Active treatment of chronic neck pain - A prospective randomized intervention

Study Design. A randomized comparative study with single-blind outcome asse ssments. Objectives. To compare the efficacy of a multimodal treatment emphasizing p roprioceptive training (ACTIVE) with activated home exercises (HOME) and re commendation of exercise (CONTROL) in patients with nonspecific chronic nec k pain. Summary of Background Data. The efficacy of active exercises and passive ph ysiotherapy for neck trouble has been somewhat disappointing in the previou s few studies. Methods. Seventy-six patients (22 men, 54 women) with chronic, nonspecific neck pain participated. Sixty-two participated the 1-year follow-up. Subjec tive pain and disability, cervical ranges of motion, and pressure pain thre shold in the shoulder region were measured at baseline, at 3 months, and at 12 months. The ACTIVE treatment consisted of 24 sessions of proprioceptive exercises, relaxation, and behavioral support. The HOME regimen included a neck lecture and two sessions of practical training for home exercises and instructions for maintaining a diary of progress. The CONTROL treatment in cluded a lecture regarding care of the neck with a recommendation to exerci se. Results, The average self-experienced total benefit was highest in the ACTI VE group, and the HOME group rated over the CONTROL group (P < 0.001). Diff erences between the groups in favor of the ACTIVE treatment were recorded i n reduction of neck symptoms and improvements in general health and self-ex perienced working ability (P < 0.01-0.03). Changes in measures of mobility and pressure pain threshold were minor. Conclusions. Regarding self-experienced benefit, the multimodal treatment w as more efficacious than activated home exercises that were clearly more ef ficacious than just advising. No major differences were noted in objective measurements of cervical function between the groups, but the content valid ity of these assessments in chronic neck trouble can be questioned.