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Resistance training vs general physical exercise in multidisciplinary rehabilitation of chronic neck pain: a randomized controlled trial

Resistance training vs general physical exercise in multidisciplinary rehabilitation of chronic neck pain: a randomized controlled trial Resistance training vs general physical exercise in multidisciplinary rehabilitation of chronic neck pain: a randomized controlled trial
Resistance training vs general physical exercise in multidisciplinary rehabilitation of chronic neck pain: a randomized controlled trial Resistance training vs general physical exercise in multidisciplinary rehabilitation of chronic neck pain: a randomized controlled trial

Neck pain in its chronic state contributes to the socio-economic and personal disability across the globe. More efficient ways of management are needed to be identified.

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Key take away

The study provides no insight in favor of replacing general physical exercise with progressive resistance training in multidisciplinary rehabilitation of chronic neck pain

Background

Neck pain in its chronic state contributes to the socio-economic and personal disability across the globe. More efficient ways of management are needed to be identified. . The previous research results indicate the effectiveness of progressive resistance training (PRT) of the shoulder and neck muscles in the management of this chronic condition. However, a recent Cochrane review raises questions on the degree of evidence available to make clear recommendations based on these studies. It has been suggested that PRT targeting whole-body muscle strength could be more beneficial than specific back exercises in low back pain due to overall improved physical functioning. It can be the case of persons with chronic neck pain, as this condition can lead to pain in other body regions, and patients with chronic pain are often deconditioned.

Multidisciplinary rehabilitation (MDR) which includes general physical exercises (GPE), group discussions, patient education and individual meetings with the therapist is often used to address physical and psychosocial aspects of chronic neck patients. In some countries, e.g. in Norway, exercise therapy is given according to patient’s interest and high-intensity strength training is generally not included in the exercise therapy regimen. One advantage of replacing GPE with PRT is that while conventional training pieces of equipment take a lot of space, PRT can be performed easily at home or in small clinics using elastic resistance bands.


Rationale behind research


  • Previous studies have evaluated the beneficial effects of progressive resistance training (PRT) in the management of chronic neck pain, but there are insufficient recommendations for the use of PRT. The recent randomized controlled trial has elucidated the role of progressive resistance training as compared to general physical exercises in the treatment of chronic neck pain.


Objective


This study is conducted to compare the effects of progressive resistance training using elastic resistance bands with general physical exercise on the improvement in neck-related disability and rehabilitation of chronic neck pain.


Method


Study outcomes

  • Baseline: Patient demographic characteristics were evaluated at baseline

  • Primary outcomes: The primary outcome includes assessment of the between-group difference in change in the Neck Disability Index from baseline to 12 weeks

  • Secondary outcomes: The secondary outcomes include assessment of the between-group difference in NDI from baseline to 3 & 12 weeks for NPRS, Hopkins symptoms checklist, Work Ability Index, EQ-5D, Fear-Avoidance Beliefs Questionnaire, pressure pain threshold, patient-specific functioning scale, neck flexor and extensor MVC strength

Time Points: 3-12 weeks


Result


Outcomes

    Baseline: No significant differences were observed at baseline

      Study outcomes:

        • At 12-week follow-up from baseline, there was no statistically notable difference observed between the primary outcomes and NDI among the study groups (Fig 2.)


        • There were no statistically significant differences found between secondary outcomes at 3 and 12 weeks, including NPRS, Hopkins symptoms checklist, Work Ability Index, EQ-5D, Fear-Avoidance Beliefs Questionnaire, pressure pain threshold, patient-specific functioning scale, extensor MVC strength and neck flexor

        Conclusion

        These trial results imply that replacing GPE with PRT using elastic resistance bands in MDR for the improvement of neck pain-related disability was not associated with any significant advantage. There is a need for future trials with a higher number of participants that can investigate whether progressive resistance training was effective in reducing pain more than the general physical exercises.  

        Limitations

          • The study was unable to reach the desired number of participants which might increase the probability for a type II error
          • The study only included patients with specialized back and neck pain unit. Therefore these study results cannot be applied to other populations 

            Clinical take-away

            The present randomized study advises the clinicians to recommend the use of either of these exercise types in the management of moderate to severe type non-specific neck pain based on the patient's interests and motivation.

            Source:

            J Rehabil Med 2018; 50: 743–750

            Article:

            Resistance training vs general physical exercise in multidisciplinary rehabilitation of chronic neck pain: A randomized controlled trial

            Authors:

            Vegard Moe Iversen et al.

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