January 2014 and explicitly including a one-year follow-up were identified. [Results] Only six articles were included in this review. They had scores of 5 to 8 points on the PEDro scale, and the level of evidence was grade I. The study results show that the main exercises used were cervical strengthening and endurance training exercise. Short-term exercises (10 to 12 weeks) helped to improve the body function, structure, activity and participation immediately after the intervention, but not at the long-term follow-up. On the other hand, long-term interventions (1 year) resulted in improvements in body function and structure at the 3 year follow-up. [Conclusion] The results of the six high-quality studies suggest that long-term exercise have long-term benefits for patients with nonspecific neck pain in terms of body function and structure.

The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: a randomized controlled trial

OBJECTIVE

To determine the effectiveness of neck and shoulder stretching exercises for relief neck pain among office workers.

DESIGN

Randomized controlled trial.

SETTING

An outpatient setting.

PARTICIPANTS

A total of 96 subjects with moderate-to-severe neck pain (visual analogue score ⩾5/10) for ⩾3 months.

INTERVENTIONS

All participants received an informative brochure indicating the proper position and ergonomics to be applied during daily work. The treatment group received the additional instruction to perform neck and around shoulder stretching exercises two times/day, five days/week during four weeks.

MAIN OUTCOMES

Pain, neck functions, and quality of life were evaluated at baseline and week 4 using pain visual analogue scale, Northwick Park Neck Pain Questionnaire, and Short Form-36, respectively.

RESULTS

Both groups had comparable baseline data. All outcomes were improved significantly from baseline. When compared between groups, the magnitude of improvement was significantly greater in the treatment group than in the control group (-1.4; 95% CI: -2.2, -0.7 for visual analogue scale; -4.8; 95% CI: -9.3, -0.4 for Northwick Park Neck Pain Questionnaire; and 14.0; 95% CI: 7.1, 20.9 for physical dimension of the Short Form-36). Compared with the patients who performed exercises <3 times/week, those who exercised ⩾3 times/week yielded significantly greater improvement in neck function and physical dimension of quality of life scores (p = 0.005 and p = 0.018, respectively).

CONCLUSION

A regular stretching exercise program performed for four weeks can decrease neck and shoulder pain and improve neck function and quality of life for office workers who have chronic moderate-to-severe neck or shoulder pain.

Effectiveness of jyoti meditation for patients with chronic neck pain and psychological distress--a randomized controlled clinical trial

Chronic neck pain is a common medical complaint partly mediated by psychosocial distress and having a high socioeconomic impact. There is preliminary evidence that stress reduction by meditation might be beneficial in chronic pain syndromes. We aimed to evaluate the effectiveness of an 8-week meditation program (jyoti meditation) in patients with chronic neck pain by means of a randomized clinical trial. Eighty-nine patients (aged 49.7 ± 10.5 years, 73 female) with chronic neck pain who scored >40 mm on a 100-mm visual analog scale and had concomitant increased perceived stress were randomized to an 8-week meditation program (jyoti meditation) with weekly 90-minute classes (n = 45) or to a home-based exercise program (n = 44) with a wait list offer for meditation. Both groups were instructed to practice at home. Outcomes were assessed at baseline and after 8 weeks. Primary outcome measure was change of mean pain at rest (visual analog scale score) from baseline to week 8. Secondary outcomes included pain at motion, functional disability, pain-related bothersomeness, perceived stress, quality of life, and psychological outcomes. Patients had neck pain for a mean of 11 years. Eighteen patients in the meditation group and 16 patients in the exercise group were lost to follow-up. Meditation training significantly reduced pain when compared to the exercise group after 8 weeks (reduction of 45.5 ± 23.3 mm to 21.6 ± 17.2 mm in the meditation group, and 43.8 ± 22.0 mm to 37.7 ± 21.5 mm in the exercise group; mean difference: 13.2 mm [95% confidence interval: 2.1, 24.4; P = .02]). Pain-related bothersomeness decreased more in the meditation group (group difference 11.0 mm [95% confidence interval: 1.0, 21.0; P = .03]). No significant treatment effects were found for pain at motion, psychological scores, and quality of life, although the meditation group showed nonsignificant greater improvements compared to the exercise group. In conclusion, meditation may support chronic pain patients in pain reduction and pain coping. Further well-designed studies including more active control comparisons and longer-term follow-up are warranted.

PERSPECTIVE

This article presents the results of a randomized controlled trial on the clinical effects of an 8-week meditation program or self-care exercise in patients with chronic neck pain. Meditation reduced pain at rest but not disability and might be a useful treatment option for pain management of chronic neck pain.

A systematic review of measures of self-reported adherence to unsupervised home-based rehabilitation exercise programmes, and their psychometric properties

BACKGROUND

Adherence is an important factor contributing to the effectiveness of exercise-based rehabilitation. However, there appears to be a lack of reliable, validated measures to assess self-reported adherence to prescribed but unsupervised home-based rehabilitation exercises.

OBJECTIVES

A systematic review was conducted to establish what measures were available and to evaluate their psychometric properties.

DATA SOURCES

MEDLINE, EMBASE, PsycINFO CINAHL (June 2013) and the Cochrane library were searched (September 2013). Reference lists from articles meeting the inclusion criteria were checked to ensure all relevant papers were included.

STUDY SELECTION

To be included articles had to be available in English; use a self-report measure of adherence in relation to a prescribed but unsupervised home-based exercise or physical rehabilitation programme; involve participants over the age of 18. All health conditions and clinical populations were included.

DATA EXTRACTION

Descriptive data reported were collated on a data extraction sheet. The measures were evaluated in terms of eight psychometric quality criteria.

RESULTS

58 studies were included, reporting 61 different measures including 29 questionnaires, 29 logs, two visual analogue scales and one tally counter. Only two measures scored positively for one psychometric property (content validity). The majority of measures had no reported validity or reliability testing.

CONCLUSIONS

The results expose a gap in the literature for well-developed measures that capture self-reported adherence to prescribed but unsupervised home-based rehabilitation exercises.

Impact of noncancer pain on health-related quality of life

BACKGROUND

While the economic costs of pain have been documented, the impact of noncancer pain on quality of life has not been studied extensively.

OBJECTIVE

To estimate the influence of noncancer pain on quality of life measures.

DESIGN

Prospective, multicenter, observational nonrandomized patient pain registry.

SETTING

Outpatient settings.

PARTICIPANTS

Patients with acute episodes of noncancer pain requiring treatment with a prescription medication containing oxycodone immediate-release on an as-needed basis for at least 5 days (n = 629).

MEASUREMENTS

The modified Brief Pain Inventory and the 12-item Short Form Health Survey (SF-12) was measured at baseline when oxycodone immediate-release began and days 7, 14, 21, and 28. Repeated measures mixed models provided estimates of impact of pain on the physical component summary score (PCS) and mental health component summary score (MCS) of the SF-12.

RESULTS

Patterns indicating pain oscillation over the 28-day window were common (Range: 44.3% back/neck pain cohort to 61.2% postoperative cohort). After adjustment for sociodemographics, concomitant medications and gastrointestinal symptoms, worst pain in 24 hours was associated with a 13.9 point PCS reduction (adjusted PCS for pain = 10: 31.1; adjusted PCS for pain = 0: 45.0) and a 7.2 point MCS reduction (adjusted MCS for pain = 10: 44.1; adjusted MCS for pain = 0: 51.3). Similar clinically relevant differences were observed among patients with arthritis, back/neck pain, injury/trauma, postoperative pain, neuropathic pain and fibromyalgia, although statistical significance was not observed in the latter 2 groups.

CONCLUSION

Among outpatients with various underlying causes of pain, the negative impact of pain on physical and mental health-related quality of life is significant.

Chronic neck pain and exercise interventions: frequency, intensity, time, and type principle

OBJECTIVE

To identify the most effective components in an active exercise physiotherapy treatment intervention for chronic neck pain based on the frequency, intensity, time, and type (FITT) exercise method of tailoring physical activity recommendations to the individual needs and goals of patients.

DATA SOURCES

Databases, including the Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health, MEDLINE, SPORTDiscus, Biomedical Reference Collection, and Academic Search Premier, were searched for relevant articles.

STUDY SELECTION

Quantitative design studies that included active exercise as part of a multimodal or stand-alone approach were selected. Only studies scoring ≥6 on the Physiotherapy Evidence Database Scale were included in the review because this reflected a good level of evidence.

DATA EXTRACTION

Study methodologies and relevant outcome measures, including isometric strength, Neck Disability Index scores, and pain scores, were extracted from relevant articles and grouped together for appraisal and synthesis.

DATA SYNTHESIS

Evidence from selected articles was synthesized according to the FITT exercise principal to determine the most effective exercise type, frequency, and intensity in the treatment of chronic neck pain.

CONCLUSIONS

Physiotherapy interventions using a multimodal approach appear to produce more beneficial outcomes in terms of increased strength, improved function, and health-related quality of life and reduced pain scores. Active strengthening exercises appear to be beneficial for all of these outcomes; the inclusion of additional stretching and aerobic exercise components appear to enhance the benefits of an exercise intervention.