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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
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European Journal of Physical and Rehabilitation Medicine 2013 June;49(3):273-81

language: English

Patient-oriented rehabilitation in the management of chronic mechanical neck pain: a randomized controlled trial

Paoloni M. 1, 2, Tavernese E. 2, Cacchio A. 3, Tattoli M. 2, Melis L. 4, Ronconi R. 4, Santilli V. 1, 2

1 Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy;
2 Department of Physical Medicine and Rehabilitation, “Sapienza” University, Rome, Italy;
3 Department of Physical Medicine and Rehabilitation, University of L’Aquila, Italy;
4 International foundation for rehabilitative researches (FIRR), Rome, Italy


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Background: Management of chronic mechanical neck pain (CMNP) still represents a challenge. A patient-oriented (Pa-O) therapeutic approach could be considered as the one in which therapies are scheduled at the start of each therapeutic session according to the patient’s current physical status, and differs from a prescription-oriented (Pr-O) therapeutic approach, in which therapies are prescribed at the first medical referral and are not adjusted at any time during the treatment period.
Aim: To determine if a Pa-O approach may be more beneficial for CMNP patients when compared to a Pr-O one.
Design: Randomized controlled trial.
Population: 220 CMNP outpatients randomized to either Pa-O group (N.=114) or Pr-O group (N.=106).
Methods: Each group received 10 therapeutic sessions over 3 weeks. Primary outcome measures were pain assessment, evaluated by Visual-Analog-Scale (VAS), and disability level, evaluated by the Neck Pain and Disability Scale (NPDS-I). Secondary outcome measures included patients’ response to treatment and treatment failures. Measurements were carried out at baseline (T0) and 1 month after treatment ended (T1). Data were analysed according to the intention-to-treat principle.
Results: Patients in both groups displayed at T1 a significant reduction in VAS and NPDS-I scores. The relative changes at T1 were greater in Pa-O group when compared with Pr-O group both for VAS (61.5% versus 48.8%; P<0.005) and for NPDS-I scores (48.4% versus 36.8%; P<0.05).
Conclusion: A Pa-O approach may be more beneficial in terms of pain and disability improvement in the short-term follow-up in suffers from CMNP. However, the occurrence of a performance-bias due to the increased level of attention from physicians to patients in Pa-O group, cannot be ruled-out.
Clinical Rehabilitation Impact: A Pa-O approach should be considered for CMNP also in an outpatient facility.

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