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European Journal of Physical and Rehabilitation Medicine 2019 October;55(5):665-75

DOI: 10.23736/S1973-9087.18.05348-0


lingua: Inglese

Multidisciplinary biopsychosocial rehabilitation in chronic neck pain: a naturalistic prospective cohort study with intraindividual control of effects and 12-month follow-up

Josefine LETZEL 1, Felix ANGST 2, Martin B. WEIGL 1

1 Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany; 2 Rehabilitation Clinic “RehaClinic”, Bad Zurzach, Switzerland

BACKGROUND: In contrast to the large evidence of the effectiveness of multidisciplinary biopsychosocial rehabilitation (MBR) in chronic low back pain, little is known about the effects of MBR in chronic neck pain (CNP).
AIM: To quantify short-term and 12-month effects of a 3-week CNP-specific MBR program.
DESIGN: Naturalistic prospective observational cohort study with intraindividual control of effects.
SETTING: Outpatient clinic at a tertiary physical medicine and rehabilitation center.
POPULATION: Consecutive patients with CNP (N.=81) who participated in a CNP-specific MBR.
METHODS: The intervention was a MBR outpatient clinic program. Primary Outcome was the North American Spine Society (NASS) questionnaire pain/function scale. Secondary outcomes included the NASS scale neurogenic symptoms, Short-Form 36 Health Survey (SF-36) and numerical rating scales (NRS) for maximum and average pain. Short-term changes of health were quantified using effect sizes (ES), which were corrected by the change during waiting time before MBR.
RESULTS: At the end of treatment, the NASS pain/function scale showed significant improvement (P<0.001) by a moderate corrected ES (ES=0.59). Moderate significant improvements were also found for the NASS scale neurogenic symptoms (ES=0.65), the SF-36 scales bodily pain (ES=0.56) and mental health (ES=0.54), and the NRS maximum pain (ES=0.59). Significant small corrected ES were found for the SF-36 scales physical functioning (ES=0.32), physical role (ES=0.41), vitality (ES=0.42), social functioning (ES=0.41), emotional role (ES=0.41) and the NRS average pain (ES=0.48). The improvement on the SF-36 scale general health was not significant (ES=0.19). At the follow-up after 12 months, the NASS pain/function scale remained its moderate ES (ES=0.52, P value <0.001). Also, the NASS Scale neurogenic symptoms, the SF-36 scales bodily pain, general health, social functioning and mental health and both NRS pain scales showed significant benefits.
CONCLUSIONS: This study showed that MBR may be effective in patients with CNP. Maintenance of moderate benefits in pain and function seems possible for at least 12 months.
CLINICAL REHABILITATION IMPACT: The findings support the concept of CNP-specific MBR.

KEY WORDS: Neck pain; Rehabilitation; Outcome assessment (health care); Pain clinics; Follow-up studies

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