The one-year
prevalence of neck pain among workers across the world varies between 27% and
48%.
Tailored treatment does
not seem to be effective over nontailored treatment in women with subacute and
chronic neck pain.
The one-year prevalence of neck pain among workers across the world varies between 27% and 48%. Although anyone can experience the neck pain, women are likely to get more affected and people in their middle age are at greater risk. In most of the cases, the specific cause of neck pain is not fully known and treatment is often based on the symptoms and functional impairments. The treatment approach generally used involves assessment of each patient and tailoring the treatment according to the individual’s requirements. However, benefits of the tailored treatment are yet to be confirmed. Most trials on non-specific neck pain have focused on interventions of a single type, producing evidence of modest improvement at its best. The heterogeneity of symptoms and functional impairments in non-specific neck pain could be a reason for the weak evidence for single type treatments. Individualized approaches have been tried for neck pain, but none of the studies discussed enough about the efficacy of tailored treatment that can be replicated. The main idea is to improve the treatment outcomes by prescribing individualized treatments using a detailed decision model. In such a model, indications for the interventions are based on appropriate cut-off values of standardized, reliable and valid assessments. One way to investigate the effect of such an approach is to conduct a randomized trial in which similar treatment components are available but where individuals in one group receive treatment tailored to their needs and the individuals in the other group have non-tailored treatment.
Rationale behind research:
Objective:
The aim was to evaluate treatment effects of a tailored treatment versus a non-tailored treatment.
Study outcomes:
Time Points: Baseline, 3, 9 and 15 month
Outcomes
Baseline: There were no significant baseline differences
between the groups.
Primary outcomes:
TT:tailored, NTT:non-tailored treatment, TAU:treatment-as-usual, NRS: numeric rating scale.
TT:tailored, NTT:non-tailored treatment, TAU:treatment-as-usual, NDI:numeric disability index.
Secondary outcomes:
The current RCT do not support for
tailored over nontailored treatment of women with subacute or chronic
non-specific neck pain when interventions were prescribed according to a
decision model that used cut-off levels in various functional tests.
Nevertheless, the evidence based treatment components incorporated in this
model, regardless of intervention group, resulted in better short-term effects
than TAU.
This was the first attempt to structure
and implement a concise decision model for neck rehabilitation, where treatment
choices for individuals with non-specific neck pain were based on cut-off
levels in specific tests. There is just a single study in the literature implementing
a decision model to individualize the treatment for neck pain. In comparison to
the model used with cut-off levels in this study and a structured interview,
Wang et al used a clinical reasoning algorithm developed by an experienced
physiotherapist. Although their study favored the individual approach, the
absence of a treatment control group and long-term follow-up reduces the impact
of their findings. Other studies evaluating tailored interventions compared
with general approaches for neck pain did not include decision models on which
the tailoring of interventions is founded.
The results of this study may be a
consequence of the decision model lacking precise enough cut-off levels, or
that associations between changes in the targeted functions of the model and
pain/disability are too weak. Further research into the effects of tailoring
interventions for neck pain disorders is warranted, but at the first instance,
more precise knowledge is needed regarding cut-off levels to determine
impairment if the current decision-model is to be further developed.
Svedmark et al. BMC Musculoskeletal Disorders (2016) 17:408
Is tailored treatment superior to non-tailored treatment for pain and disability in women with non-specific neck pain? A randomized controlled trial
Åsa Svedmark et al.
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