Author: Law, Yuk Hung Ellis
Title: Investigation on the effectiveness of two different therapeutic exercise programs in patients with chronic mechanical neck pain : a randomized controlled trial
Advisors: Chiu, Thomas T. W. (RS)
Ng, Joseph (RS)
Degree: Ph.D.
Year: 2015
Subject: Neck pain -- Treatment.
Physical therapy.
Hong Kong Polytechnic University -- Dissertations
Department: Department of Rehabilitation Sciences
Pages: xix, 175 pages : illustrations (some color)
Language: English
Abstract: The first part of this thesis focuses on the validation of an apparatus(the ARCON Electronic Goniometer) for measuring cervical spine Active Range of Motion (CROM) particularly in patients with chronic neck pain and disorders. Fifty-two subjects (26 normal subjects and 26 patients with chronic neck pain) were recruited from the United Christian Hospital (UCH) in Hong Kong in a cross-sectional reliability study. The mean age of normal subjects was 45.28 (±9.12) years, whereas that of the neck pain group was 44.52 (±7.11) years. The intra-and interrater reliabilities of electronic goniometer readings for measuring CROM in both groups were high, with Intra-class Correlation Coefficients (ICC) ranging from 0.75 to 0.92 and 0.81 to 0.92,respectively. The construct validity of the goniometer was investigated by comparing the total CROM of patients with chronic mechanical neck pain and normal subjects. The mean total CROM of chronic neck pain subject was 292.6 degrees (± 35.08) and for normal subjects it was 374.7 degrees (±30.86). There was significant difference in the total CROM between chronic pain subjects and normal subjects with p < 0.001. It is thus concluded that the electronic CROM goniometer is valid and reliable for measuring the CROM in patients with chronic neck pain. The major part of this thesis involved a randomized controlled clinical trial undertaken to investigate the effects of two different therapeutic exercise programmes in-patient with chronic mechanical neck pain. Three hundred subjects were recruited from the Physiotherapy Department of UCH and randomly assigned to either one of the experimental groups or the control group. The Neck McKenzie Class (NMC) group (n=103, age 50.6±11.55) were given a 5-week McKenzie exercise program and the Upper Quarter Stabilization (UQS) exercise group (n= 84, age 52.98 ±11.01) were given a 5-week core stabilization exercise program, while the control group (n=84, age 53.83±10.75) participated in a neck postural care workshop for one session.
The outcome measures included level of pain (measured with the Numeric Pain Rating Scale, (NPRS)), neck disability (based on the values of the Chinese version of The Northwick Park Neck Pain Questionnaire (NPQ)), cervical active range of motion (AROM) and global change or patient satisfaction (based on Numeric Global Rating Changes Scale (NGRCS)). A blinded assessor made assessments at baseline, immediately after completion of an exercise program, and three months and six months after completion of treatment.Comparison of the three groups at baseline did not reveal any significant between group difference in most of the demographic characteristics (ps=0.067-0.966) except NPQ with F ratio 8.23 and p value <0.001, neck NPRS on exertion with F ratio 3.89 and p value =0.022 and left and right side flexion range with F ratio 3.15 and p value =0.045; left and right rotation with F ratio 3.10 and p value =0.047. These baseline scores were treated as covariates and repeated measures ANCOVAs were used instead of ANOVA in the analysis of the main trials outcomes.At 6 months follow-up, we compared NMC and UQS groups with control, there were significant between group effects in NGRCS (F=25.14; p<0.001), AROM (Left & right Side Flexion F=18.17; p<0.001, Flexion-Extension F=4.01; p=0.019) and NPQ (F=5.66; p=0.004). At 1 and 3 months follow-up, the NMC and UQS groups showed no significant mean difference in AROM (except Side Flexion direction) but significant mean difference in NPQ (NMC mean difference 9.88; p<0.001 and UQS mean difference 8.43; p=0.001) and significant difference in NGRCS (NMC mean difference -2.66, p<0.001; UQS mean difference -2.27, p<0.001). At 6 months follow-up, NMC and UQS groups showed significant difference with control in AROM (Flexion-extension direction: NMC mean difference -7.40; p<0.001 and UQS mean difference -5.83; p=0.003 and left and right side flexion: NMC is -8.64, p<0.001; UQS is -7.26, p=0.001). When compared to the control, the NMC group demonstrated greater group mean differences than the UQS group (except neck NPRS on exertion at 3-month and shoulder NPRS at rest at 6-month).However,no statistically significant difference could be demonstrated between the two exercise interventions; neither of them was superior when compared to the other (P values range from 0.66 to 1.0) in all stages of follow up. The results of the study demonstrated that both upper quarter stabilization exercise and neck McKenzie exercise were effective in improving cervical active range of motion and numeric rating change scale over 6 months but at initial follow-up there was a difference in the NPQ scores only. Hence, UQS and NMC could be an effective means of treating patients with chronic mechanical neck pain.
Rights: All rights reserved
Access: open access

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