Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain? A randomised control trial with a 4-month follow up.
OBJECTIVE
To investigate the effect of combining pain education, specific exercises and graded physical activity training (exercise) compared with pain education alone (control) on physical health-related quality of life (HR-QoL) in chronic neck pain patients.


METHODS
A multicentre randomised controlled trial of 200 neck pain patients receiving pain education. The exercise group received additional exercises for neck/shoulder, balance and oculomotor function, plus graded physical activity training. Patient-reported outcome measures (Short Form-36 Physical and Mental component summary scores, EuroQol-5D, Beck Depression Inventory-II, Neck Disability Index, Pain Bothersomeness, Patient-Specific Functioning Scale, Tampa Scale of Kinesiophobia, Global Perceived Effect) and clinical tests (Aastrand Physical Fitness, cervical Range of Motion, Pressure Pain Threshold at infraspinatus, tibialis anterior and cervical spine, Cranio-cervical Flexion, Cervical Extension muscle function, and oculomotion) were recorded at baseline and after 4 months.


RESULTS
The exercise group showed statistically significant improvement in physical HR-QoL, mental HR-QoL, depression, cervical pressure pain threshold, cervical extension movement, muscle function, and oculomotion. Per protocol analyses confirmed these results with additional significant improvements in the exercise group compared with controls.


CONCLUSIONS
This multimodal intervention may be an effective intervention for chronic neck pain patients.


BACKGROUND
The trial was registered on www.ClinicalTrials.govNCT01431261 and at the Regional Scientific Ethics Committee of Southern Denmark S-20100069.
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Metropolitan University College, Tagensvej 18, 2200 Copenhagen N, Denmark. Electronic address: iris@health.sdu.dk.
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Ris
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
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Søgaard
Institute of Regional Health Research: Centre of South West Jutland, Finsensgade 35, 6700 Esbjerg, Denmark.
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Gram
Spine Centre, Medical Department, Regionshospitalet Silkeborg, Falkevej 1-3, 8600 Silkeborg, Denmark.
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Agerbo
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, M5T 3M7, Canada.
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Boyle
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Bergen University College, Institute of Occupational Therapy, Physiotherapy and Radiography, Department of Health Sciences, 5020 Bergen, Norway.
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Juul-Kristensen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000503:physiopathology* / Q000628:therapy*; D059408:Pain Management; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D011788:Quality of Life
Chronic neck pain; Exercise; Graded activity; Pain education