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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
European Journal of Physical and Rehabilitation Medicine 2013 June;49(3):273-81
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
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.