Elsevier

Manual Therapy

Volume 18, Issue 3, June 2013, Pages 199-205
Manual Therapy

Original article
A randomised controlled trial comparing graded exercise treatment and usual physiotherapy for patients with non-specific neck pain (the GET UP neck pain trial)

https://doi.org/10.1016/j.math.2012.09.005Get rights and content

Abstract

Evidence supports exercise-based interventions for the management of neck pain, however there is little evidence of its superiority over usual physiotherapy. This study investigated the effectiveness of a group neck and upper limb exercise programme (GET) compared with usual physiotherapy (UP) for patients with non-specific neck pain. A total of 151 adult patients were randomised to either GET or UP. The primary measure was the Northwick Park Neck pain Questionnaire (NPQ) score at six weeks, six months and 12 months. Mixed modelling identified no difference in neck pain and function between patients receiving GET and those receiving UP at any follow-up time point. Both interventions resulted in modest significant and clinically important improvements on the NPQ score with a change score of around 9% between baseline and 12 months. Both GET and UP are appropriate clinical interventions for patients with non-specific neck pain, however preferences for treatment and targeted strategies to address barriers to adherence may need to be considered in order to maximise the effectiveness of these approaches.

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

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