Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium.
Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Pain Pract. 2020 Jul;20(6):600-614. doi: 10.1111/papr.12884. Epub 2020 Apr 20.
In the context of interventions aimed at reducing pain, disability, and maladaptive pain cognitions in chronic neck pain, it is hypothesized that patients who have greater symptom reduction possibly also demonstrate greater improvement in cervical motor output. Therefore, the aim of this study was to examine the effect of pain neuroscience education plus cognition-targeted motor control training on cervical motor output.
Impairments in cervical motor output were measured in 64 subjects with chronic neck pain using standardized tests. Cervical muscle strength, cervical mobility, balance, and cervical neuromuscular control were derived. To assess the differences between groups in response to treatment, a random-intercept linear mixed-models analysis, applying a diagonal covariance matrix, was used.
A significant treatment × time interaction effect was found for neuromuscular control of the deep cervical flexors, favoring the experimental treatment at 3 months' follow-up (mean group difference: 1.982; 95% confidence interval 0.779, 3.185; large effect size d = 0.82). Significant main effects of time were found for the neuromuscular capacity of scapulothoracic muscles and for cervical mobility. No significant effects were found for balance, cervical muscle strength, or endurance of cervical flexors.
Pain neuroscience education combined with cognition-targeted motor control training is not more effective than biomedically focused education and exercise therapy for improving cervical motor output in people with chronic neck pain. Our findings question the relative importance of factors such as pain, disability, and maladaptive pain cognitions on cervical motor output and the need to address it in treatment.
在旨在减轻慢性颈痛患者疼痛、残疾和适应不良的疼痛认知的干预措施中，假设症状减轻较多的患者可能在颈椎运动输出方面也有更大的改善。因此，本研究旨在探讨疼痛神经科学教育加认知靶向运动控制训练对颈椎运动输出的影响。
使用标准化测试测量了 64 例慢性颈痛患者的颈椎运动输出障碍。得出了颈椎肌肉力量、颈椎活动度、平衡和颈椎神经肌肉控制的结果。为了评估治疗组之间的差异，使用随机截距线性混合模型分析，应用对角线协方差矩阵。
在深颈屈肌的神经肌肉控制方面，发现治疗与时间的交互作用有显著的效果，实验组在 3 个月的随访中表现出更好的效果（平均组间差异：1.982；95%置信区间 0.779，3.185；大效应量 d=0.82）。肩胛胸肌的神经肌肉能力和颈椎活动度的时间主效应显著。平衡、颈椎肌肉力量或颈屈肌耐力均无显著影响。
疼痛神经科学教育结合认知靶向运动控制训练在改善慢性颈痛患者颈椎运动输出方面并不比生物医学为重点的教育和运动疗法更有效。我们的研究结果质疑了疼痛、残疾和适应不良的疼痛认知等因素对颈椎运动输出的相对重要性，以及在治疗中需要解决这些因素的必要性。
