title: Manual Therapy, Therapeutic Patient Education, and Therapeutic Exercise, an Effective Multimodal Treatment of Nonspecific Chronic Neck Pain: A Randomized Controlled Trial.
abstract: OBJECTIVE
  The aim of this study was to determine the effectiveness of a multimodal treatment in the short and medium term for disability in nonspecific chronic neck pain.
  
  
  METHODS
  The design of this study is a single-blinded randomized controlled trial carried out in a university research laboratory. Forty-five patients between 18 and 65 yrs with nonspecific chronic neck pain were included in this study. Each patient was treated eight times over a 4-wk period. The sample was divided into three groups: control group, subjected to a protocol of manual therapy; experimental group 1, subjected to a protocol of manual therapy and therapeutic patient education; and experimental group 2, subjected to manual therapy, therapeutic patient education, and a therapeutic exercise protocol. Assessments were performed at baseline and at 4, 8, and 16 wks using the following measurements: the Neck Disability Index, the 11-item Tampa Scale of Kinesiophobia, the Fear Avoidance Beliefs Questionnaire, the Neck Flexor Muscle Endurance Test, and the Visual Analog Fatigue Scale.
  
  
  RESULTS
  The nonparametric Kruskal-Wallis test for the Neck Disability Index showed statistically significant differences between baseline outcomes and all follow-up periods (P < 0.01). In the Kruskal-Wallis test, differences were found for the Visual Analog Fatigue Scale and the Neck Flexor Muscle Endurance Test in the follow-ups at 8 and 16 wks (P < 0.05). Analysis of variance for group × time interaction showed statistically significant changes (Tampa Scale of Kinesiophobia, F = 3.613, P = 0.005; Fear Avoidance Beliefs Questionnaire, F = 2.803, P = 0.022). Minimal detectable changes were obtained in both experimental groups for the 11-item Tampa Scale of Kinesiophobia but not in the control group.
  
  
  CONCLUSIONS
  Differences between experimental groups and the control group were found in the short and medium term. A multimodal treatment is a good method for reducing disability in patients with nonspecific chronic neck pain in the short and medium term.
authors.affiliation: From the Department of Physiotherapy, Faculty of Health Science (HB-A, IL-d-U-V, RLT), and Research Group on Movement and Behavioural Science and Study of Pain (HB-A, IL-d-U-V, JF-C, RLT), The Center for Advanced Studies University La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain; Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain (HB-A, IL-d-U-V, JF-C, RLT); Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain (IL-d-U-V, JF-C, RLT); and Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain (JF-C).
authors.forename: Hector
authors.initials: H
authors.lastname: Beltran-Alacreu
authors.forename: Ibai
authors.initials: I
authors.lastname: López-de-Uralde-Villanueva
authors.forename: Josué
authors.initials: J
authors.lastname: Fernández-Carnero
authors.forename: Roy
authors.initials: R
authors.lastname: La Touche
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D019547:Neck Pain / Q000534:rehabilitation*; D010353:Patient Education as Topic; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult