Patient-oriented rehabilitation in the management of chronic mechanical neck pain: a randomized controlled trial
Paoloni, M.; Tavernese, E.; Cacchio, A.; Tattoli, M.; Melis, L.; Ronconi, R.; Santilli, V.
European Journal of Physical and Rehabilitation Medicine 49(3): 273-281
2013
ISSN/ISBN: 1973-9095 PMID: 23172400 Document Number: 666150
Management of chronic mechanical neck pain (CMNP) still represents a challenge. A patient-oriented (Pa-O) therapeutic approach could be considered as the one in which therapies are scheduled at the start of each therapeutic session according to the patient's current physical status, and differs from a prescription-oriented (Pr-O) therapeutic approach, in which therapies are prescribed at the first medical referral and are not adjusted at any time during the treatment period. To determine if a Pa-O approach may be more beneficial for CMNP patients when compared to a Pr-O one. Randomized controlled trial. 220 CMNP outpatients randomized to either Pa-O group (N.=114) or Pr-O group (N.=106). Each group received 10 therapeutic sessions over 3 weeks. Primary outcome measures were pain assessment, evaluated by Visual-Analog-Scale (VAS), and disability level, evaluated by the Neck Pain and Disability Scale (NPDS-I). Secondary outcome measures included patients' response to treatment and treatment failures. Measurements were carried out at baseline (T0) and 1 month after treatment ended (T1). Data were analysed according to the intention-to-treat principle. Patients in both groups displayed at T1 a significant reduction in VAS and NPDS-I scores. The relative changes at T1 were greater in Pa-O group when compared with Pr-O group both for VAS (61.5% versus 48.8%; P<0.005) and for NPDS-I scores (48.4% versus 36.8%; P<0.05). A Pa-O approach may be more beneficial in terms of pain and disability improvement in the short-term follow-up in suffers from CMNP. However, the occurrence of a performance-bias due to the increased level of attention from physicians to patients in Pa-O group, cannot be ruled-out. A Pa-O approach should be considered for CMNP also in an outpatient facility.