Musculoskeletal Physiotherapy Services, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom.
College of Life and Environmental Sciences, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine) School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.
PLoS One. 2021 Jul 1;16(7):e0253523. doi: 10.1371/journal.pone.0253523. eCollection 2021.
Chronic non-specific neck pain is highly prevalent, resulting in significant disability. Despite exercise being a mainstay treatment, guidance on optimal exercise and dosage variables is lacking. Combining submaximal effort deep cervical muscles exercise (motor control) and superficial cervical muscles exercise (segmental) reduces chronic non-specific neck pain, but evaluation of optimal exercise and dosage variables is prevented by clinical heterogeneity.
To gain consensus on important motor control and segmental exercise and dosage variables for chronic non-specific neck pain.
An international 3-round e-Delphi study, was conducted with experts in neck pain management (academic and clinical). In round 1, exercise and dosage variables were obtained from expert opinion and clinical trial data, then analysed thematically (two independent researchers) to develop themes and statements. In rounds 2 and 3, participants rated their agreement with statements (1-5 Likert scale). Statement consensus was evaluated using progressively increased a priori criteria using descriptive statistics.
Thirty-seven experts participated (10 countries). Twenty-nine responded to round 1 (79%), 26 round 2 (70%) and 24 round 3 (65%). Round 1 generated 79 statements outlining the interacting components of exercise prescription. Following rounds 2 and 3, consensus was achieved for 46 important components of exercise and dosage prescription across 5 themes (clinical reasoning, dosage variables, exercise variables, evaluation criteria and progression) and 2 subthemes (progression criteria and progression variables). Excellent agreement and qualitative data supports exercise prescription complexity and the need for individualised, acceptable, and feasible exercise. Only 37% of important exercise components were generated from clinical trial data. Agreement was highest (88%-96%) for 3 dosage variables: intensity of effort, frequency, and repetitions.
Multiple exercise and dosage variables are important, resulting in complex and individualised exercise prescription not found in clinical trials. Future research should use these important variables to prescribe an evidence-informed approach to exercise.
慢性非特异性颈部疼痛的患病率很高，导致严重的残疾。尽管运动是主要的治疗方法，但缺乏关于最佳运动和剂量变量的指导。结合次最大努力的深层颈部肌肉运动（运动控制）和浅层颈部肌肉运动（节段性）可减轻慢性非特异性颈部疼痛，但由于临床异质性，无法评估最佳运动和剂量变量。
就慢性非特异性颈部疼痛的重要运动控制和节段性运动及剂量变量达成共识。
采用国际 3 轮电子德尔菲研究，对颈部疼痛管理（学术和临床）的专家进行研究。在第 1 轮中，从专家意见和临床试验数据中获得运动和剂量变量，然后进行主题分析（两名独立研究人员），以制定主题和陈述。在第 2 轮和第 3 轮中，参与者根据 1-5 级李克特量表对陈述进行了评价。使用描述性统计数据，根据逐步增加的先验标准评估陈述的共识。
37 名专家参与（来自 10 个国家）。29 人回复了第 1 轮（79%），26 人回复了第 2 轮（70%），24 人回复了第 3 轮（65%）。第 1 轮生成了 79 个陈述，概述了运动处方的相互作用成分。经过第 2 轮和第 3 轮，在 5 个主题（临床推理、剂量变量、运动变量、评估标准和进展）和 2 个子主题（进展标准和进展变量）下，达成了 46 个重要运动和剂量处方组成部分的共识。良好的一致性和定性数据支持运动处方的复杂性以及对个体化、可接受和可行运动的需求。只有 37%的重要运动成分是从临床试验数据中得出的。3 个剂量变量的一致性最高（88%-96%）：努力强度、频率和重复次数。
多个运动和剂量变量很重要，导致了临床试验中没有发现的复杂和个体化的运动处方。未来的研究应该使用这些重要的变量来规定循证运动方法。
