Nilmart Patcharin, Sichuai Arrada, Chedang Asree, Goontharo Chanikarn, Janjamsai Nollapan
Faculty of Physical Therapy, Srinakharinwirot University, 63 Moo 7 Rangsit-Nakhon Nayok Highway, Ongkharak, Nakhon Nayok, 26120, Thailand, 66 89-4635274.
School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand.
JMIR Rehabil Assist Technol. 2025 Jul 25;12:e74979. doi: 10.2196/74979.
BACKGROUND: Neck pain is a common musculoskeletal disorder, often linked to forward head posture (FHP). Studies have shown that exercise interventions can improve pain, craniovertebral angle (CVA), range of motion, and function in individuals with FHP. While telerehabilitation exercise has proven effective for other musculoskeletal conditions, its effectiveness in addressing neck pain and FHP is still being investigated. OBJECTIVE: This study aimed to evaluate and compare the effectiveness of an internet-based telerehabilitation therapeutic exercise program with an in-person supervised program in improving clinical outcomes among young adult females with chronic nonspecific neck pain and FHP. The study hypothesized that there would be no significant differences in outcomes between the 2 groups. METHODS: A randomized controlled trial was conducted with 50 participants experiencing chronic neck pain and FHP, recruited through public announcement and voluntary sign-up. Participants were randomly assigned to either a telerehabilitation group or an in-person supervision group. Both groups completed the same 6-week, physiotherapist-supervised therapeutic exercise program, delivered via Zoom (Zoom Video Communications) or in the physiotherapy department laboratory, respectively. Outcome assessments were conducted face-to-face by blinded assessors at baseline, after 4 and 6 weeks of intervention, and at a 2-week follow-up. Outcome measures included pain intensity (assessed using the Visual Analog Scale [VAS]), CVA, neck disability (assessed using the Neck Disability Index [NDI]), and cervical range of motion (CROM). Adherence was monitored using attendance logs. RESULTS: Of the 50 participants, 48 completed the intervention with 1 dropout from each group. Adherence among completers was 100 percent in both groups. All 50 participants were included in the analysis using the intention-to-treat principle. No differences in effectiveness were found between the telerehabilitation and in-person groups, as no significant interaction effect between group and time was observed across all outcome measures including VAS, CVA, NDI, and CROM (P values ranged .07-.61). However, improvements were observed in all outcomes across time, including a 2.2- to 4.1-cm reduction in VAS, 5°-8.8° increase in CVA, 3.3- to 7.1-point reduction in NDI (P<.001 for all), and 3.5°-22.7° increase in CROM (P<.001 to P=.04). CONCLUSIONS: Both telerehabilitation and in-person supervision were similarly effective in improving pain, posture, neck disability, and CROM in young adult females with chronic neck pain and FHP. These findings suggest that telerehabilitation may be a feasible and accessible alternative to conventional in-person therapeutic exercise programs for managing chronic neck pain with FHP.
背景:颈部疼痛是一种常见的肌肉骨骼疾病,常与头部前倾姿势(FHP)有关。研究表明,运动干预可以改善FHP患者的疼痛、颅椎角(CVA)、活动范围和功能。虽然远程康复运动已被证明对其他肌肉骨骼疾病有效,但其在解决颈部疼痛和FHP方面的有效性仍在研究中。 目的:本研究旨在评估和比较基于互联网的远程康复治疗运动计划与现场监督计划在改善患有慢性非特异性颈部疼痛和FHP的年轻成年女性临床结局方面的有效性。该研究假设两组之间的结局无显著差异。 方法:进行了一项随机对照试验,通过公告招募了50名患有慢性颈部疼痛和FHP的参与者,他们自愿报名。参与者被随机分配到远程康复组或现场监督组。两组均完成相同的为期6周、由物理治疗师监督的治疗运动计划,分别通过Zoom(Zoom视频通信)或在物理治疗部门实验室进行。结局评估由盲法评估者在基线、干预4周和6周后以及2周随访时进行面对面评估。结局指标包括疼痛强度(使用视觉模拟量表[VAS]评估)、CVA、颈部功能障碍(使用颈部功能障碍指数[NDI]评估)和颈椎活动范围(CROM)。使用出勤记录监测依从性。 结果:50名参与者中,48名完成了干预,每组各有1名退出。两组完成者的依从率均为100%。所有50名参与者均按照意向性分析原则纳入分析。在远程康复组和现场监督组之间未发现有效性差异,因为在包括VAS、CVA、NDI和CROM在内的所有结局指标中,未观察到组与时间之间的显著交互作用(P值范围为0.07 - 0.61)。然而,随着时间推移,所有结局指标均有改善,包括VAS降低2.2至4.1厘米、CVA增加5°至8.8°、NDI降低3.3至7.1分(所有P < 0.001)以及CROM增加3.5°至22.7°(P < 0.001至P = 0.04)。 结论:远程康复和现场监督在改善患有慢性颈部疼痛和FHP的年轻成年女性的疼痛、姿势、颈部功能障碍和CROM方面同样有效。这些发现表明,对于管理伴有FHP的慢性颈部疼痛,远程康复可能是传统现场治疗运动计划的一种可行且可及的替代方案。
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