title: Is tailored treatment superior to non-tailored treatment for pain and disability in women with non-specific neck pain? A randomized controlled trial.
abstract: The evidence for the effect of treatments of neck pain is modest. In the absence of causal treatments, a possibility is to tailor the treatment to the individuals' functional limitations and symptoms. The aim was to evaluate treatment effects of a tailored treatment versus a non-tailored treatment. Our hypothesis was that tailored treatment (TT) would have better effect on pain intensity and disability than either non-tailored treatment (NTT) (same treatment components but applied quasi-randomly) or treatment-as-usual (TAU) (no treatment from the study, no restrictions). We further hypothesized that TT and NTT would both have better effect than TAU.
  
  
  
  One hundred twenty working women with subacute and chronic non-specific neck pain were allocated to 11 weeks of either TT, NTT or TAU in a randomized controlled trial with follow-ups at 3, 9 and 15 months. The TT was designed from a decision model based on assessment of function and symptoms with defined cut-off levels for the following categories: reduced cervical mobility, impaired neck-shoulder strength and motor control, impaired eye-head-neck control, trapezius myalgia and cervicogenic headache. Primary outcomes were pain and disability. Secondary outcomes were symptoms, general improvement, work productivity, and pressure pain threshold of m. trapezius.
  
  
  
  Linear mixed models analysis showed no differences between TT and NTT besides work productivity favoring TT at 9- and 15-months follow-ups. TT and NTT improved significantly more than TAU on pain, disability and symptoms at 3-month follow-up. General improvement also favored TT and NTT over TAU at all follow-ups.
  
  
  
  Tailored treatment according to our proposed decision model was not more effective than non-tailored treatment in women with subacute and chronic neck pain. Both tailored and non-tailored treatments had better short-term effects than treatment-as-usual, supporting active and specific exercise therapy, although therapist-patient interaction was not controlled for. Better understanding of the importance of functional impairments for pain and disability, in combination with a more precise tailoring of specific treatment components, is needed to progress.
  
  
  
  Current Controlled Trials ISRCTN 49348025. Registered 2 August 2011.
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87, Umeå, Sweden. asa.svedmark@umu.se.
authors.forename: Åsa
authors.identifier: 0000-0003-4485-3868
authors.initials: Å
authors.lastname: Svedmark
authors.affiliation: Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Djupsjöbacka
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87, Umeå, Sweden.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Häger
authors.affiliation: Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, QLD, 4072, Australia.
authors.forename: Gwendolen
authors.initials: G
authors.lastname: Jull
authors.affiliation: Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87, Umeå, Sweden.|Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Björklund
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000628:therapy*; D006233:Persons with Disabilities; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019547:Neck Pain / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D017288:Pain Threshold; D057285:Precision Medicine / Q000379:methods*; D011369:Professional-Patient Relations; D012782:Shoulder; D016896:Treatment Outcome
keywords: Cut-off; Individualized treatment; Neck-shoulder pain; Physiotherapy; Rehabilitation; Trapezius