Effects of back school-based intervention on non-specific neck pain in adults: a randomized controlled trial

Abstract

Background Neck pain has a high prevalence and socioeconomic impact worldwide. The Back School consists of programs that include exercises and educational interventions to treat back pain. Accordingly, the main objective was to evaluate the effects of an intervention based on Back School on non-specific neck pain in an adult population. The secondary objectives were to analyze the effects on disability, quality of life and kinesiophobia. Methods A randomized controlled trial was conducted with 58 participants with non-specific neck pain divided into two groups. The experimental group (EG) carried out the 8-week programme based on the Back School, (two sessions per week, for a total of 16 sessions, lasting 45 min). Of all the classes, 14 had a practical focus (strengthening and flexibility exercises) and the other two had a theoretical focus (concepts of anatomy and healthy lifestyle). The control group (CG) stated that they did not vary their lifestyle. The assessment instruments were: Visual Analogue Scale, Neck Disability Index, Short-Form Health Survey-36 and Tampa Scale of Kinesiophobia. Results The EG reduced pain (-40 points, CI95% [-42 to -37], g = -1.03, p < 0.001), EG had less disability (-9.3 points, CI95% [-10.8 to -7.8], g = -1.22, p < 0.001), EG improved the physical dimension of the survey Short-Form Health Survey-36 (4.8 points, CI95% [4.1 to 5.5], g = 0.55, p = 0.01) but had not significant change in psychosocial dimension of the survey Short-Form Health Survey-36 and EG reduced Kinesiophobia (-10.8 points, CI95% [-12.3 to -9.3], g = -1.84, p < 0.001). The CG did not obtain significant results in any variable of the study. Significant differences in change between both groups were found on pain (-11 points, CI95% [5.6 to 16.6], p < 0.001, g = 1.04), disability (-4 points, CI95% [2.5 to 6.2], p < 0.001, g = 1.23), physical dimension of the survey Short-Form Health Survey-36 (3 points, CI95% [-4-4 to -2-5], p = 0.01, g = -1.88), and kinesiophobia ( 7 points, CI95%[-8.3 to -5.4], p < 0.001, g = 2.04), while no significant differences were found on psychosocial dimension of the survey Short-Form Health Survey-36 (-0.02, CI95% [-1.7 to 1.8], g = 0.01, p = 0.98). Conclusions The back school-based programme has beneficial effects on pain, neck disability, the physical dimension of quality of life and kinesiophobia in an adult population with non-specific neck pain. However, it did not lead to improvements in the psychosocial dimension of the participants’ quality of life. This programme could be applied by health care providers with the aim of reducing the severe socio-economic impact of non-specific neck pain worldwide. Trial registration in ClinicalTrials.gov NCT05244876 (registered prospectively, date of registration: 17/02/2022).

Effects of exercise/physical activity on fear of movement in people with spine-related pain: a systematic review

“…Although, improvement was greater in the combined KT and CSE group, showing that modalities such as KT and CSE are effective in the treatment of NSCLBP. Additionally, a study by Hernandez-Lucas et al (2023) evaluating the effects of the Back School on non-specific neck pain in adults aged ≥18, showed a beneficial effect on kinesiophobia, however, this study did not have a post-intervention follow-up, making it difficult to ascertain its long-term effect. Furthermore, due to the small sample size, generalisability of the results may be compromised.…”

“…The 17 studies selected were published between the years 2011 to 2023. The 17 selected studies (Nassif et al, 2011 ; Miyamoto et al, 2013 , 2018 ; Da Luz Junior et al, 2014 ; Vincent et al, 2014 ; Cruz-Díaz et al, 2017 , 2018 ; Keane, 2017 ; Zadro et al, 2019 ; Galan-Martin et al, 2020 ; Tagliaferri et al, 2020 ; Akodu et al, 2021 ; Vicente-Campos et al, 2021 ; Martins de Sousa et al, 2022 ; Cana-Pino et al, 2023 ; Hernandez-Lucas et al, 2023 ; Ogunniran et al, 2023 ) involved 1,354 participants. Variation in chronic non-specific spine-related pain, exercise/physical activity and measures used to assess kinesiophobia contributed to the significant level of heterogeneity between the studies and reported effect estimates.…”

“…This was largely because of blinding, allocation sequence concealment and deviation from intended intervention. Five studies (Nassif et al, 2011 ; Miyamoto et al, 2013 , 2018 ; Zadro et al, 2019 ; Galan-Martin et al, 2020 ) were rated as having high risk of risk, ten (Vincent et al, 2014 ; Keane, 2017 ; Cruz-Díaz et al, 2018 ; Tagliaferri et al, 2020 ; Akodu et al, 2021 ; Vicente-Campos et al, 2021 ; Martins de Sousa et al, 2022 ; Cana-Pino et al, 2023 ; Hernandez-Lucas et al, 2023 ; Ogunniran et al, 2023 ) with some concerns of bias and two (Da Luz Junior et al, 2014 ; Cruz-Díaz et al, 2017 ) deemed low risk. Most studies adequately described the follow-up period, but attrition rate was poorly defined.…”

“…For all studies, the analytical approach utilized was considered appropriate. In seven studies (Vincent et al, 2014 ; Keane, 2017 ; Tagliaferri et al, 2020 ; Akodu et al, 2021 ; Vicente-Campos et al, 2021 ; Hernandez-Lucas et al, 2023 ; Ogunniran et al, 2023 ) consisted of a small sample size which is a major limitation and demonstrate a lack of adequate sample size calculation.…”

“…One study had a follow-up at the end of a 4-week intervention (Vincent et al, 2014). Another study (Hernandez-Lucas et al, 2023) did not report follow-up period.…”