Active treatment of chronic neck pain: a prospective randomized intervention.
METHODS
A randomized comparative study with single-blind outcome assessments.


OBJECTIVE
To compare the efficacy of a multimodal treatment emphasizing proprioceptive training (ACTIVE) with activated home exercises (HOME) and recommendation of exercise (CONTROL) in patients with nonspecific chronic neck pain.


BACKGROUND
The efficacy of active exercises and passive physiotherapy for neck trouble has been somewhat disappointing in the previous few studies.


METHODS
Seventy-six patients (22 men, 54 women) with chronic, nonspecific neck pain participated. Sixty-two participated the 1-year follow-up. Subjective pain and disability, cervical ranges of motion, and pressure pain threshold in the shoulder region were measured at baseline, at 3 months, and at 12 months. The ACTIVE treatment consisted of 24 sessions of proprioceptive exercises, relaxation, and behavioral support. The HOME regimen included a neck lecture and two sessions of practical training for home exercises and instructions for maintaining a diary of progress. The CONTROL treatment included a lecture regarding care of the neck with a recommendation to exercise.


RESULTS
The average self-experienced total benefit was highest in the ACTIVE group, and the HOME group rated over the CONTROL group (P < 0.001). Differences between the groups in favor of the ACTIVE treatment were recorded in reduction of neck symptoms and improvements in general health and self-experienced working ability (P < 0.01-0.03). Changes in measures of mobility and pressure pain threshold were minor.


CONCLUSIONS
Regarding self-experienced benefit, the multimodal treatment was more efficacious than activated home exercises that were clearly more efficacious than just advising. No major differences were noted in objective measurements of cervical function between the groups, but the content validity of these assessments in chronic neck trouble can be questioned.
Taimela
S
S
DBC International, Vantaa; the Unit for Sports and Exercise Medicine, Institute of Biomedicine, University of Helsinki, Finland.
Takala
E P
EP
Asklöf
T
T
Seppälä
K
K
Parviainen
S
S
D000328:Adult; D002908:Chronic Disease; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D010147:Pain Measurement; D017288:Pain Threshold; D010349:Patient Compliance; D011434:Proprioception; D011446:Prospective Studies; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome