PURPOSE: To evaluate whether long-term neck and upper body exercises conducted in economical community-based outpatient clinic and home-based settings could improve health-related quality of life (HRQoL)for individuals affected by chronic neck pain. The effect of baseline HRQoL and neck pain values on training adherence was also studied.
METHODS: Subjects (n = 101, 91 women/10 men, mean age 41.0 ± 9.5 years) with chronic non-specific neck pain were randomized to a combined strength-training and stretching-exercise group (CSSG, n = 49) or to a stretching exercise group (SG, n = 52). HRQoL was assessed at baseline and after 12 months using the RAND-36 questionnaire. Comparisons between groups were performed using bootstrap-type analysis of covariance. The impact of HRQoL and neck pain values on training adherence, determined using participants' exercise logs, was studied using generalized estimating equations.
RESULTS: CSSG showed significant improvements in five and SG in four of eight of the HRQoL dimensions. There were no significant differences between the groups. Adherence to long-term training was only slightly affected by baseline-assessed HRQoL and neck pain values.
CONCLUSIONS: The two training protocols were feasible and equally effective in improving HRQoL. Baseline HRQoL and pain values had only a minor effect on training adherence.
IMPLICATIONS FOR REHABILITATION: • Long-term strength training and stretching are effective in improving HRQoL in people with chronic neck pain. • Baseline HRQoL and neck pain values have little effect on training adherence.
Objective: To evaluate the effectiveness of treatment with collar or physiotherapy compared with a wait and see policy in recent onset cervical radiculopathy. Design: Randomised controlled trial. Setting: Neurology outpatient clinics in three Dutch hospitals. Participants: 205 patients with symptoms and signs of cervical radiculopathy of less than one month's duration Interventions Treatment with a semi-hard collar and taking rest for three to six weeks; 12 twice weekly sessions of physiotherapy and home exercises for six weeks; or continuation of daily activities as much as possible without specific treatment (control group). Main outcome measures: Time course of changes in pain scores for arm and neck pain on a 100 mm visual analogue scale and in the neck disability index during the first six weeks. Results: In the wait and see group, arm pain diminished by 3 mm/week on the visual analogue scale (β=-3.1 mm, 95% confidence interval -4.0 to -2.2 mm) and by 19 mm in total over six weeks. Patients who were treated with cervical collar or physiotherapy achieved additional pain reduction (collar: β=-1.9 mm, -3.3 to -0.5 mm; physiotherapy: β=-1.9, -3.3 to -0.8), resulting in an extra pain reduction compared with the control group of 12 mm after six weeks. In the wait and see group, neck pain did not decrease significantly in the first six weeks (β=-0.9 mm, -2.0 to 0.3). Treatment with the collar resulted in a weekly reduction on the visual analogue scale of 2.8 mm (-4.2 to -1.3), amounting to 17 mm in six weeks, whereas physiotherapy gave a weekly reduction of 2.4 mm (-3.9 to -0.8) resulting in a decrease of 14 mm after six weeks. Compared with a wait and see policy, the neck disability index showed a significant change with the use of the collar and rest (β=-0.9 mm, -1.6 to -0.1) and a non-significant effect with physiotherapy and home exercises. Conclusion: A semi-hard cervical collar and rest for three to six weeks or physiotherapy accompanied by home exercises for six weeks reduced neck and arm pain substantially compared with a wait and see policy in the early phase of cervical radiculopathy. Trial registration: Clinical trials NCT00129714.
OBJECTIVE: To compare the effectiveness of a 12-month home-based combined strength training and stretching programme against stretching alone in the treatment of chronic neck pain.
DESIGN: A randomized follow-up study.
PARTICIPANTS: One hundred and one patients with chronic non-specific neck pain were randomized in two groups.
INTERVENTION: The strength training and stretching group was supported by 10 group training sessions and the stretching group was instructed to perform stretching exercises only as instructed in one group session.
MAIN OUTCOME MEASUREMENTS: Neck pain, disability, neck muscle strength and mobility of cervical spine were measured before and after the intervention.
RESULTS: No significant differences in improvement in neck pain and disability were found between the two training groups. Mean (SD) pain decreased from 64 (17) mm by 37 (95% confidence interval (CI) 44 to 30) mm in the strength training and stretching group, and from 60 (17) mm by 32 (39 to 25) mm in the stretching group. The improvements in disability were significant in both groups (P<0.001), while the changes in neck strength and mobility were minor. Training adherence decreased over time from the targeted three sessions a week, ending up at 1.1 (0.7) times a week for strength training and stretching group and 1.4 (0.8) times a week for stretching group.
CONCLUSIONS: No statistically significant differences in neck pain and disability were observed between the two home-based training regimens. Combined strength training and stretching or stretching only were probably as effective in achieving a long-term improvement although the training adherence was rather low most of the time.
BACKGROUND: Many patients with chronic whiplash-associated disorders have reduced neuromuscular control of the neck and head. It has been proposed that a new sling exercise therapy may promote neuromuscular control of the neck.
OBJECTIVES: To compare the effects of traditional physiotherapy vs traditional physiotherapy combined with a new sling exercise therapy on discomfort and function in patients with chronic whiplash-associated disorders who have unsettled compensation claims; and to investigate possible additional effects of guided, long-term home training.
DESIGN: A randomized multi-centre trial with 4 parallel groups.
METHODS: A total of 214 patients were assigned randomly to 4 treatment groups, and received either traditional physiotherapy with or without home training, or new sling exercise therapy with or without home training. Outcome measures were pain, disability, psychological distress, sick leave and physical tests.
RESULTS: A total of 171 patients (80%) completed the study. There were no important statistical or clinical differences between the groups after 4 months of treatment. There was a small statistically significant effect at 12-month follow-up in both groups with home training regarding pain during rest (p = 0.05) and reported fatigue in the final week (p = 0.02).
CONCLUSION: No statistically significant differences were found between the traditional physiotherapy group and the new sling exercise group, with or without home training. Since the groups were not compared with a control group without treatment, we cannot conclude that the studied treatments are effective for patients with whiplash-associated disorder, only that they did not differ in our study.
OBJECTIVE: To compare the effects of manual therapy and stretching exercise on neck pain and disability.
DESIGN: An examiner-blinded randomized cross-over trial. Patients: A total of 125 women with non-specific neck pain.
METHODS: Patients were randomized into 2 groups. Group 1 received manual therapy twice weekly and Group 2 performed stretching exercises 5 times a week. After 4 weeks the treatments were changed. The follow-up times were after 4 and 12 weeks. Neck pain (visual analogue scale) and disability indices were measured.
RESULTS: Mean value (standard deviation) for neck pain was 50 mm (22) and 49 mm (19) at baseline in Group 1 and Group 2, respectively, and decreased during the first 4 weeks by 26 mm (95% Confidence Interval 20-33) and 19 mm (12-27), respectively. There was no significant difference between groups. Neck and shoulder pain and disability index decreased significantly more in Group 1 after manual therapy (p=0.01) as well as neck stiffness (p=0.01).
CONCLUSION: Both stretching exercise and manual therapy considerably decreased neck pain and disability in women with non-specific neck pain. The difference in effectiveness between the 2 treatments was minor. Low-cost stretching exercises can be recommended in the first instance as an appropriate therapy intervention to relieve pain, at least in the short-term.
OBJECTIVE: To investigate the effects of therapeutic exercises and sleeping neck support contoured pillows on patients with chronic neck pain.
METHODS: Using a factorial design in a prospective clinical trial, participants were equally allocated at random to 4 treatment groups in the study: (1) placebo control, of hot or cold packs and massage; (2) sleeping neck support pillow and placebo; (3) active neck exercises and placebo; and (4) combined exercise and sleeping neck support pillow and placebo. Participants were treated by physical therapists over a 6 week period and assessed by masked independent assessors at 0, 3, 6, 12, 24 weeks, and 12 months, with the 12 week assessment being the primary decision time. The primary outcome measure was the Northwick Park Neck Pain Questionnaire (NPQ).
RESULTS: For the 128/151 (85%) participants tested at 12 weeks, the NPQ descriptive statistics of count, mean (standard deviation) were: Initial: 128, 31.0 (11.3) at Week 12; All: 128, 18.5 (11.6); Control: 34, 18.6 (10.0); Pillow: 32, 21.5 (13.1); Active neck exercises: 29, 20.1 (11.6); and Combined: 33, 14.1 (10.6). Factorial analysis of variance showed that the main effects of Exercise (p = 0.146) and Pillow (p = 0.443) were not statistically significant; but the interaction of Exercise plus Pillow (p = 0.029) was statistically significant and clinically meaningful.
CONCLUSION: Treatment by physiotherapists trained to teach both exercises and the use of a neck support pillow achieved the most favorable benefit for participants with chronic neck pain; either strategy alone was not more effective than a control regimen. Time was an important cofactor.
Whiplash-associated disorders are common and incur considerable expense in social and economic terms. There are no known effective treatments for those people whose pain and disability persist beyond 3 months. We conducted a randomized, assessor-blinded, controlled trial at two centres in Australia. All participants received 3 advice sessions. In addition the experimental group participated in 12 exercise sessions over 6 weeks. Primary outcomes were pain intensity, pain bothersomeness and function measured at 6 weeks and 12 months. Exercise and advice was more effective than advice alone at 6 weeks for all primary outcomes but not at 12 months. The effect of exercise on the 0-10 pain intensity scale was -1.1 (95%CI -1.8 to -0.3, p=0.005) at 6 weeks and -0.2 (0.6 to -1.0, p=0.59) at 12 months; on the bothersomeness scale the effect was -1.0 (-1.9 to -0.2, p=0.003) at 6 weeks and 0.3 (-0.6 to 1.3, p=0.48) at 12 months. The effect on function was 0.9 (0.3 to 1.6, p=0.006) at 6 weeks and 0.6 (-0.1 to 1.4, p=0.10) at 12 months. High levels of baseline pain intensity were associated with greater treatment effects at 6 weeks and high levels of baseline disability were associated with greater treatment effects at 12 months. In the short-term exercise and advice is slightly more effective than advice alone for people with persisting pain and disability following whiplash. Exercise is more effective for subjects with higher baseline pain and disability.
To evaluate whether long-term neck and upper body exercises conducted in economical community-based outpatient clinic and home-based settings could improve health-related quality of life (HRQoL)for individuals affected by chronic neck pain. The effect of baseline HRQoL and neck pain values on training adherence was also studied.
METHODS:
Subjects (n = 101, 91 women/10 men, mean age 41.0 ± 9.5 years) with chronic non-specific neck pain were randomized to a combined strength-training and stretching-exercise group (CSSG, n = 49) or to a stretching exercise group (SG, n = 52). HRQoL was assessed at baseline and after 12 months using the RAND-36 questionnaire. Comparisons between groups were performed using bootstrap-type analysis of covariance. The impact of HRQoL and neck pain values on training adherence, determined using participants' exercise logs, was studied using generalized estimating equations.
RESULTS:
CSSG showed significant improvements in five and SG in four of eight of the HRQoL dimensions. There were no significant differences between the groups. Adherence to long-term training was only slightly affected by baseline-assessed HRQoL and neck pain values.
CONCLUSIONS:
The two training protocols were feasible and equally effective in improving HRQoL. Baseline HRQoL and pain values had only a minor effect on training adherence.
IMPLICATIONS FOR REHABILITATION:
• Long-term strength training and stretching are effective in improving HRQoL in people with chronic neck pain. • Baseline HRQoL and neck pain values have little effect on training adherence.
