Galaasen Bakken Anders, Eklund Andreas, Oksanen Anna, Axén Iben
Unit of Intervention and Implementation Research for Worker Health, Department of Environmental Medicine, Karolinska Institutet, Nobels Väg 13, 171 77, Stockholm, Sweden.
Division of Biostatistics, Karolinska Institutet, Nobels Väg 13, 171 77, Stockholm, Sweden.
Chiropr Man Therap. 2025 Apr 11;33(1):13. doi: 10.1186/s12998-025-00579-y.
Manual therapy and exercise are recommended for patients with neck pain. In a recent randomized controlled trial, home stretching exercises with or without manual therapy were offered to subjects with persistent or recurrent neck pain. No difference in pain or disability between the treatment groups were found after the two-week intervention period. We aimed to investigate whether these patients had a better outcome after individual tailoring of the treatment content two months after the initial structured intervention period.
This manuscript is a secondary analysis of a previous clinical trial where 131 patients with persistent or recurrent neck pain received treatments over two weeks (the intervention period). Pain and disability were assessed for two months following the intervention period. During this period, the treating therapists could recommend further individualized tailored treatment, including any treatment modality, regardless of the intervention group and whether the participants responded to the intervention (responders) or not (non-responders). Responders from the intervention period were defined as reporting a minimal clinical improvement on the numeric rating scale (NRS-11) at a 20-percentage points improvement (2 increments), regardless of group belonging in the original trial. All other participants were considered non-responders. We also evaluated the number of treatments, differences in disability, quality and affective component of pain, and quality of life during the individualized care period.
For responders to a randomized trial of manual therapy and stretching exercises, a significant worsening in pain was associated with an increasing number of treatments during a two-month individualized care period. Among non-responders to the initial intervention period, improvement in neck pain disability was observed with individually tailored treatments.
For responders to a randomized trial of manual therapy and stretching, worsening pain in the individualized care period was associated with increasing numbers of individually tailored treatments. Among non-responders to the initial intervention period, improvement in neck pain disability was observed with individually tailored treatments.
The trial was registered at ClinicalTrials.gov, registration number NCT03576846, on 23rd of June 2018.
对于颈部疼痛患者，推荐采用手法治疗和运动疗法。在最近一项随机对照试验中，为患有持续性或复发性颈部疼痛的受试者提供了有或没有手法治疗的家庭伸展运动。在为期两周的干预期后，未发现治疗组之间在疼痛或功能障碍方面存在差异。我们旨在调查在初始结构化干预期两个月后对治疗内容进行个体化调整后，这些患者是否会有更好的治疗效果。
本手稿是对先前一项临床试验的二次分析，在该试验中，131名患有持续性或复发性颈部疼痛的患者接受了为期两周（干预期）的治疗。在干预期后的两个月内评估疼痛和功能障碍情况。在此期间，治疗师可推荐进一步的个体化定制治疗，包括任何治疗方式，无论干预组情况以及参与者对干预是否有反应（有反应者）或无反应（无反应者）。干预期的有反应者定义为在数字评定量表（NRS-11）上报告有至少20个百分点改善（2个增量）的最小临床改善，无论其在原试验中的分组情况如何。所有其他参与者被视为无反应者。我们还评估了个体化护理期间的治疗次数、功能障碍差异、疼痛的质量和情感成分以及生活质量。
对于手法治疗和伸展运动随机试验的有反应者，在为期两个月的个体化护理期间，疼痛显著恶化与治疗次数增加有关。在初始干预期的无反应者中，个体化定制治疗可使颈部疼痛功能障碍得到改善。
对于手法治疗和伸展运动随机试验的有反应者，个体化护理期间疼痛恶化与个体化定制治疗次数增加有关。在初始干预期的无反应者中，个体化定制治疗可使颈部疼痛功能障碍得到改善。
该试验于2018年6月23日在ClinicalTrials.gov注册，注册号为NCT03576846。
