Original articleA randomised controlled trial comparing graded exercise treatment and usual physiotherapy for patients with non-specific neck pain (the GET UP neck pain trial)
Introduction
Neck pain is a costly problem which affects around 50% of people at some point in their lives (Borghouts et al., 1999; Fejer et al., 2006). The role of different conservative treatments for managing neck pain is not clear. Evidence from systematic reviews supports the use of exercise for managing neck pain (Hurwitz et al., 2008). In particular, general neck and upper limb endurance training, dynamic strengthening programmes and cervical stabilisation exercises appear to be more favourable exercise options than stretching, return to normal activity or no intervention (Jull et al., 2002; Sarig-Bahat, 2003). However, exercise is not superior to other conservative treatment approaches (Viljanen et al., 2003). For example, multimodal treatments such as those usually offered by physiotherapy may also be effective for patients with neck pain (Hurwitz et al., 2008). Usual physiotherapy offers a broad range of treatments which are normally tailored to individual patients needs. Interventions commonly include specifically tailored exercises such as McKenzie exercises in combination with manual therapy, other passive treatments, advice and education (Klaber Moffett et al., 2005).
This study aimed to investigate, at six weeks, six months and 12 months, the effectiveness of a graded neck and upper limb exercise programme, based on stabilisation, endurance and strengthening principles, compared with usual physiotherapy for patients with non-specific neck pain.
Section snippets
Study design
This multi-centre, pragmatic, randomised controlled trial (RCT) recruited patients with non-specific neck pain. Patients were randomised to either a graded neck and upper limb exercise class (GET) or usual physiotherapy (UP). Ethics approval was gained from Hull & East Riding Research & Ethics Committee.
Recruitment of participants
Patients were recruited from waiting lists of four secondary care physiotherapy departments in England between February 2004 and July 2005. Patient follow-up proceeded until July 2006. Referral
Study population
The CONSORT flow-chart (see Fig. 1) shows that a total of 483 patients with neck pain were referred for possible inclusion into the study, with 151 patients eventually being recruited (GET n = 75, UP n = 76). The participants in this study were similar to non-participants except on age; {participants mean age 54.25 (14.63), non-participants mean age 49.98 (16.09), p = 0.006}. At six weeks, six months and 12 months respectively 31 (20.5%), 34 (22.5%) and 36 (23.8%) patients were lost to
Discussion
This paper reports the findings from an RCT investigating the effectiveness of a neck and upper limb exercise class (GET) compared with usual physiotherapy (UP). The GET intervention was found to be similarly effective as the UP intervention. No significant between group differences in neck pain and function were found at six weeks, six months or 12 months between patients receiving GET and those receiving UP. Both interventions reduced NPQ scores by a statistically significant amount over
Conclusions
This study demonstrated that GET and UP produced modest but significant reductions in pain and disability for patients with non-specific neck pain at six and 12 month follow-up. Both approaches are appropriate for use in clinical practice although both interventions had high levels of non-adherence. 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. Health
Acknowledgement
Arthritis Research UK and Hull and East Yorkshire Hospitals NHS Trust funded this research. We declare that there are no conflicts of interests
References (39)
- et al.
Cost-of-illness of neck pain in the Netherlands in 1996
Pain
(1999) - et al.
Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review
Manual Therapy
(2010) - et al.
Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review
Journal of Physiotherapy
(2011) - et al.
Interventions for enhancing adherence with physiotherapy: a systematic review
Manual Therapy
(2010) - et al.
Manual therapy and exercise for neck pain: a systematic review
Manual Therapy
(2010) Evidence for exercise therapy in mechanical neck disorders
Manual Therapy
(2003)- et al.
Exercise adherence for a strength training program in older adults
The Journal of Nutrition, Health & Aging
(1997) - et al.
A randomized trial comparing a group exercise programme for back pain patients with individual physiotherapy in a severely deprived area
Disability and Rehabilitation
(2005) - et al.
The impact of social deprivation on chronic back pain outcomes
Chronic Illness
(2005) - et al.
Effectiveness of manual therapy or pulsed shortwave diathermy in addition to advice and exercise for neck disorders: a pragmatic randomized controlled trial in physical therapy clinics
Arthritis and Rheumatism
(2005)
The prevalence of neck pain in the world population: a systematic critical review of the literature
European Spine Journal
Effects of exercise adherence on physical function among overweight older adults with knee osteoarthritis
Arthritis and Rheumatism
Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain
Annals of Internal Medicine
Interventions for enhancing medication adherence
Cochrane Database of Systematic Reviews
Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The upper extremity collaborative group (UECG)
American Journal of Industrial Medicine
Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000–2010 Task Force on neck pain and its associated disorders
Spine
Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults
Cochrane Database of Systematic Reviews
A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache
Spine
Cited by (30)
Treatment classifications and interventions for neck pain: a scoping review
2023, Journal of Clinical EpidemiologyHigh-intensity interval training in individuals with spinal cord injury
2022, Diagnosis and Treatment of Spinal Cord InjuryThe clinical reasoning process in randomized clinical trials with patients with non-specific neck pain is incomplete: A systematic review
2018, Musculoskeletal Science and PracticeCitation Excerpt :Of the 122 studies thirty-seven studies, (30%) scored a complete clinical reasoning process (Fig. 2). Fifty-six studies (46%) scored “-” on item 2 (cause) of the rating scale and therefore, the problem related outcome, matched intervention and intervention related outcome measures also scored negative (Akhter et al., 2014; Ali et al., 2014; Andrade Ortega et al., 2014; Beltran-Alacreu et al., 2015; Borman et al., 2008; Brage et al., 2015; Chiu et al., 2011; Cleland et al., 2007; Cook et al., 2015; Cunha et al., 2008; David et al., 1998; Dusunceli et al., 2009; Dziedzic et al., 2005; Escortell-Mayor et al., 2011; Evans et al., 2012; Gonzalez-Iglesias et al., 2009b; Griffiths et al., 2009; Griswold et al., 2015; Hakkinen et al., 2008; Helewa et al., 2007; Hoving et al., 2002; Hudson and Ryan, 2010; Izquierdo Perez et al., 2014; Jordan et al., 1998; Kanlayanaphotporn et al., 2009, 2010; Karlsson et al., 2014; Kumar et al., 2011; Lansinger et al., 2007, 2013; Lau et al., 2011; Leaver et al., 2010; Madson et al., 2010; Martel et al., 2011; Masaracchio et al., 2013; McLean et al., 2013; Monticone et al., 2012; Paoloni et al., 2013; Pool et al., 2010; Puntumetakul et al., 2015; Rendant et al., 2011; Saavedra-Hernandez et al., 2013, 2012; Schomacher, 2009; Sherman et al., 2014; Snodgrass et al., 2014; Taimela et al., 2000; Thompson et al., 2016; Viljanen et al., 2003; von Trott et al., 2009; Walker et al., 2008; Ylinen et al., 2003; Ylinen et al., 2007a,b; Zaproudina et al., 2007). Sixty-six RCTs (54%) described a cause of the experienced problem (Bakar et al., 2014; Beer et al., 2012; Beinert and Taube, 2013; Bid et al., 2014; Borisut et al., 2013; Briem et al., 2007; Casanova-Mendez et al., 2014; Celenay et al., 2016a,b; Chiu et al., 2004; Chiu et al., 2005; Cleland et al., 2005, 2007; Dawood et al., 2013; de Camargo et al., 2011; Deepa et al., 2014; Dunning et al., 2012; Falla et al., 2006; Falla et al., 2007; Falla et al., 2008; Falla et al., 2013; Gallego Izquierdo et al., 2016; Ganesh et al., 2014; Giombini et al., 2013; Gonzalez-Iglesias et al., 2009a; Griffiths et al., 2009; Haas et al., 2003; Hakkinen et al., 2008; Humphreys and Irgens, 2002; Javanshir et al., 2015; Jull et al., 2007, 2009; Khan et al., 2014; Kim et al., 2015; Kim and Kwag, 2016; Kjellman and Oberg, 2002; Klaber Moffett et al., 2005; Ko et al., 2010; Krauss et al., 2008; Lee et al., 2013; Lee and Kim, 2016; Lee et al., 2016; Lluch et al., 2014a, b; Maayah and Al-Jarrah, 2010; Mansilla-Ferragut et al., 2009; Martinez-Segura et al., 2012; O'Leary et al., 2007a,b; O'Leary et al., 2012; Pillastrini et al., 2016; Pires et al., 2015; Puentedura et al., 2011; Revel et al., 1994; Rolving et al., 2014; Rudolfsson et al., 2014; Saayman et al., 2011; Salom-Moreno et al., 2014; Sarig Bahat et al., 2015; Sillevis et al., 2010; Sterling et al., 2001; Vernon et al., 1990; Vonk et al., 2009; Yang et al., 2015; Ylinen et al., 2005).
Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain? A randomised control trial with a 4-month follow up
2016, Manual TherapyCitation Excerpt :In general, chronic pain patients are at higher risk of being physically inactive with increased risk of associated lifestyle diseases (Mannerkorpi et al., 2008), so, it could be assumed, this applies also to chronic neck pain patients. Graded physical activity training has been shown to be effective for physical work capacity and psychological variables in chronic fatigue patients (Wallman et al., 2004), but in neck pain patients, this effect has not yet been studied (McLean et al., 2013). There seems to be some evidence for pain education combined with other modalities for chronic neck pain patients (Geneen et al., 2015; Gross et al., 2015).
The Treatment of Neck Pain–Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline
2016, Journal of Manipulative and Physiological TherapeuticsA new measure of exercise adherence: the ATEMPT (Adherence To Exercise for Musculoskeletal Pain Tool)
2023, British Journal of Sports Medicine