Exercise not superior to physiotherapy for neck pain

By Lucy Piper, Senior medwireNews Reporter

Both exercise-based interventions and physiotherapy are effective for reducing pain in patients with nonspecific neck pain, UK researchers have found, but adherence to such treatments remains a challenge.

"Both approaches are appropriate for use in clinical practice," say Sionnadh McLean, from Sheffield Hallam University, and colleagues. "There is no evidence that one treatment provides greater benefit than the other for neck pain or upper limb disability."

They suggest that "patients should be assessed to establish whether either of these interventions is likely to meet their clinical needs and whether they have a preference for either of the interventions."

The researchers compared a group neck and upper limb exercise program (GET) with usual physiotherapy in 151 patients with nonspecific neck pain.

The 75 patients receiving GET attended 6 to 12 exercise sessions over a 6-week period that involved a range of movement exercises for the neck, trunk and upper limbs, as well as endurance training for the upper limbs, trunk, and lower limbs.

The remaining 76 patients received usual physiotherapy encompassing home exercises, manual therapy, and modalities such as traction, ultrasound, and acupuncture.

Both treatments produced modest but significant reductions in pain. The mean improvement in Northwick Park Neck pain Questionnaire score at 6 months was 5.0% for the GET group and 7.7% for the physiotherapy group. At 12-month follow up, this improvement was 9.1% and 9.4%, respectively.

Scores on the Disabilities of the Arm, Shoulder and Hand questionnaire did not change significantly over the follow up.

However, the researchers note in Manual Therapy that 36% of patients did not adhere to treatment: they either failed to attend all treatment sessions or complete treatment as per protocol.

"Health professionals should attempt to identify possible cognitive, behavioural, demographic, organizational, or practical barriers which may impact on patient adherence with treatment," they recommend.

"Supporting patients to overcome their barriers may help patients to optimize treatment outcome, though strategies to improve adherence require further investigation."

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