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Effect of Therapeutic Exercise and Sleeping Neck Support on Patients with Chronic Neck Pain:
A Randomized Clinical Trial
ANTOINE HELEWA, CHARLES H. GOLDSMITH, HUGH A. SMYTHE, PETER LEE, KATHY OBRIGHT, and LARRY STITT ABSTRACT. Objective. To investigate the effects of therapeutic exercises and sleeping neck support contoured pillows on patients with chronic neck pain. Methods. Using a factorial design in a prospective clinical trial, participants were equally allocated at random to 4 treatment groups in the study: (1) placebo control, of hot or cold packs and massage; (2) sleeping neck support pillow and placebo; (3) active neck exercises and placebo; and (4) combined exercise and sleeping neck support pillow and placebo. Participants were treated by physical therapists over a 6 week period and assessed by masked independent assessors at 0, 3, 6, 12, 24 weeks, and 12 months, with the 12 week assessment being the primary decision time. The primary outcome measure was the Northwick Park Neck Pain Questionnaire (NPQ). Results. For the 128/151 (85%) participants tested at 12 weeks, the NPQ descriptive statistics of count, mean (standard deviation) were: Initial: 128, 31.0 (11.3) at Week 12; All: 128, 18.5 (11.6); Control: 34, 18.6 (10.0); Pillow: 32, 21.5 (13.1); Active neck exercises: 29, 20.1 (11.6); and Combined: 33, 14.1 (10.6). Factorial analysis of variance showed that the main effects of Exercise (p = 0.146) and Pillow (p = 0.443) were not statistically significant; but the interaction of Exercise plus Pillow (p = 0.029) was statistically significant and clinically meaningful. Conclusion. Treatment by physiotherapists trained to teach both exercises and the use of a neck support pillow achieved the most favorable benefit for participants with chronic neck pain; either strategy alone was not more effective than a control regimen. Time was an important cofactor. (First Release Nov 1 2006; J Rheumatol 2007;34:151–8) Key Indexing Terms:
NECK PAIN THERAPY From the School of Physical Therapy, University of Western Ontario, London, Ontario; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario; Department of Medicine, University of Toronto, Toronto, Ontario; and Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada. This study was conducted at the School of Physical Therapy, Elborn College, University of Western Ontario, London, Ontario; supported by a grant from the National Health Research Development Plan (Grant 6606-5681-403), Health Canada. A. Helewa, MSc, Professor Emeritus; K. Obright, MSc, Professor, School of Physical Therapy; L.W. Stitt, MSc, Department of Epidemiology and Biostatistics, University of Western Ontario; C.H. Goldsmith, PhD, Professor Emeritus, Department of Clinical Epidemiology and Biostatistics, McMaster University, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, Hamilton, Ontario; H.A. Smythe, MD, FRCPC, Professor Emeritus, University of Toronto; P. Lee, MD, FRCPC, Professor, Department of Medicine, University of Toronto, The Mount Sinai Hospital, Toronto, Ontario. Address reprint requests to Dr. H.A. Smythe, University of Toronto, 2 Heathbridge Park, Toronto, Ontario, M4G 2Y6 Canada. E-mail: hasmythe@rogers.com Accepted for publication August 15, 2006. |
