Burton Wren, Wayne Peter M, Litrownik Dan, Long Cynthia R, Vining Robert, Rist Pamela, Kilgore Karen, Lisi Anthony, Kowalski Matthew H
Brigham and Women's Hospital and Harvard Medical School, Osher Center for Integrative Health, Boston, MA, USA.
Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Integr Complement Med. 2024 Dec;30(12):1189-1199. doi: 10.1089/jicm.2024.0043. Epub 2024 Aug 22.
Chronic nonspecific neck pain (CNNP) is prevalent among health care workers, with particularly high rates among nurses. Nurses experiencing CNNP often report decreased job satisfaction, increased absenteeism, and reduced productivity. In recent years, nonpharmacologic approaches have gained attention as effective treatments for the management of CNNP, with exercise and manual therapies representing two of the most common. Early evidence shows that multimodal treatments may be more effective than unimodal strategies. The purpose of this current study was to assess the feasibility and observe the clinical outcomes of combined multimodal chiropractic care (MCC) and Tai Chi (TC) for CNNP in nurses. A single-arm mixed-methods pilot trial was conducted including 16 weeks of MCC and TC in nurses with self-reported CNNP. Feasibility outcomes were recruitment, retention, and adherence to the interventions. Clinical outcomes of interest included neck pain and related disabilities. Secondary outcomes of interest were functional, affective, and work-related performance. Qualitative interviews were also conducted. Of the 59 screened, 36 met the eligibility criteria, and 21 were enrolled. The retention rate was 71.4%, and adherence rates were 85.3% for MCC and 62.5% for TC classes. Multiple pain and disability-related outcomes exhibited modest improvement from baseline to 16-week follow-up. Qualitative analysis identified six emergent themes: (1) neck pain being an inherent part of nursing, (2) nurses push through their pain, (3) MCC relieves pain and is instructive for preventing pain, (4) TC provides overall relaxation, (5) both interventions increased body awareness and improved posture, and (6) scheduling difficulties were a key obstacle for participating. Observed reductions in neck pain and disability suggest the potential utility of combined MCC and TC interventions for managing CNNP. Along with qualitative feedback regarding facilitators and barriers to participation, the findings support and inform a future randomized trial evaluating the combined benefits of MCC and TC for CNNP in nurses. Clinical Trial Registration #NCT06523036.
慢性非特异性颈部疼痛（CNNP）在医护人员中很普遍，在护士中发病率尤其高。患有CNNP的护士经常报告工作满意度下降、旷工增加和工作效率降低。近年来，非药物治疗方法作为治疗CNNP的有效手段受到关注，运动疗法和手法治疗是最常见的两种。早期证据表明，多模式治疗可能比单模式治疗更有效。本研究的目的是评估联合多模式整脊疗法（MCC）和太极拳（TC）治疗护士CNNP的可行性，并观察其临床疗效。对16名自我报告患有CNNP的护士进行了一项单臂混合方法试点试验，包括16周的MCC和TC治疗。可行性结果包括招募、保留和对干预措施的依从性。感兴趣的临床结果包括颈部疼痛和相关残疾。感兴趣的次要结果是功能、情感和与工作相关的表现。还进行了定性访谈。在59名筛查对象中，36名符合入选标准，21名被纳入研究。保留率为71.4%，MCC的依从率为85.3%，TC课程的依从率为62.5%。从基线到16周随访，多项与疼痛和残疾相关的结果有适度改善。定性分析确定了六个新出现的主题：（1）颈部疼痛是护理工作的固有部分，（2）护士忍痛工作，（3）MCC缓解疼痛并对预防疼痛有指导作用，（4）TC提供全面放松，（5）两种干预措施都提高了身体意识并改善了姿势，（6）时间安排困难是参与的关键障碍。观察到的颈部疼痛和残疾的减轻表明联合MCC和TC干预措施在管理CNNP方面的潜在效用。连同关于参与的促进因素和障碍的定性反馈，这些发现支持并为未来一项评估MCC和TC联合治疗护士CNNP综合效益的随机试验提供了信息。临床试验注册号#NCT06523036。
