title: Patient-oriented rehabilitation in the management of chronic mechanical neck pain: a randomized controlled trial.
abstract: BACKGROUND
  Management of chronic mechanical neck pain (CMNP) still represents a challenge. A patient-oriented (Pa-O) therapeutic approach could be considered as the one in which therapies are scheduled at the start of each therapeutic session according to the patient's current physical status, and differs from a prescription-oriented (Pr-O) therapeutic approach, in which therapies are prescribed at the first medical referral and are not adjusted at any time during the treatment period.
  
  
  OBJECTIVE
  To determine if a Pa-O approach may be more beneficial for CMNP patients when compared to a Pr-O one.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  220 CMNP outpatients randomized to either Pa-O group (N.=114) or Pr-O group (N.=106).
  
  
  METHODS
  Each group received 10 therapeutic sessions over 3 weeks. Primary outcome measures were pain assessment, evaluated by Visual-Analog-Scale (VAS), and disability level, evaluated by the Neck Pain and Disability Scale (NPDS-I). Secondary outcome measures included patients' response to treatment and treatment failures. Measurements were carried out at baseline (T0) and 1 month after treatment ended (T1). Data were analysed according to the intention-to-treat principle.
  
  
  RESULTS
  Patients in both groups displayed at T1 a significant reduction in VAS and NPDS-I scores. The relative changes at T1 were greater in Pa-O group when compared with Pr-O group both for VAS (61.5% versus 48.8%; P<0.005) and for NPDS-I scores (48.4% versus 36.8%; P<0.05).
  
  
  CONCLUSIONS
  A Pa-O approach may be more beneficial in terms of pain and disability improvement in the short-term follow-up in suffers from CMNP. However, the occurrence of a performance-bias due to the increased level of attention from physicians to patients in Pa-O group, cannot be ruled-out.
  
  
  CONCLUSIONS
  A Pa-O approach should be considered for CMNP also in an outpatient facility.
authors.affiliation: Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy. paolonim@tin.it
authors.forename: M
authors.initials: M
authors.lastname: Paoloni
authors.forename: E
authors.initials: E
authors.lastname: Tavernese
authors.forename: A
authors.initials: A
authors.lastname: Cacchio
authors.forename: M
authors.initials: M
authors.lastname: Tattoli
authors.forename: L
authors.initials: L
authors.lastname: Melis
authors.forename: R
authors.initials: R
authors.lastname: Ronconi
authors.forename: V
authors.initials: V
authors.lastname: Santilli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000534:rehabilitation*; D010147:Pain Measurement; D012046:Rehabilitation / Q000379:methods; D055815:Young Adult