The effectiveness of a supervised physical training model tailored to the individual needs of patients with whiplash-associated disorders--a randomized controlled trial

OBJECTIVE: To evaluate the effects of a physical training programme which is supervised and tailored to meet the needs of patients with subacute whiplash-associated disorders. DESIGN: A randomized controlled trial with follow-up at three and nine months after randomization. SETTING: An interdisciplinary rehabilitation centre. SUBJECTS: Forty-seven patients with subacute disorders following a whiplash trauma. INTERVENTIONS: Patients were randomized to a supervised training group or a self-administered home training group. MAIN MEASURES: Primary outcome measures were the Self-Efficacy Scale, the Tampa Scale for Kinesiophobia and the Pain Disability Index. Secondary outcome measures were neck pain intensity, sensory and affective dimensions of pain, pain location and duration, muscle tenderness, grip strength, cervical mobility, sick leave and analgesic consumption. RESULTS: Forty patients (85%) completed the intervention period, and the drop-outs were followed up by intention-to-treat. The results showed that supervised training was significantly more favourable than home training, with a more rapid improvement in self-efficacy (P = 0.03), fear of movement/(re)injury (P = 0.03) and pain disability (P = 0.03) at three months. Further, supervised training significantly reduced the frequency of analgesic consumption (P = 0.03). The improvements were partly maintained at nine months, even though there was no amelioration in pain and physical disorders. Despite the favourable outcome, supervised intervention did not reduce sick leave. CONCLUSIONS: The findings indicate a treatment approach that is feasible in the rehabilitation of patients with subacute whiplash-associated disorders in the short term, but additional research is needed to extend these findings and elucidate treatment strategies that also are cost effective.     

A cognitive-behavioral return-to-work program: effects on pain patients with a history of long-term versus short-term sick leave

A cognitive-behavioral return-to-work focused program was evaluated in a randomized controlled design, and the effects were compared between two groups of women with musculoskeletal pain. One group of patients (n=36) had a history of long-term sick leave (>12 months) at the start of the program and the other (n=36) had a history of short-term sick leave (2-6 months). The outpatient treatment program, conducted by a psychologist, included 12 sessions with the primary aim to help the patients return-to-work. The treatment first included teaching of coping strategies such as applied relaxation, stress management, graded activity training and pacing. Thereafter the patients were taught how to manage difficulties at their return-to-work and how to generalize coping strategies to different risk factors at their work places. The control condition received treatment-as-usual. The results showed that the cognitive-behavioral return-to-work program was more effective than the treatment-as-usual control condition in reducing the number of days on sick leave for patients on short-term sick leave, but not for patients on long-term sick leave. The treatment program also helped the patients on short-term sick leave to increase their ability to control and decrease pain and to increase their general activity level compared to the control condition. These results underscore the need for an early return-to-work focused rehabilitation to prevent long-term sick leave and disability.     

Cost-of-illness of neck pain in The Netherlands in 1996

The prevalence of neck pain in the general population ranges from 10 to 15%. The complaints can result in substantial medical consumption, absenteeism from work and disability. In this study we investigated the costs of neck pain in the Netherlands in 1996 to assess the financial burden to society. The study was based on prevalence data. Data sources included national registries, reports of research institutes and health care authorities. Direct health care costs were estimated for hospital care, general practice care and paramedical care. These costs were calculated using fees. Calculation of indirect costs (absenteeism and disability) was based on the Human Capital Method (HCM). As an alternative approach the Friction Cost Method (FCM) was used. The total cost of neck pain in The Netherlands in 1996 was estimated to be US $686 million. The share of these costs was about 1% of total health care expenditures and 0.1% of the Gross Domestic Product (GDP) in 1996. Direct costs were $160 million (23%). Paramedical care accounted for largest proportion of direct costs (84%). When applying the HCM for calculating indirect costs, these costs amounted to $527 million (77%). The total number of sick days related to neck pain were estimated to be 1.4 million with a total cost of $185.4 million in 1996. Disability for neck pain accounted for the largest proportion (50%) of the total costs related to neck pain in 1996 ($341). When applying the FCM for calculating the indirect costs, these costs were reduced to $96 million. The costs related to neck pain in 1996 in The Netherlands were substantial. Some caution should be taken in interpretation, as a number of assumptions had to be made in order to estimate the total costs. The cost structure shown in this study, with high indirect costs, has also been found in other studies. From an economical point of view it seems to be important to prevent patients from having to take sick leave and disability. One way in achieving this goal is to develop and investigate more effective treatments for acute neck pain, in order to prevent patients developing chronic pain and disability. Another option is to protect chronic patients from sick leave and disability by careful management. Thus, also in the area of direct medical costs, there may be room for cost savings by stimulating and improving cost-efficiency and cost-effectiveness of the (para)medical care. In order to deal with the lack of specific disease information, more detailed information of medical consumption, sick leave and disability is required for future cost analysis.     

Neck pain and disability: a cross-sectional survey of the demographic and clinical characteristics of neck pain seen in a rheumatology clinic

This hospital-based cross-sectional cohort study examines the clinical and demographic features of neck pain, disability (using the Northwick Park neck pain questionnaire) and relationships to handicap in employment. Of 173 consecutive referrals to a rheumatology clinic with neck pain, 70% had neck/arm pain without neurological involvement, 13% other conditions, 11% nerve involvement and 5% other spinal pain. 141 patients (mean age 50 years) had mechanical or degenerative neck pain, of which 13% was probably work-related and 13% was trauma-related. 44 had taken sickness absence for an average of 30 weeks. Comorbidities were frequent (lumbar pain 51%). Those in work were significantly less disabled than those not working (p = 0.001) and those off sick (p < 0.01). Those reporting sleep disturbance, tearfulness and crying were significantly more disabled (p = 0.0001) than those who did not. Neck pain in secondary care is complicated by physical and emotional comorbidities. Comprehensive management requires a biopsychosocial model of care.     

Kopf-Nacken-Schulter-Arm-Beschwerden: arbeitsplatzbedingt?

Disorders of the supporting and locomotor apparatus, particularly the spinal column, rank first among causes for sick leave in Austria. They also represent the most important reason for early retirement. The cited frequency of painful disorders of the spine, especially the increase in pain syndromes involving the neck, shoulder, and arm region, not only calls for effective advancements in diagnostics and treatment of these conditions but also requires analysis of the underlying causes with a view to preventive measures. The aim of this study was to define the possible debilitating role of office or computer work. Noteworthy among the results is that in a group of 558 respective employees, only 4 had absolutely no complaints. There are significant differences between women and men regarding neck ailments. Women suffer more intensely from neck tension, which appears as early as 2–3 h after beginning work at a computer. Women also complain of significantly severer arm ailments and headaches. The extent of the complaints correlates significantly with fatigue, thus also affecting concentration and productivity. None of the subjects questioned had performed goal-oriented preventive exercises.     

Integrated health programme: a workplace randomized controlled trial

Title.  Integrated health programme: a workplace randomized controlled trial.
Aim.  This paper is the report of a pilot study to assess if an Integrated Health Programme would reduce sick leave and subjective health complaints, and increase coping in a population of nursing personnel.
Background.  The work group in Norway with most sick leave is healthcare workers. More than 50% of the sick leave is because of subjective health complaints. Work place physical exercise interventions have a documented positive effect on sick leave.
Method.  After baseline screening, employees who had agreed to participate ( n  = 40) were randomized to an intervention or control group. The intervention group participated in an Integrated Health Programme twice weekly during working hours. The programme consisted of physical exercise, stress management training, health information and an examination of the participants' workplace. The control group was offered the same intervention after the project was finished. This study was carried out from 2001 to 2002.
Findings.  There were no statistically significant effects on sick leave or health-related quality of life. The intervention group reported fewer neck complaints compared to the control group, but otherwise there were no effects on subjective health complaints. However, the subjective effects were large and highly statistically significant, the intervention group reporting improvement in health, physical fitness, muscle pain, stress management, maintenance of health and work situation.
Conclusion.  The Integrated Health Programme was not effective in reducing sick leave and subjective health complaints, but may be of use to employers wanting to increase employee job satisfaction and well-being.     

Back to work – a two-year outcome of a multidisciplinary rehabilitation programme focused on physical function and pain

Purpose. To analyze why some responded positively to rehabilitation and why some did not.

Method. Sixty participants with musculoskeletal disorders, mainly neck and back pain participated in a 7-week rehabilitation programme which was based on a combination of theoretical and practical education and physical activities. Before and after the programme and 6, 12 and 24 months after completion of the programme all participants were evaluated with the Disability Rating Index (DRI) and Pain Intensity Rating on a Visual analogue scale (VAS).

Results. In the participants who had full-time sick leave from the start of the programme to the 2-year follow-up (Group I) self-experienced physical disability and pain ratings were high and showed no decrease and were maintained up until the 2-year follow-up. For the participants who had part-time sick leave or no sick leave (Group II) physical disability and pain ratings were initially lower than in Group I and decreased gradually, (p < 0.01) and (p < 0.05), respectively throughout the 2-year follow-up period.

Conclusion. Participants in Group I did not benefit from the rehabilitation programme and did not show improvement in their physical disability and pain rating. Group II showed decreased physical disability and pain rating. The decrease was gradual and was maintained up until the 2-year follow-up period. These results may indicate that persons with musculoskeletal pain with severe disability and pain require other rehabilitation programmes than those with moderate symptoms. This research has highlighted the need for development of such programmes.     

A cognitive-behavioral group intervention as prevention for persistent neck and back pain in a non-patient population: a randomized controlled trial

Given the demand for interventions that may prevent the development of persistent musculoskeletal pain problems, we investigated the effects of a cognitive-behavioral program in a group of non-patients with neck or back pain symptoms. Two hundred and fifty-three people selected from a population study were invited to participate. These people had experienced four or more episodes of relatively intense spinal pain during the past year but had not been out of work more than 30 days. Participants were randomly assigned to either a cognitive-behavioral group intervention or a treatment as usual comparison group. The experimental group received a standardized six-session program, provided by a trained therapist according to a manual. A significant overall analysis at the 1-year follow-up showed that the cognitive-behavioral group produced better results on 26 of the 33 outcome variables. Group comparisons indicated that the cognitive-behavioral group, relative to the comparison group, had significantly better results with regard to fear-avoidance beliefs, number of pain-free days, as well as the key variable of sick leave. Participation in the cognitive behavioral group reduced the risk for long-term sick leave during the follow-up by threefold. Thus, despite the strong natural recovery rate for back pain, the cognitive-behavioral intervention produced a significant preventive effect with regard to disability.     

Traditional physical therapy exercises combined with sensorimotor training: The effects on clinical outcomes for chronic neck pain in a double-blind,randomized controlled trial

ObjectiveThis study examined the effects of combining traditional physical therapy exercises with sensorimotor training on joint position sense, pain, muscle endurance, balance and disability in patients with chronic, non-specific neck pain.DesignDouble-blind, randomized controlled trial.SubjectsA total of 53 patients with chronic non-specific neck pain were randomized to either traditional or combined exercise groups.InterventionsAll patients received 12 sessions of supervised intervention 3 times per week. The traditional group performed traditional exercises, and the combined exercise group performed sensorimotor training in addition to traditional exercises.Outcome measuresJoint position sense, pain, neck flexor muscle endurance test, 10 Meter Walk Test, step test, and the Neck Disability Index.ResultsThe combined exercise group showed significantly greater improvement compared to the traditional group in joint position sense during extension, flexion, right rotation, the 10 m walk test with head turn, and the step test. Pain intensity, muscle endurance, and disability improved in both groups. Additionally, there was a higher degree of effect on muscle endurance in the combined exercise group compared to a moderate effect in the traditional group.ConclusionsA combination of sensorimotor training with traditional physical therapy exercises could be more effective than traditional exercises alone in improving joint position sense, endurance, dynamic balance and walking speed.     

Characteristics of low back pain patients who do not complete physiotherapeutic treatment

Patients' problems in following recommendations of health professionals is an issue of great concern. The purpose of the present study was to investigate whether patients with low back pain (n = 46) who dropped out of a treatment programme differed in characteristics measured prior to treatment from a matched comparison group (n = 46) who completed the programme. Data collected on work disability and sick leave, frequency, duration and intensity of pain, physical function, and personality characteristics were compared. The results indicated that the groups differed significantly on 3 of 16 variables. The non-completers had been on sick leave for a longer time period prior to treatment, experienced more intense pain and performed at a lower level on the test of physical function than those who completed the treatment programme.     

Effect of Deep Cervical Flexor Muscles Training Using Pressure Biofeedback on Pain and Disability of School Teachers with Neck Pain

[Purpose] The job of secondary school teachers involves a lot of head down posture as frequent reading, assignment correction, computer use and writing on a board put them at risk of developing occupational related neck pain. Available studies of neck pain experienced by teachers are limited. The purpose of this study was to determine whether training of deep cervical flexor muscles with pressure biofeedback has any significant advantage over conventional training for pain and disability experienced by school teachers with neck pain. [Subjects] Thirty teachers aged 25–45 years with neck pain and poor craniocervical flexion test participated in this study. [Methods] A pretest posttest experimental group design was used in which experimental group has received training with pressure biofeedback and conventional exercises while control group received conventional exercises only. Measurements of dependent variables were taken at baseline, and after 2 and 4 weeks of training. Pain intensity was assessed using a numeric pain rating scale and functional disability was assessed using the neck disability index. [Results] The data analysis revealed that there was significant improvement in pain and disability in both the groups and the results were better in the experimental group. [Conclusion] Addition of pressure biofeedback for deep cervical flexor muscles training gave a better result than conventional exercises alone. Feedback helps motor learning which is the set of processes associated with practice or experience leading to permanent changes in ability to respond.Key words: Neck pain, Disability, Teachers     

A randomized study of new sling exercise treatment vs traditional physiotherapy for patients with chronic whiplash-associated disorders with unsettled compensation claims.

BACKGROUND: Many patients with chronic whiplash-associated disorders have reduced neuromuscular control of the neck and head. It has been proposed that a new sling exercise therapy may promote neuromuscular control of the neck. OBJECTIVES: To compare the effects of traditional physiotherapy vs traditional physiotherapy combined with a new sling exercise therapy on discomfort and function in patients with chronic whiplash-associated disorders who have unsettled compensation claims; and to investigate possible additional effects of guided, long-term home training. DESIGN: A randomized multi-centre trial with 4 parallel groups. METHODS: A total of 214 patients were assigned randomly to 4 treatment groups, and received either traditional physiotherapy with or without home training, or new sling exercise therapy with or without home training. Outcome measures were pain, disability, psychological distress, sick leave and physical tests. RESULTS: A total of 171 patients (80%) completed the study. There were no important statistical or clinical differences between the groups after 4 months of treatment. There was a small statistically significant effect at 12-month follow-up in both groups with home training regarding pain during rest (p = 0.05) and reported fatigue in the final week (p = 0.02). CONCLUSION: No statistically significant differences were found between the traditional physiotherapy group and the new sling exercise group, with or without home training. Since the groups were not compared with a control group without treatment, we cannot conclude that the studied treatments are effective for patients with whiplash-associated disorder, only that they did not differ in our study.     

Role of physical activity in the occurrence of falls and fall-related injuries in community-dwelling adults over 50 years old

Purpose.?There is no knowledge if short-term outcome in patients after anterior cervical decompression and fusion (ACDF) can be used to identify which patients have remaining deficit in long term. This study investigates if 6-month outcome with a broad assessment after ACDF with a cervical intervertebral fusion cage can be a guide for the 3-years outcome.

Method.?A prospective study. Questions about background data, pain, numbness, neck specific disability, distress, sick leave, health, symptom satisfaction and effect of and satisfaction with surgery were asked 28 patients 3 years after ACDF. Measurements have earlier been obtained before and 6 and 12 months after ACDF.

Results.?Compared with the results before surgery patients had improved in pain intensity (p = 0.001), neck pain (0.001), numbness (p = 0.02) and were more ‘satisfied’ with having their neck problems (p = 0.01). Except for a worsening in expectations of surgery fulfilled (p = 0.04) there were no significant differences between 6-month and 3-year outcome. Three years after ACDF about two-thirds of the patients had remaining deficit with regard to pain intensity, Neck Disability Index, Distress and Risk Assessment Method and general health. According to the parameters studied 50 – 78% of those who at the 6-month follow-up were without deficit were still healthy at the 3-year follow-up. For patients with deficit at 6-month follow-up, still 83 – 100% had deficit 3 years after surgery.

Conclusions.?Despite a rather small study obtained the stability of 6-month and 3-year results indicates that short-term results might be sufficient for evaluating effects of the treatment. Since the patients in this study clearly demonstrate broad problems array of development of more structured multi-professional rehabilitation models including exercises which improve neck muscle strength, endurance and proprioception need to be introduced.     

Secondary prevention of work-related disability in nonspecific low back pain: does problem-solving therapy help? A randomized clinical trial

OBJECTIVES: Given the individual and economic burden of chronic work disability in low back pain patients, there is a need for effective preventive interventions. The aim of the present study was to investigate whether problem-solving therapy had a supplemental value when added to behavioral graded activity, regarding days of sick leave and work status. DESIGN: Randomized controlled trial. PATIENTS AND SETTING: Employees who were recently on sick leave as a result of nonspecific low back pain were referred to the rehabilitation center by general practitioner, occupational physician, or rehabilitation physician. Forty-five employees had been randomly assigned to the experimental treatment condition that included behavioral graded activity and problem-solving therapy (GAPS), and 39 employees had been randomly assigned to behavioral graded activity and group education (GAGE). OUTCOME MEASURES: Days of sick leave and work status. Data were retrieved from occupational health services. RESULTS: Data analyses showed that employees in the GAPS group had significantly fewer days of sick leave in the second half-year after the intervention. Moreover, work status was more favorable for employees in this condition, in that more employees had a 100% return-to-work and fewer patients ended up receiving disability pensions one year after the intervention. Sensitivity analyses confirmed these results. CONCLUSIONS: The addition of problem-solving therapy to behavioral graded activity had supplemental value in employees with nonspecific low back pain.     

Internet-based rehabilitation for individuals with chronic pain and burnout: a randomized trial

This study investigates utilization of the Internet in the rehabilitation of people on long-term sick leave with chronic pain and/or burnout. Fifty-five people were randomly assigned to two groups: a treatment group (n = 27) that participated in a rehabilitation course over the Internet and a waiting list group (n = 28). The goals were to improve participants' health and increase quality of life, and, for those who were not on permanent disability pensions, to increase work capacity, if possible. A 20-week program, based on 19 films on different themes, was supplemented with written material and a Socratic dialogue over the Internet. Upon completion of the rehabilitation course, statistically significant improvements were observed in the treatment group in comparison to the waiting list group, for variables such as depression, pain, vitality, social function, performance problems involving work or other activities due to physical illness and the presence of stress symptoms. Thirteen of 23 individuals (57%) also increased their work capacity. The number needed to treat regarding recovering from anxiety and depression was 2. For increased work capacity, the number needed to treat was 3. Rehabilitation of people on long-term sick leave carried out over the Internet is a good complement to other rehabilitation programs.     

Long-term effect of direction-movement control training on female patients with chronic neck pain

Background

Treatment of movement faults in the neck is known as an important factor in treatment of chronic neck pain. Along with the identification of site and direction of the faults, direction-movement control intervention retrains the control of the movement faults.

The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach.

The aim of this study was to determine whether graded activity restored occupational function in industrial blue-collar workers who were sick-listed for 8 weeks because of subacute, nonspecific, mechanical low back pain (LBP). Patients with LBP, who had been examined by an orthopedic surgeon and a social worker, were randomly assigned to either an activity group (n = 51) or a control group (n = 52). Patients with defined orthopedic, medical, or psychiatric diagnoses were excluded before randomization. The graded activity program consisted of four parts: (1) measurements of functional capacity; (2) a work-place visit; (3) back school education; and (4) an individual, submaximal, gradually increased exercise program, with an operant-conditioning behavioral approach, based on the results of the tests and the demands of the patient's work. Records of the amount of sick leave taken over a 3-year period (ie, the 1-year periods before, during, and after intervention) were obtained from each patient's Social Insurance Office. The patients in the activity group returned to work significantly earlier than did the patients in the control group. The median number of physical therapist appointments before return to work was 5, and the average number of appointments was 10.7 (SD = 12.3). The average duration of sick leave attributable to LBP during the second follow-up year was 12.1 weeks (SD = 18.4) in the activity group and 19.6 weeks (SD = 20.7) in the control group. Four patients in the control group and 1 patient in the activity group received permanent disability pensions. The graded activity program made the patients occupationally functional again, as measured by return to work and significantly reduced long-term sick leave.     

Influence of modified work on return to work for employees on sick leave due to musculoskeletal complaints.

OBJECTIVE: To determine which individual and work-related factors are associated with performing modified work and to evaluate the influence of modified work on the duration of sick leave and health-related outcomes among employees with musculoskeletal complaints. STUDY DESIGN: A prospective study with 12 months follow-up. METHODS: In this prospective study a total of 164 employees on sick leave for 2-6 weeks due to musculoskeletal complaints completed 2 questionnaires. At baseline we gathered information about individual characteristics, physical and psychosocial workload, and disease specific and general health. The follow-up questionnaire, sent to respondents who returned to their original job on full duty, collected information about having performed modified work, and disease-specific and general health. RESULTS: Employees were less likely to perform modified work when their regular work was characterized by frequent lifting and their relationship with colleagues was less than good. Employees were more likely to return to modified work when they had a better mental health, had prolonged periods of standing in their regular job and had less skill discretion. Duration of sick leave was influenced by chronicity of complaints and disability, but not by modified work. CONCLUSION: Modified work, as the only advice given by a occupational health physician, did not influence the total duration of sick leave nor the improvement in health during sick leave for employees on sick leave due to musculoskeletal complaints.     

Development of a Neck Pain Risk Score for Predicting Nonspecific Neck Pain With Disability in Office Workers: A 1-Year Prospective Cohort Study

Objective

The purpose of this study was to develop a neck pain risk score for office workers (NROW) to identify office workers at risk for developing nonspecific neck pain with disability.

Methods

A 1-year prospective cohort study of 559 healthy office workers was conducted. At baseline, risk factors were assessed using questionnaires and standardized physical examination. The incidence of neck pain was collected every month thereafter. Disability level was evaluated using the neck disability index. Logistic regression was used to select significant factors to build a risk score. The coefficients from the logistic regression model were transformed into the components of a risk score.

Results

Among 535 (96%) participants who were followed up for 1 year, 23% reported incident neck pain with disability (≥ 5). After adjusting for confounders, the onset of neck pain with disability was significantly associated with history of neck pain, chair adjustability, and perceived muscular tension. Thus, the NROW comprises 3 questions about history of neck pain, chair adjustability, and perceived muscular tension. The NROW had scores ranging from 0 to 4. A cut-off score of at least 2 had a sensitivity of 82% and specificity of 48%. The positive and negative predictive values were 29% and 91%, respectively. The area under the receiver operating characteristic curve was 0.75.

Conclusion

The risk score for nonspecific neck pain with disability in office workers was developed, and it contained 3 items with scores ranging from 0 to 4. This study shows that the score appears to have reasonable sensitivity, specificity, positive predictive value, and negative predictive values for the cut-off point of at least 2.     

Aktives Nackenmuskeltraining in der Behandlung chronischer Nackenschmerzen bei Frauen

Zusammenfassung Aktives körperliches Training ist eine weitverbreitete Therapie für Patienten mit chronischen Nackenschmerzen; bisher konnte dessen Wirksamkeit jedoch noch nicht in randomisierten Studien nachgewiesen werden. Ziel dieser Studie war es, die Wirksamkeit von intensivem isometrischem Nackenmuskeltraining und leichterem Ausdauertraining zu evaluieren. Wir führten eine Untersucher-verblindete randomisierte kontrollierte Studie von Februar 2000 bis März 2002 durch. Die Teilnehmer wurden von betriebsärztlichen Einrichtungen in Süd- und Ostfinnland rekrutiert, wobei 180weibliche Büroangestellte zwischen 25 und 53 Jahren mit chronischen unspezifischen Nackenschmerzen untersucht wurden. Die Patientinnen wurden randomisiert entweder einer von zwei Trainingsgruppen oder der Kontrollgruppe zugeteilt. Die Ausdauertrainingsgruppe führte dynamische Nackenmuskelübungen durch (Anheben des Kopfes, ausgehend von Supinations- und Pronationshaltung). Die Krafttrainingsgruppe betrieb intensive isometrische Übungen zur Kräftigung und Stabilisierung der Nackenmuskulatur mit Hilfe eines elastischen Bandes. Beide Trainingsgruppen führten dynamische Übungen für Schultern und Arme mit Hanteln durch. Alle Gruppen wurden angewiesen regelmäßig 3-mal pro Woche Aerobic und Stretching zu betreiben. Schmerzen und Störungen im Nackenbereich wurden mit Hilfe einer visuellen Analogskala, des Index für Schmerzen und Störungen an Nacken und Schulter sowie des Vernon-Index für Nackenbeschwerden festgestellt. Während der Studie wurde die Stimmungslage bezüglich Depressionen berücksichtigt sowie die maximale Nackenmuskelkraft und das Bewegungsausmaß der Nackenmuskulatur. Nach 12-monatiger Studiendauer hatten Schmerzen und Störungen im Nackenbereich in beiden Trainingsgruppen statistisch signifikant abgenommen im Vergleich zur Kontrollgruppe (p<0.005). In der Gruppe des Krafttrainings fand sich eine Verbesserung der Flexion um 110%, der Rotation um 76% und der Extension um 69%. Dem standen Ergebnisse der Ausdauergruppe von 28%, 29% und 16% und der Kontrollgruppe von 10%, 10% und 7% gegenüber. Auch das Bewegungsausmaß der Rotation hatte sich in beiden Trainingsgruppen statistisch signifikant verbessert verglichen mit der Kontrollgruppe. Statistisch signifikante Verbesserungen der Lateralflexion, der Flexion und der Extension wies jedoch nur die Krafttrainingsgruppe auf.

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Active neck muscle training for treatment of women with chronic neck pain: a randomized controlled study

Active physical training is commonly recommended for patients with chronic neck pain; however, its efficacy has not been demonstrated in randomized studies. This study evaluates the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles to alleviate pain and disability in women with chronic, nonspecific neck pain. An examiner-blinded randomized controlled trial was conducted between February 2000 and March 2002. A total of 180 female office workers aged 25–53 years with chronic, nonspecific neck pain were recruited from occupational health care systems in southern and eastern Finland. The patients were randomly assigned to either two training groups or to a control group with 60 patients in each group. The endurance training group performed dynamic neck exercises, which included lifting the head up from the supine and prone positions. The strength training group performed high-intensity isometric neck strengthening and stabilization exercises with an elastic band. Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells. All groups were advised to do aerobic and stretching exercises regularly three times a week. Neck pain and disability were assessed by a visual analog scale, the neck and shoulder pain and disability index, and the Vernon neck disability index. Intermediate outcome measures included mood assessed by a short depression inventory and by maximal isometric neck strength and range of motion measures. At the 12-month follow-up visit, both neck pain and disability had decreased in both training groups compared with the control group (P<0.005). Maximal isometric neck strength had improved flexion by 110%, rotation by 76%, and extension by 69% in the strength training group. The respective improvements in the endurance training group were 28%, 29%, and 16% and in the control group 10%, 10%, and 7%. Range of motion had also improved statistically significantly in both training groups compared with the control group in rotation, but only the training group had statistically significant improvements in lateral flexion and in flexion and extension.

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Diese Studie wurde von der Social Insurance Institution, Helsinki, Finland, finanziert.