PHYSICAL THERAPY & REHAB
Evaluation of pain and function after two home exercise programs in a clinical trial on women with chronic neck pain - with special emphasises on completers and responders
This report has been verified
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)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
2/4
Randomization
2/4
Outcome Measurements
3/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
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.
主な研究課題は何ですか？
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?
重要な知見は？
- 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.
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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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