Fandim Junior V, Almeida de Oliveira Lisandra, Yamato Tiê P, Kamper Steven J, Costa Leonardo Op, Maher Christopher G, Saragiotto Bruno T
Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
Cochrane Database Syst Rev. 2025 Aug 12;8(8):CD014428. doi: 10.1002/14651858.CD014428.pub2.
Neck pain is a very common condition, ranked fourth in terms of years lived with disability worldwide. Telerehabilitation has been growing in popularity with advances in technologies and telecommunication. Despite the potential benefits and the increased number of trials, there is uncertainty about the effectiveness of telerehabilitation in people with non-specific neck pain.
To evaluate the benefits and harms of telerehabilitation to improve pain and function compared to no treatment, waiting list, usual care, or any other active intervention in people with acute, subacute, and chronic non-specific neck pain.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, five other databases, and two trial registers to 11 April 2024 without language or publication status restrictions. We screened reference lists of relevant potential studies.
We included randomised controlled trials of telerehabilitation in adults with non-specific neck pain. We classified telerehabilitation interventions into three categories: 1. telehealth delivery of psychological or education interventions; 2. telehealth delivery of exercise or physical activity interventions; and 3. telehealth delivery of multicomponent interventions. We included trials comparing telerehabilitation with minimal intervention, matched non-telehealth treatment, and unmatched treatment controls. The primary outcomes were pain intensity, function, health-related quality of life, anxiety, depression, any adverse events, withdrawals due to adverse events, and short-term serious adverse events. The secondary outcomes were return to work, self-efficacy, fear avoidance, pain catastrophising, and adherence.
Two review authors independently screened relevant records, extracted data, and assessed risk of bias in included studies. We extracted data using a standardised form. We pooled trial results using a random-effects model meta-analysis. We combined results in a meta-analysis using mean difference (MD with pain and disability outcomes expressed on a 0 to 100 scale) or standardised mean difference (SMD), and 95% confidence intervals (CI) for continuous outcomes at immediate-, short-, intermediate-, and long-term follow-up. Otherwise, we report the data with a narrative summary. We assessed heterogeneity using the I value and Chi test, and assessed the certainty of the evidence using the GRADE approach.
We included 13 randomised controlled trials (1042 participants). Most studies included women (71%), aged 21 to 60 years (mean 39 years, standard deviation 11 years). Studies used different modalities for telerehabilitation, such as telephone, smartphone applications, pre-recorded videos, videoconference, and websites. The studies were conducted in China, Denmark, Germany, Greece, Italy, the Netherlands, South Korea, Thailand, and Turkey. The telerehabilitation interventions lasted from one day to 48 weeks. Most studies had a low risk of selection bias, attrition bias, and reporting bias. All studies had a high risk of performance bias related to blinding of participants and therapists, and detection bias for outcome assessment. Chronic neck pain Telerehabilitation (psychological or education) versus minimal intervention We found very low-certainty evidence that there may be little to no difference between telerehabilitation (psychological or education) and minimal intervention in pain intensity at short-term follow-up, but the evidence is very uncertain (MD -8.4, 95% CI -23.9 to 7.1; 2 studies, 170 participants). We found moderate-certainty evidence that telerehabilitation (psychological or education) probably improves function when compared to minimal intervention at short-term follow-up (MD 6.0, 95% CI 0.9 to 11.1; 1 study, 53 participants). We found low-certainty evidence that telerehabilitation (psychological or education) may not improve health-related quality of life related to the Physical Component when compared to minimal intervention at short-term follow-up (mean: 47.4 with telerehabilitation versus 45.1 with minimal intervention; 1 study, 117 participants) and health-related quality of life related to Mental Component at short-term follow-up (mean: 45.4 with telerehabilitation versus 47.2 with minimal intervention; 1 study, 117 participants). We found moderate-certainty evidence that telerehabilitation (psychological or education) probably reduces anxiety slightly compared to minimal intervention at short-term follow-up (MD -4.5, 95% CI -8.9 to -0.1; 1 study, 53 participants). We found low-certainty evidence that there may be little to no difference between telerehabilitation (psychological or education) and minimal intervention for depression at short-term follow-up (MD -2.3, 95% CI -6.5 to 1.9; 1 study, 53 participants). No study in this comparison reported withdrawal due to adverse events or serious adverse events. Telerehabilitation (exercise and physical activity) versus minimal intervention We found low-certainty evidence that telerehabilitation (exercise and physical activity) may reduce pain intensity when compared to minimal intervention at short-term follow-up (MD -20.4, 95% CI -21.9 to -19.1; 3 studies, 146 participants). We found very low-certainty evidence that telerehabilitation may improve function compared to minimal intervention at short-term follow-up, but the evidence is very uncertain (MD 5.0, 95% CI 0.5 to 9.4; 3 studies, 146 participants). We found very low-certainty evidence that there may be little to no difference between telerehabilitation (exercise and physical activity) and minimal intervention in quality of life (Physical Component) at short-term follow-up (SMD -0.06, 95% CI -0.7 to 0.6; 2 studies, 64 participants) or quality of life (Mental Component) at short-term follow-up (SMD -0.3, 95% CI -0.8 to 0.2; 2 studies, 64 participants), but the evidence is very uncertain. No study in this comparison assessed anxiety, depression, withdrawal due to adverse events, or serious adverse events. Telerehabilitation (multicomponent interventions) versus minimal intervention We found low-certainty evidence that there may be little to no difference between telerehabilitation (multicomponent) and minimal intervention in pain intensity at short-term follow-up (MD -1.0, 95% CI -5.9 to 3.9; 1 study, 213 participants). No study in this comparison assessed function, health-related quality of life, anxiety, depression, withdrawals due to adverse events, and serious adverse events.
AUTHORS' CONCLUSIONS: The current available evidence is inconclusive due to its very low certainty, and thus the question of the effectiveness of telerehabilitation interventions for non-specific neck pain remains unanswered.
颈部疼痛是一种非常常见的病症，在全球因残疾而导致的寿命损失年数方面排名第四。随着技术和电信的进步，远程康复越来越受欢迎。尽管有潜在益处且试验数量不断增加，但远程康复对非特异性颈部疼痛患者有效性仍存在不确定性。
评估与不治疗、等待名单、常规护理或任何其他积极干预相比，远程康复对改善急性、亚急性和慢性非特异性颈部疼痛患者疼痛和功能的益处及危害。
我们检索了Cochrane对照试验中心注册库（CENTRAL）、MEDLINE、Embase及其他五个数据库，以及两个试验注册库，检索截至2024年4月11日，无语言或出版状态限制。我们筛选了相关潜在研究的参考文献列表。
我们纳入了针对非特异性颈部疼痛成人的远程康复随机对照试验。我们将远程康复干预分为三类：1. 心理或教育干预的远程医疗服务；2. 运动或身体活动干预的远程医疗服务；3. 多成分干预的远程医疗服务。我们纳入了比较远程康复与最小干预、匹配的非远程医疗治疗及不匹配治疗对照的试验。主要结局为疼痛强度、功能、健康相关生活质量、焦虑、抑郁、任何不良事件、因不良事件退出及短期严重不良事件。次要结局为重返工作、自我效能、恐惧回避、疼痛灾难化及依从性。
两位综述作者独立筛选相关记录、提取数据并评估纳入研究的偏倚风险。我们使用标准化表格提取数据。我们采用随机效应模型荟萃分析汇总试验结果。我们在荟萃分析中合并结果，使用均数差（疼痛和残疾结局以0至100量表表示时为MD）或标准化均数差（SMD），以及即时、短期、中期和长期随访时连续结局的95%置信区间（CI）。否则，我们用叙述性总结报告数据。我们使用I值和卡方检验评估异质性，并使用GRADE方法评估证据的确定性。
我们纳入了13项随机对照试验（1042名参与者）。大多数研究纳入女性（71%），年龄在21至60岁之间（平均39岁，标准差11岁）。研究使用了不同的远程康复方式，如电话、智能手机应用程序、预录制视频、视频会议和网站。这些研究在中国、丹麦、德国、希腊、意大利、荷兰、韩国、泰国和土耳其进行。远程康复干预持续时间从1天到四十八周不等。大多数研究在选择偏倚、失访偏倚和报告偏倚方面风险较低。所有研究在参与者和治疗师盲法相关的实施偏倚以及结局评估的检测偏倚方面风险较高。慢性颈部疼痛 远程康复（心理或教育）与最小干预相比 我们发现证据确定性极低，表明在短期随访时，远程康复（心理或教育）与最小干预在疼痛强度方面可能几乎没有差异，但证据非常不确定（MD -8.4，95% CI -23.9至7.1；2项研究，170名参与者）。我们发现证据确定性中等，表明与最小干预相比，在短期随访时远程康复（心理或教育）可能改善功能（MD 6.0，95% CI 0.9至11.1；1项研究，53名参与者）。我们发现证据确定性低，表明与最小干预相比，在短期随访时远程康复（心理或教育）可能不会改善与身体成分相关的健康相关生活质量（平均：远程康复组为47.4，最小干预组为45.1；1项研究，117名参与者）以及在短期随访时与精神成分相关健康相关生活质量（平均：远程康复组为45.4，最小干预组为47.2；1项研究，117名参与者）。我们发现证据确定性中等，表明与最小干预相比 在短期随访时远程康复（心理或教育）可能会使焦虑略有降低（MD -4.5，95% CI -8.9至-0.1；1项研究，53名参与者）。我们发现证据确定性低，表明在短期随访时，远程康复（心理或教育）与最小干预在抑郁方面可能几乎没有差异（MD -2.3，95% CI -6.5至1.9；1项研究，53名参与者）。该比较中没有研究报告因不良事件退出或严重不良事件。远程康复（运动和身体活动）与最小干预相比 我们发现证据确定性低，表明与最小干预相比，在短期随访时远程康复（运动和身体活动）可能会降低疼痛强度（MD -20.4，95% CI -21.9至-19.1；3项研究，146名参与者）。我们发现证据确定性极低，表明与最小干预相比，在短期随访时远程康复可能改善功能，但证据非常不确定（MD 5.0，95% CI 0.5至9.4；3项研究，146名参与者）。我们发现证据确定性极低，表明在短期随访时，远程康复（运动和身体活动）与最小干预在生活质量（身体成分）方面可能几乎没有差异（SMD -0.06，95% CI -0.7至0.6；2项研究，64名参与者）或在短期随访时生活质量（精神成分）方面（SMD -0.3，95% CI -0.8至0.2；2项研究，64名参与者），但证据非常不确定。该比较中没有研究评估焦虑、抑郁、因不良事件退出或严重不良事件。远程康复（多成分干预）与最小干预相比 我们发现证据确定性低，表明在短期随访时，远程康复（多成分）与最小干预在疼痛强度方面可能几乎没有差异（MD -1.0，95% CI -5.9至3.9；1项研究，213名参与者）。该比较中没有研究评估功能健康相关生活质量、焦虑、抑郁、因不良事件退出及严重不良事件。
由于现有证据确定性极低，目前尚无定论，因此远程康复干预对非特异性颈部疼痛有效性的问题仍未得到解答。
