Differences in response between traumatic and non-traumatic chronic neck pain patients in a multimodal intervention?

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Abstract title: Do traumatic and non-traumatic chronic neck pain patients respond different on a combination of pain education, exercises and training? Authors: Inge Ris, Karen Søgaard, Bibi Gram, Karina Agerbo, Eleanor Boyle, Birgit Juul-Kristensen Background: Previous studies have investigated the effect of a variety of multimodal approaches for patients with chronic neck pain. However, the effect of specific exercises combined with graded physical activity training and pain education, measured on Health Related Quality of Life (HR-QoL) is unknown. Also, possible differences between traumatic and non-traumatic chronic neck pain patients in response to such a treatment are unknown. Question: Does a combination of pain education, specific exercises and graded physical activity training compared with pain education alone improve physical HR-QoL in chronic neck pain patients? Do patients with a traumatic onset respond differently to this intervention compared to those with non-traumatic onset? Methods: A two-armed multicentre randomised controlled trial including 200 patients with neck pain was performed, comparing two interventions: pain education (control group) versus pain education and additional exercises for neck/shoulder, balance and oculomotor function, plus graded physical activity training (exercise group). Patient-reported outcome measures (Short Form-36 Physical and Mental Component Summary – SF36-PCS and SF36-MCS, 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 (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 4-months follow-up. Statistical analyses were based on ‘intention-to-treat’ principles, with missing data replaced using the ‘Baseline Observation Carried Forward’ technique, in addition a ‘per protocol’ analysis was performed, based on participants with 75%’ adherence to the allocated intervention. Regression analyses were used, adjusted for sex. Logistic regression analyses were used for binary variables and ordinal regression analyses for ordinal variables. Significant statistical differences were defined as p-values <0.05 Results: The exercise group (n=101) showed statistically significant improvements 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. The improvement in physical HR-QoL was a mean change from baseline (baseline: 35.0 for traumatic and 36.1 for non-traumatic chronic neck pain patients) for non-traumatic patients of 4.6 and for traumatic patients of 1.4 on SF36-PCS and 0.2 and 3.5 respectively on SF36-MCS. Discussion: The change in HR-QoL is statistically significant. The minimal clinically important difference of SF-36-PCS is reported in other patients groups varying from 2.0 to 4.1. The minimal clinically important difference of SF36-PCS is not established in the population of this study, therefore the clinical relevance of the outcome is unknown. Conclusions: This multimodal intervention should be considered as intervention for patients with chronic neck pain with focus on increased HR-QoL. Traumatic chronic neck pain patients may experience a larger impact on mental HR-QoL and the non-traumatic group a larger impact on physical HR-QoL.
Original languageEnglish
Publication date14. Sep 2017
Publication statusPublished - 14. Sep 2017
Event2017 International Back and Neck Pain Research Forum - Oslo, Norway
Duration: 12. Sep 201715. Sep 2017


Conference2017 International Back and Neck Pain Research Forum
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