Department of Physiotherapy and Occupational Therapy Aarhus University Hospital, Aarhus, Denmark -
Eur J Phys Rehabil Med. 2014 Dec;50(6):617-26. Epub 2014 May 30.
The optimal type of exercise protocol in the physical rehabilitation of non-specific neck pain has not yet been established. Furthermore, the role of fear-avoidance belief in the maintenance of pain and disability has been highlighted. Research indicates that exercise may be a means to reduce fear-avoidance belief, but evidence is scarce.
To compare the effect of two different exercise programs on pain, strength and fear-avoidance belief.
Randomized clinical trial.
A specialized outpatient hospital clinic in Denmark.
Twenty-three men and 60 women on sick leave due to non-specific neck pain.
Participants were randomized to either general physical activity (GPA group) or GPA and additional strength training of the neck and shoulder (SST group). The primary outcome was pain intensity. Secondary outcomes were muscle strength of the neck and shoulder and fear-avoidance belief.
Pain was significantly reduced within groups with a median of -1 (IQR: -3 to 0, P<0.001) in the SST group and -1 (IQR: -4 to 1, P=0.046) in the GPA group. The difference between groups was not significant. Changes in strength did not differ between groups. Both groups experienced significant increases in neck flexion strength of 14.7 N (IQR: -1 to 28.4, P=0. 001) in the SST group and 6.9 N (IQR: -4.9 to18.6, P=0.014) in the GPA group. Furthermore, the SST group achieved an increase of 18.6 N (IQR: -2.6 to 69.7, P=0.005) in neck extension. Fear-avoidance beliefs improved with 6 (IQR: 3 to 12, P<0.001) in the SST group, while the GPA group improved with 3 (IQR: 0 to 8, P=0.004). This between-group difference was significant (P=0.046).
This study indicates that in rehabilitation of subjects severely disabled by non-specific neck pain, there is no additional improvement on pain or muscle strength when neck exercises are given as a home-based program with a minimum of supervision. However, strength training of the painful muscles seems to be effective in decreasing fear-avoidance beliefs.
在非特异性颈部疼痛的物理康复中，还没有确定最佳的运动方案。此外，恐惧回避信念在维持疼痛和残疾方面的作用已得到强调。研究表明，运动可能是减少恐惧回避信念的一种手段，但证据有限。
比较两种不同运动方案对疼痛、力量和恐惧回避信念的影响。
随机临床试验。
丹麦一家专门的门诊医院诊所。
23 名男性和 60 名因非特异性颈部疼痛而休病假的女性。
参与者被随机分配到一般体育活动（GPA 组）或 GPA 和颈部及肩部额外力量训练（SST 组）。主要结局是疼痛强度。次要结局是颈部和肩部肌肉力量以及恐惧回避信念。
SST 组疼痛明显减轻，中位数为-1（IQR：-3 至 0，P<0.001），GPA 组疼痛明显减轻，中位数为-1（IQR：-4 至 1，P=0.046）。组间差异无统计学意义。两组之间的力量变化无差异。SST 组颈部屈曲力量显著增加 14.7 N（IQR：-1 至 28.4，P=0.001），GPA 组增加 6.9 N（IQR：-4.9 至 18.6，P=0.014）。此外，SST 组颈部伸展力量增加 18.6 N（IQR：-2.6 至 69.7，P=0.005）。恐惧回避信念在 SST 组改善 6（IQR：3 至 12，P<0.001），而 GPA 组改善 3（IQR：0 至 8，P=0.004）。组间差异有统计学意义（P=0.046）。
本研究表明，在严重受非特异性颈部疼痛影响的患者康复中，当颈部运动作为一种最低限度监督的家庭方案进行时，疼痛或肌肉力量没有额外改善。然而，疼痛肌肉的力量训练似乎可以有效减少恐惧回避信念。
