Is tailored treatment superior to non-tailored treatment for pain and disability in women with non-specific neck pain? A randomized controlled trial

Abstract

BackgroundThe evidence for the effect of treatments of neck pain is modest. In the absence of causal treatments, a possibility is to tailor the treatment to the individuals’ functional limitations and symptoms. The aim was to evaluate treatment effects of a tailored treatment versus a non-tailored treatment. Our hypothesis was that tailored treatment (TT) would have better effect on pain intensity and disability than either non-tailored treatment (NTT) (same treatment components but applied quasi-randomly) or treatment-as-usual (TAU) (no treatment from the study, no restrictions). We further hypothesized that TT and NTT would both have better effect than TAU.MethodOne hundred twenty working women with subacute and chronic non-specific neck pain were allocated to 11 weeks of either TT, NTT or TAU in a randomized controlled trial with follow-ups at 3, 9 and 15 months. The TT was designed from a decision model based on assessment of function and symptoms with defined cut-off levels for the following categories: reduced cervical mobility, impaired neck-shoulder strength and motor control, impaired eye-head-neck control, trapezius myalgia and cervicogenic headache. Primary outcomes were pain and disability. Secondary outcomes were symptoms, general improvement, work productivity, and pressure pain threshold of m. trapezius.ResultsLinear mixed models analysis showed no differences between TT and NTT besides work productivity favoring TT at 9- and 15-months follow-ups. TT and NTT improved significantly more than TAU on pain, disability and symptoms at 3-month follow-up. General improvement also favored TT and NTT over TAU at all follow-ups.ConclusionTailored treatment according to our proposed decision model was not more effective than non-tailored treatment in women with subacute and chronic neck pain. Both tailored and non-tailored treatments had better short-term effects than treatment-as-usual, supporting active and specific exercise therapy, although therapist-patient interaction was not controlled for. Better understanding of the importance of functional impairments for pain and disability, in combination with a more precise tailoring of specific treatment components, is needed to progress.Trial registrationCurrent Controlled Trials ISRCTN 49348025. Registered 2 August 2011.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1263-9) contains supplementary material, which is available to authorized users.

Comparing the effectiveness of integrating ergonomics and motor control to conventional treatment for pain and functional recovery of work‐related neck–shoulder pain: A randomized trial

“…Their exercise programme also consisted of a variety of exercises involving stretching and strengthening exercises, but there was no emphasis on workplace interventions or correcting postures at work. In other studies by Björklund, Djupsjöbacka, Svedmark, and Häger () and Svedmark, Djupsjöbacka, Häger, Jull, and Björklund (), they compared the effects of a “tailored treatment” (TT) programme and non‐tailored treatment against “treatment as usual” (TAU) on individuals with chronic neck pain. Their concepts have some similarity to our study design, but their emphasis was more based on a clinical decision model to design the interventions.…”

“…Their exercise programme also consisted of a variety of exercises involving stretching and strengthening exercises, but there was no emphasis on workplace interventions or correcting postures at work. In other studies by Björklund, Djupsjöbacka, Svedmark, and Häger (2012) and Svedmark, Djupsjöbacka, Häger, Jull, and Björklund (2016), they compared the effects of a "tailored treatment" (TT) programme and non-tailored T A B L E 3 Pain and functional outcome scores measured at three time points (T0-T2) with Intention-to-treat (ITT) analysis…”

Is a combined programme of manual therapy and exercise more effective than usual care in patients with non-specific chronic neck pain? A randomized controlled trial

“…21 Although the effectiveness of physiotherapy intervention in patients with non-specific chronic neck pain was extensively evaluated in previous studies, the pragmatic studies are scarce and the effects of physiotherapy intervention in real-world clinical practice remain unknown. 22…”

“…21 Although the effectiveness of physiotherapy intervention in patients with non-specific chronic neck pain was extensively evaluated in previous studies, the pragmatic studies are scarce and the effects of physiotherapy intervention in real-world clinical practice remain unknown. 22 Therefore, the aim of this study was to perform a pragmatic randomized controlled trial to compare the effects of a six-week manual therapy and exercise programme with those of usual care in physiotherapy intervention, on disability, pain intensity and global perceived recovery, in patients with non-specific chronic neck pain.…”

Patients’ perceptions with musculoskeletal disorders regarding their experience with healthcare providers and health services: an overview of reviews

“…First, the application of individualized, tailored treatment has been proposed in the management of musculoskeletal disorders, with emphasis on customizing interventions for any given individual pathological, functional, and psychosocial variations [ 62 – 64 ]. In a shared decision-making model, patient’s diagnoses, clinical manifestations, severity of symptoms, cognitive and mental status as well as their needs should all be taken into consideration to formulate holistic, personalized plans of care [ 65 ].…”