Expert consensus on the important chronic non-specific neck pain motor control and segmental exercise and dosage variables: An international e-Delphi study

Abstract

Background Chronic non-specific neck pain is highly prevalent, resulting in significant disability. Despite exercise being a mainstay treatment, guidance on optimal exercise and dosage variables is lacking. Combining submaximal effort deep cervical muscles exercise (motor control) and superficial cervical muscles exercise (segmental) reduces chronic non-specific neck pain, but evaluation of optimal exercise and dosage variables is prevented by clinical heterogeneity. Objective To gain consensus on important motor control and segmental exercise and dosage variables for chronic non-specific neck pain. Methods An international 3-round e-Delphi study, was conducted with experts in neck pain management (academic and clinical). In round 1, exercise and dosage variables were obtained from expert opinion and clinical trial data, then analysed thematically (two independent researchers) to develop themes and statements. In rounds 2 and 3, participants rated their agreement with statements (1–5 Likert scale). Statement consensus was evaluated using progressively increased a priori criteria using descriptive statistics. Results Thirty-seven experts participated (10 countries). Twenty-nine responded to round 1 (79%), 26 round 2 (70%) and 24 round 3 (65%). Round 1 generated 79 statements outlining the interacting components of exercise prescription. Following rounds 2 and 3, consensus was achieved for 46 important components of exercise and dosage prescription across 5 themes (clinical reasoning, dosage variables, exercise variables, evaluation criteria and progression) and 2 subthemes (progression criteria and progression variables). Excellent agreement and qualitative data supports exercise prescription complexity and the need for individualised, acceptable, and feasible exercise. Only 37% of important exercise components were generated from clinical trial data. Agreement was highest (88%-96%) for 3 dosage variables: intensity of effort, frequency, and repetitions. Conclusion Multiple exercise and dosage variables are important, resulting in complex and individualised exercise prescription not found in clinical trials. Future research should use these important variables to prescribe an evidence-informed approach to exercise.

Therapeutic routine with respiratory exercises improves posture, muscle activity, and respiratory pattern of patients with neck pain: a randomized controlled trial

“…Our study limitation was that no long-term follow-up assessment was considered in the current study, so a similar study with a follow-up stage is highly recommended 38 – 40 . Future research should combine the assessment of neck impairments 50 with advanced respiratory assessment and respiratory exercise tools such as spirometry and power breath to assess respiratory factors associated with neck pain.…”

Considerations on the Obstacles That Lead to Slow Recruitment in a Pain Management Clinical Trial: Experiences from the Belgian PELICAN (PrEgabalin Lidocaine Capsaicin Neuropathic Pain) Pragmatic Study

“…A multiple round Delphi protocol was also applied to explore new diagnostic criteria for opioid use disorders [59]. Te availability of e-Delphi surveys allows for the inclusion of participants from many diferent countries into a single project, even when applying diferent rounds [60].…”

Trainieren statt Massieren – HWS untersuchen und behandeln bei unspezifischem Nackenschmerz – Teil 2 von 2

“…Während einige Übungen beispielsweise besser geeignet sind, die Kraft oder Ausdauer der Nackenmuskulatur zu steigern, verbessern andere die motorische Kontrolle oder den kinästhetischen Sinn der HWS. „Low-Dose-Übungen“ erhöhen die neuromuskuläre Kontrolle der ventralen Stabilisatoren 19 , 20 , 22 , 23 – 29 . Intensive Übungen und entsprechende Trainingsparameter verbessern hingegen vorliegende Kraftdefizite.…”

“…Aus Sicht der Wissenschaft besteht bis heute keine Eindeutigkeit über die besten Trainingsparameter und das ideale Training bei Nackenschmerzen 29 und es bedarf weiterer Forschung.…”