title: Group-based multimodal exercises integrated with cognitive-behavioural therapy improve disability, pain and quality of life of subjects with chronic neck pain: a randomized controlled trial with one-year follow-up.
abstract: OBJECTIVE
  To evaluate the effect of a group-based multidisciplinary rehabilitation programme on disability, pain and quality of life in subjects with chronic neck pain.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Specialized rehabilitation centre.
  
  
  METHODS
  A total of 170 patients (mean age of 53 years (13); 121 females).
  
  
  METHODS
  The multidisciplinary group underwent a multidisciplinary rehabilitation programme combining multimodal exercises with psychologist-lead cognitive-behavioural therapy sessions. The general exercise group underwent general physiotherapy. Both groups followed group-based programmes once a week for ten weeks. Additionally, the multidisciplinary group met with the psychologist once a week for a 60-minute session.
  
  
  METHODS
  The Neck Disability Index (primary outcome), the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, a pain numerical rating scale and the Short-Form Health Survey. The participants were evaluated before, after training and after 12 months.
  
  
  RESULTS
  A linear mixed model for repeated measures was used for each outcome measure. Significant effects ( p-value <0.001) were found over time and between groups for all outcome measures. After training, significant improvements were found for both groups for all outcome measures except kinesiophobia and catastrophizing, which did not change in the control group; however, the improvements were significantly greater for the multidisciplinary group. At 12-month follow-up a clinically meaningful between-group difference of 12.4 Neck Disability Index points was found for disability.
  
  
  CONCLUSIONS
  A group-based multidisciplinary rehabilitation programme including cognitive-behavioural therapy was superior to group-based general physiotherapy in improving disability, pain and quality of life of subjects with chronic neck pain. The effects lasted for at least one year.
authors.affiliation: 1 Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy.|2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation IRCCS, Lissone, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Monticone
authors.affiliation: 2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation IRCCS, Lissone, Italy.|3 Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Ambrosini
authors.affiliation: 2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation IRCCS, Lissone, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Rocca
authors.affiliation: 2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation IRCCS, Lissone, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Cazzaniga
authors.affiliation: 2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation IRCCS, Lissone, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Liquori
authors.affiliation: 3 Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pedrocchi
authors.affiliation: 4 Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
authors.forename: Howard
authors.initials: H
authors.lastname: Vernon
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000534:rehabilitation*; D010147:Pain Measurement; D010348:Patient Care Team / Q000458:organization & administration; D011788:Quality of Life; D012047:Rehabilitation Centers; D018570:Risk Assessment; D013647:Task Performance and Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Chronic neck pain; cognitive-behavioural therapy; randomized controlled trial; rehabilitation; task-oriented exercises