Home-based strength and stretching exercises for chronic neck pain yield similar outcomes .
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by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(8):26 BMC Musculoskelet Disord. 2014 Jan 8;15(1):6. doi: 10.1186/1471-2474-15-657 female patients with chronic neck pain were randomized to undergo either a home-based strength exercise program or stretching exercise program for one-year. The two interventions were compared with respect to changes in neck pain intensity and function. No significant difference was found in either neck pain intensity or function between the treatment groups at the 4-6 and 12-month follow-up assessments. A similar finding was observed when only completers who adhered to the exercise programs were considered. Although the exercise programs were safe, participant adherence rates for both interventions were low, especially after 6 months.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
2/4
Aleatorización
2/4
Medición de resultados
3/4
Inclusión / exclusión
4/4
Descripción de la terapia
4/4
Estadísticas
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
Chronic neck pain, with a prevalence rate of 20-60%, is a debilitating condition that can gravely affect an individual's quality of life. Previous studies have examined the effect of specific exercises which aim to improve pain and function, however the optimal exercise type and dosage has not yet been established. As patients with chronic neck pain are found to have weaker neck muscles when compared to controls, strengthening exercises have been proposed as an effective method of treatment for this condition. No study has previously evaluated the outcomes and adherence rates using only home-based treatments programs for neck pain. Therefore, this study was conducted to compare the effectiveness of two one-year home-based exercise programs with respect to neck pain intensity and neck function.
Was war die wichtigste Forschungsfrage?
In women with chronic neck pain, how does a one-year, home-based muscle strengthening program compare to a one-year, home-based muscle stretching program with regards to neck pain intensity and neck function?
- From baseline to the 4 to 6-month follow-up, function on the NDI (neck function) significantly improved within the strength group (median difference: 2 (0, 5.5); p=0.036), but not within the stretch group (median difference: 1 (-2, 4); p>0.05). Neck and shoulder pain did not significantly improve in either group when assessed at 4-6 months (p>0.05).
- At the 4 to 6-month follow-up, there were no significant differences between groups with respect to improvement in pain intensities (p=0.59 to 0.93) and neck function (p=0.50). For secondary outcomes, although there were no between-group differences observed in range of motion (except for left neck rotation; p=0.01) (p=0.38 to 0.99), or neck strength (p=0.09 to 0.52), the strength group exhibited significantly better improvements in shoulder abduction (p=0.04) and standing row (p=0.02).
- From baseline to the 12-month follow-up, function on the NDI significantly improved within both groups (strength: p=0.002; stretch: p=0.015). Following the same timeline, neck and shoulder pain were significantly improved within the stretch group (p=0.009 and p=0.017, respectively), but not within the strength group (p>0.05).
- At 12 months, there were no significant differences between groups in neck pain intensity improvements (p=0.50 to 0.91), or function (p=0.71). For secondary outcomes, the strength group produced significantly better results for flexion strength of the neck (p=0.031), shoulder abductions (p=0.01) and standing row (p</=0.00). There were no between-group differences in range of motion (p=0.15 to 0.65) or neck strength (p=0.09).
- At the 4-6-month follow-up, the strength group was performing exercises 1.5-2.5 times per week, with exercise frequency being 1.5 times/week or less thereafter. In the stretch group at the 4-6-month follow-up, exercises were being performed at least 2 times per week. Until month 10, the stretch group was exercising at a frequency of 1.5 times/week or more, and exercise frequency was <1.5 times/week thereafter.
- There was no significant difference between groups in the number of completers at 4-6 months (strength: 79%; stretch: 89%; p=0.28) or at 12 months (strength: 55%; stretch: 53%; p=0.90). Among the completers, at 12 months, there was no significant difference between groups in the proportion of responders for neck pain (strength: 45%; stretch: 40%; p=0.41), shoulder pain (strength: 55%; stretch: 50%; p=0.64), or function (strength: 55%; stretch: 20%; p=0.07).
- There were no intervention-related adverse events or harms reported in either group.
Was sollte ich mir besonders merken?
Neck pain intensity and neck function were similar at both the 4-6- and 12-month follow-up assessments, whether participants underwent a home based strength or stretching exercise program. A similar finding was observed when only completers of the exercise program were considered. Although the exercise programs were safe, participant adherence was low, especially after 6 months.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
This study found that a one-year, home-based strength exercise program yielded similar improvements in pain relief and neck function as a stretching exercise program. However, this finding could be due to the lack of statistical power. As such, additional high-quality studies are needed to confirm these results. Future studies should focus on factors for improving adherence rates for home-based exercise programs.
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