Cognitive behavioural interventions, and function and pain outcomes among patients with chronic neck pain managed with the McKenzie approach

Abstract

Objectives Graded activity and graded exposure in vivo are recommended cognitive behavioural approaches to improve function and pain outcomes for patients receiving physiotherapy for chronic nonspecific neck pain. The McKenzie method is a common treatment approach for patients with neck pain. The study objectives were to examine associations between interventions with graded activity and/or graded exposure, as determined by the treating physiotherapist, and function and pain outcomes for patients with chronic nonspecific neck pain managed by clinicians with credentials in the McKenzie approach. Method A cohort study was carried out, in which subjects (n = 366) with chronic nonspecific neck pain completed intake surveys (i.e., the Neck Functional Status Computerized Adaptive Test and the Numeric Pain Rating Scale), and questions related to their demographic, lifestyle and health status. Treatment with graded activity/graded exposure during the episode of care was recorded. Function and pain measures were repeated at discharge. Multivariable models examining associations between patients receiving versus not receiving graded activity/graded exposure, and pain and function outcomes were constructed, controlling for potential confounding effects. Results Despite statistical significance, there were no clinically relevant differences between treatment versus no treatment with graded activity/graded exposure, and function or pain outcomes. Conclusion There is insufficient evidence to suggest that patients being managed with McKenzie methods will attain clinically relevant improvements in function or pain outcomes when augmenting treatment with graded activity and/or graded exposure when the choice to intervene with these cognitive behavioural approaches is determined by the treating physiotherapist.

Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation

“…The patients with disc herniation have intermittent pain or numbness over the neck and upper extremities and they demonstrated a limited range of neck motion. The exclusion criteria for the participants were as follows: (1) past history of cervical surgery, such as disc replacement, bone fusion, discectomy, etc., (2) significant potential for spinal cord injury, such as cord impingement from a large disk herniation, (3) advanced cervical spondylosis, (4) severe spinal stenosis, (5) inflammatory arthritic disorders (ankylosing spondylitis or rheumatoid arthritis), (6) severe spinal instability, and (7) pregnancy [19][20][21][22]. The Visual Analogue Scale (VAS) and Neck Disability Index (NDI) were applied to evaluate the patient's status presence and to assess the evolution across the intervention in this study.…”

“…The active exercise was suggested to be performed 10-15 times each session, 6-10 sessions per day [18,[22][23][24]. The programs were administrated by an experienced orthopedic physical therapist in the Department of Physical Medicine and Rehabilitation to match the patients' directional preferences, where significantly and rapidly decreased pain and improved functional outcomes were reported.…”

Effectiveness of McKenzie approach and segmental spinal stabilization exercises on neck pain in individuals with cervical postural syndrome: An experimental study

“…In this approach, patients are evaluated using repeated end range cervical movements and postural assessments to identify a specific mechanical classification. [ 14 ] A key aspect of the McKenzie approach is that the patients receive individualized treatment based upon their clinical presentation. The McKenzie method customs an assessment method, which purposes to identify subgroups of patients among the nonspecific spinal pain population whose complains behave in a parallel way when subjected to mechanical forces within the physical examination.…”