title: Effect of therapeutic exercise and sleeping neck support on patients with chronic neck pain: a randomized clinical trial.
abstract: 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);
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Physical Therapy, Elborn College, University of Western Ontario, London, Ontario, Canada.
authors.forename: Antoine
authors.initials: A
authors.lastname: Helewa
authors.forename: Charles H
authors.initials: CH
authors.lastname: Goldsmith
authors.forename: Hugh A
authors.initials: HA
authors.lastname: Smythe
authors.forename: Peter
authors.initials: P
authors.lastname: Lee
authors.forename: Kathy
authors.initials: K
authors.lastname: Obright
authors.forename: Larry
authors.initials: L
authors.lastname: Stitt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000517:prevention & control / Q000628:therapy*; D009989:Orthotic Devices; D010147:Pain Measurement / Q000379:methods*; D004856:Postural Balance; D011446:Prospective Studies; D016683:Supine Position; D016896:Treatment Outcome