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- Dedering, Asa, et al.
(författare)
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The Effects of Neck-Specific Training Versus Prescribed Physical Activity on Pain and Disability in Patients With Cervical Radiculopathy: A Randomized Controlled Trial
- 2018
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : W B SAUNDERS CO-ELSEVIER INC. - 0003-9993 .- 1532-821X. ; 99:12, s. 2447-2456
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare the effects of a neck-specific training program to prescribed physical activity with both groups receiving a cognitive behavioral approach, on pain and disability in patients with cervical radiculopathy (CR). Design: Parallel-group randomized clinical trial with follow-up at 3, 6, 12, and 24 months. Setting: Recruitment and assessments of participants were performed at a university hospital. Interventions were performed in primary care setting at outpatient physiotherapy clinics. Participants: Patients (N=144) with CR were recruited to participate in this clinical trial. Interventions: Patients were randomly assigned to 3 months of either of a neck-specific training program or prescribed physical activity. Main Outcome Measures: Primary outcomes included self-rated neck and arm pain as collected by the visual analog scale (VAS). Secondary outcomes were self-rated headache measured with the VAS, the Neck Disability Index, the EuroQol 5D, the Fear Avoidance Beliefs Questionnaire, and the Hospital Anxiety and Depression Scale. Assessments were performed at baseline and at 3-, 6-, 12-, and 24-month follow-up periods. Results: Intention-to-treat and per-protocol analyses showed no significant interaction (group x time) or group effects. There were, however, significant time effects indicating improvement over time for both groups for all outcomes except for levels of depression. Conclusions: The study revealed that neck-specific training as well as prescribed physical activity both including additional cognitive behavioral approach decreased the pain in patients with CR, that is, participants improved regardless of the intervention received. There is a lack of consensus of how to best manage individuals with CR. However, our findings suggest that CR has a natural favorable long-term outcome when patients are prescribed neck-specific training and exercise in combination with a behavioral approach. (C) 2018 by the American Congress of Rehabilitation Medicine
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- Landén Ludvigsson, Maria, et al.
(författare)
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Factors associated with pain and disability reduction following exercise interventions in chronic whiplash
- 2016
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Ingår i: European Journal of Pain. - : WILEY-BLACKWELL. - 1090-3801 .- 1532-2149. ; 20:2, s. 307-315
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSome studies support the prescription of exercise for people with whiplash-associated disorders (WAD); however, the response is highly variable. Further research is necessary to identify factors which predict response. MethodsThis is a secondary analysis of a randomized, multicentre controlled clinical trial of 202 volunteers with chronic WAD (grades 2 and 3). They received either neck-specific exercise with, or without a behavioural approach, or prescription of physical activity for 12weeks. Treatment response, defined as a clinical important reduction in pain or disability, was registered after 3 and 12months, and factors associated with treatment response were explored using logistic regression. ResultsParticipation in the neck-specific exercise group was the only significant factor associated with both neck pain and neck disability reduction both at 3 and 12months. Patients in this group had up to 5.3 times higher odds of disability reduction and 3.9 times higher odds of pain reduction compared to those in the physical activity group. Different baseline features were identified as predictors of response depending on the time point examined and the outcome measure selected (pain vs. disability). ConclusionFactors associated with treatment response after exercise interventions differ in the short and long term and differ depending on whether neck pain or disability is considered as the primary outcome. Participation in a neck-specific exercise intervention, in contrast to general physical activity, was the only factor that consistently indicated higher odds of treatment success. These results support the prescription of neck-specific exercise for individuals with chronic WAD.
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- Liew, Bernard X. W., et al.
(författare)
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Mechanisms of recovery after neck-specific or general exercises in patients with cervical radiculopathy
- 2021
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 25:5, s. 1162-1172
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Tidskriftsartikel (refereegranskat)abstract
- Background The mechanisms of action that facilitate improved outcomes after conservative rehabilitation are unclear in individuals with cervical radiculopathy (CR). This study aims to determine the pathways of recovery of disability with different exercise programs in individuals with CR. Methods We analysed a dataset of 144 individuals with CR undergoing conservative rehabilitation. Eleven variables collected at baseline, 3, 6 and 12 months follow-up were used to build a Bayesian Network (BN) model: treatment group (neck-specific vs. general exercises), age, sex, self-efficacy, catastrophizing, kinesiophobia, anxiety, neck-arm pain intensity, headache pain intensity and disability. The model was used to quantify the contribution of different mediating pathways on the outcome of disability at 12th months. Results All modelled variables were conditionally independent from treatment groups. A one-point increase in anxiety at 3rd month was associated with a 2.45-point increase in 12th month disability (p <.001). A one-point increase in head pain at 3rd month was associated with a 0.08-point increase in 12th month disability (p <.001). Approximately 83% of the effect of anxiety on disability was attributable to self-efficacy. Approximately 88% of the effect of head pain on disability was attributable to neck-arm pain. Conclusions No psychological or pain-related variables mediated the different treatment programs with respect to the outcome of disability. Thus, the specific characteristics investigated in this study did not explain the differences in mechanisms of effect between neck-specific training and prescribed physical activity. The present study provides candidate modifiable mediators that could be the target of future intervention trials. Significance Psychological and pain characteristics did not differentially explain the mechanism of effect that two exercise regimes had on disability in individuals with cervical radiculopathy. In addition, we found that improvements in self-efficacy was approximately five times more important than that of neck-arm pain intensity in mediating the anxiety-disability relationship. A mechanistic understanding of recovery provides candidate modifiable mediators that could be the target of future intervention trials. Trials registration ClinicalTrials.gov identifier: NCT01547611.
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- Peolsson, Anneli, 1967-, et al.
(författare)
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Physiotherapy after anterior cervical spine surgery for cervical disc disease: study protocol of a prospective randomised study to compare internet-based neck-specific exercise with prescribed physical activity
- 2019
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 9:2, s. e027387-
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Tidskriftsartikel (refereegranskat)abstract
- Patients suffering from remaining disability after anterior cervical decompression and fusion (ACDF) surgery for cervical disc disease may be prescribed physical activity (PPA) or neck-specific exercises (NSEs). Currently, we lack data for the success of either approach. There is also a knowledge gap concerning the use of internet-based care for cervical disc disease. The scarcity of these data, and the high proportion of patients with various degrees of incapacity following ACDF, warrant increased efforts to investigate and improve cost-effective rehabilitation. The objective is to compare the effectiveness of a structured, internet-based NSE programme, versus PPA following ACDF surgery.Methods and analysisThis is a prospective, randomised, multicentre study that includes 140 patients with remaining disability (≥30% on the Neck Disability Index, NDI) following ACDF for radiculopathy due to cervical disc disease. Patient recruitment occurs following attendance at routine clinical appointments, scheduled at 3 months postsurgery. Patients are then randomised to one of two groups (70 patients/group) for a 3-month treatment programme/period of either internet-based NSE or PPA. Questionnaires on background data, pain and discomfort, physical and mental capacity, satisfaction with care, and health and workplace factors are completed, along with physical measures of neck-related function conducted by independent test leaders blinded to randomisation. Measures are collected at inclusion, after the 3-month treatments (end of treatment) and at a 2-year follow-up. Radiography will be completed at the 2-year follow-up. Preoperative data will be collected from the Swedish Spine Registry. Data on healthcare consumption, drug use and sick leave will be requested from the relevant national registers.Ethical considerationsThis study was approved by the Regional Ethical Review Board in Linköping Ref. 2016/283–31 and 2017/91– 32. The scientists are independent with no commercial ties. Patients are recruited after providing written informed consent. Patient data are presented at group level such that no connection to any individual can be made. All data are anonymised when reported, and subject to the Swedish Official Secrets Health Acts. The test leaders are independent and blinded for randomisation. Exercises, both general and neck-specific, have been used extensively in clinical practice and we anticipate no harm from their implementation other than a risk of muscle soreness. Both randomisation groups will receive care that is expected to relieve pain, although the group receiving NSE is expected to demonstrate a greater and more cost-effective improvement versu s the PPA group. Any significant harm or unintended effects in each group will be collected by the test leaders. All questionnaires and test materials are coded by the research group, with code lists stored in locked, fireproof file cabinets, housed at the university in a room with controlled (card-based) access. Only individuals in receipt of a unique website address posted by the researchers can access the programme; patients can neither communicate with each other nor with caregivers via the programme.Study participation might lead to improved rehabilitation versus non-participation, and might therefore be of benefit. The results of this study should also contribute to more effective and flexible rehabilitation, shorter waiting times, lower costs and the possibility to implement our findings on a wider level.DisseminationIf effective, the protocols used in this study can be implemented in existing healthcare structures. The results of the study will be presented in scientific journals and popular science magazines of relevance to health. The findings will also be presented at local, regional, national and international conferences and meetings, as well as in the education of university students and at public lectures. Information about the results will be communicated to the general population in cooperation with patient organisations and the media.Trial registrationNCT03036007.
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- Svensson, Jard, et al.
(författare)
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The effect of neck-specific exercise and prescribed physical activity on headache and dizziness in individuals with cervical radiculopathy: Further analyses of a randomized study with a 1-year follow-up
- 2023
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Ingår i: Physiotherapy Theory and Practice. - : TAYLOR & FRANCIS INC. - 0959-3985 .- 1532-5040.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the effect of neck-specific exercise (NSE) compared to prescribed physical activity (PPA) on headache and dizziness in individuals with cervical radiculopathy (CR). Also, to investigate associations between headache or dizziness and pain, neck muscle endurance (NME), neck mobility, physical activity, and fear avoidance beliefs.Methods: Individuals randomized to either NSE or PPA were selected to a headache subgroup (n = 59) and/or a dizziness subgroup (n = 73). Data were evaluated, according to headache and/or dizziness outcomes at baseline and at 3, 6, and 12-month follow-ups.Results: No significant between-group differences were found between NSE and PPA in either subgroup. In the headache subgroup, significant within-group improvements were seen at all follow-ups for NSE (p < .001) and from baseline to 3 (p = .037) and 12 (p = .003) months for PPA. For dizziness, significant within-group improvements were seen from baseline to 3 months for NSE (p = .021) and from baseline to 3 (p = .001) and 6 (p = .044) months for PPA. Multiple regression models showed significant associations at baseline between headache intensity and neck pain (adjusted R-square = 0.35, p < .001), and for dizziness with neck pain and dorsal NME (adjusted R-square = 0.34, p < .001).Conclusion: NSE and PPA show similar improvements in headache intensity and dizziness in individuals with CR. Headache intensity is associated with neck pain, and dizziness with neck pain and dorsal NME, highlighting the importance of these factors when evaluating headache and dizziness.
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