Effects of tailored neck-shoulder pain treatment based on a decision model guided by clinical assessments and standardized functional tests. A study protocol of a randomized controlled trialReport as inadecuate




Effects of tailored neck-shoulder pain treatment based on a decision model guided by clinical assessments and standardized functional tests. A study protocol of a randomized controlled trial - Download this document for free, or read online. Document in PDF available to download.

BMC Musculoskeletal Disorders

, 13:75

First Online: 20 May 2012Received: 05 April 2012Accepted: 18 April 2012

Abstract

BackgroundA major problem with rehabilitation interventions for neck pain is that the condition may have multiple causes, thus a single treatment approach is seldom efficient. The present study protocol outlines a single blinded randomised controlled trial evaluating the effect of tailored treatment for neck-shoulder pain. The treatment is based on a decision model guided by standardized clinical assessment and functional tests with cut-off values. Our main hypothesis is that the tailored treatment has better short, intermediate and long-term effects than either non-tailored treatment or treatment-as-usual TAU on pain and function. We sub-sequentially hypothesize that tailored and non-tailored treatment both have better effect than TAU.

Methods-Design120 working women with minimum six weeks of nonspecific neck-shoulder pain aged 20–65, are allocated by minimisation with the factors age, duration of pain, pain intensity and disability in to the groups tailored treatment T, non-tailored treatment NT or treatment-as-usual TAU. Treatment is given to the groups T and NT for 11 weeks 27 sessions evenly distributed. An extensive presentation of the tests and treatment decision model is provided. The main treatment components are manual therapy, cranio-cervical flexion exercise and strength training, EMG-biofeedback training, treatment for cervicogenic headache, neck motor control training. A decision algorithm based on the baseline assessment determines the treatment components given to each participant of T- and NT-groups. Primary outcome measures are physical functioning Neck Disability Index and average pain intensity last week Numeric Rating Scale. Secondary outcomes are general improvement Patient Global Impression of Change scale, symptoms Profile Fitness Mapping neck questionnaire, capacity to work in the last 6 weeks quality and quantity and pressure pain threshold of m. trapezius. Primary and secondary outcomes will be reported for each group with effect size and its precision.

DiscussionWe have chosen not to include women with psychological ill-health and focus on biomedical aspects of neck pain. Future studies should aim at including psychosocial aspects in a widened treatment decision model. No important adverse events or side-effects are expected.

Trial registrationCurrent Controlled Trials registration ISRCTN49348025.

KeywordsNeck Trapezius Myalgia Neck-shoulder pain RCT Individualized treatment Rehabilitation Physiotherapy Tailored AbbreviationsANCOVAAnalysis of covariance

ANOVAAnalysis of variance

CCFCranio-cervical flexion

C-PILECervical progressive isoinertial lifting evaluation test

CUACost-utility analyses

EMGElectromyography

EQ-5DEuroQoL 5-dimensions

ILIntervention leader

ITTIntention-to-treat

LBPLow back pain

MAQMuscle Action Quality

MVCMaximal voluntary contraction

NDINeck Disability Index

NRSNumeric Rating Scale

NT-groupNon-tailored treatment group

PETProblem Elicitation Technique

PGICSPatient Global Impression of Change scale

PLProject leader

PPPer protocol

PPTPressure pain threshold

ProFitMap-neckProfile Fitness Mapping neck questionnaire

QALYQuality adjusted life year

QPS NordicGeneral Nordic Questionnaire for Psychological and Social Factors at Work

RCTRandomized controlled clinical trial

ROMRange of motion

SF-36Short Form Health Survey

TAUTreatment-as-usual

T-groupTailored treatment group.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2474-13-75 contains supplementary material, which is available to authorized users.

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Author: Martin Björklund - Mats Djupsjöbacka - Åsa Svedmark - Charlotte Häger

Source: https://link.springer.com/







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