An Educational and Physical Program to Reduce Headache, Neck/Shoulder Pain in a Working Community: A Cluster-Randomized Controlled Trial

Abstract

BackgroundNoninvasive physical management is often prescribed for headache and neck pain. Systematic reviews, however, indicate that the evidence of its efficacy is limited. Our aim was to evaluate the effectiveness of a workplace educational and physical program in reducing headache and neck/shoulder pain.Methodology/Principal FindingsCluster-randomized controlled trial. All municipal workers of the City of Turin, Italy, were invited to participate. Those who agreed were randomly assigned, according to their departments, to the intervention group (IG) or to the control group and were given diaries for the daily recording of pain episodes for 1 month (baseline). Subsequently, only the IG (119 departments, 923 workers) began the physical and educational program, whereas the control group (117 departments, 990 workers) did not receive any intervention. All participants were again given diaries for the daily recording of pain episodes after 6 months of intervention. The primary outcome was the change in the frequency of headache (expressed as the proportion of subjects with a ≥50% reduction of frequency; responder rate); among the secondary outcomes there were the absolute reduction of the number of days per month with headache and neck/shoulder pain. Differences between the two groups were evaluated using mixed-effect regression models. The IG showed a higher responder rate [risk ratio, 95% confidence interval (CI)] for headache (1.58; 1.28 to 1.92) and for neck/shoulder pain (1.53; 1.27 to 1.82), and a larger reduction of the days per month (95% CI) with headache (−1.72; −2.40 to −1.04) and with neck/shoulder pain (−2.51; −3.56 to −1.47).ConclusionsThe program effectively reduced headache and neck/shoulder pain in a large working community and appears to be easily transferable to primary-care settings. Further trials are needed to investigate the program effectiveness in a clinical setting, for highly selected patients suffering from specific headache types.Trial RegistrationClinicalTrials.gov NCT00551980

The influence of home exercise programs for patients with non-specific or specific neck pain: a systematic review of the literature

“…11,16,[18][19][20][21] Two of the included studies failed to perform a follow-up; 11,16 others studies performed follow-up at 4 weeks, 18 14 weeks, 17 6 months, 19,20 40 weeks, 17 and 12 months post discharge.…”

“…Within the seven included studies, one study used the HEP as a co-intervention to clinical treatment, 19 whereas six studies used a HEP only 11,[16][17][18]20,21 Adherence was defined in six of the studies and varied as to what constituted adherence (Table 6). Bronfort et al 17 was the only study to not indicate adherence.…”

“…Bronfort et al 17 was the only study to not indicate adherence. Adherence to the prescribed HEP was measured in six of the seven studies using means such as training diaries 11,[19][20][21] and questionnaires.…”

“…11,[18][19][20][21] Blinding throughout the studies was variable. All seven studies were unable to blind the examiner rendering treatment, and only one of the seven studies was able to blind the patients from the intervention.…”

“…18 Treatment group allocation was not concealed in four out of the seven studies. 11,[19][20][21] Allocation concealment ensures precise implementation of a random allocation sequence without prior knowledge of treatment assignments. 30 Two of the included studies, Mongini et al 20 and…”