The processes underpinning reductions in disability among people with chronic neck pain. A preliminary comparison between two distinct types of physiotherapy intervention

Abstract

Purpose: To establish whether different processes underpin changes in disability in people with neck pain who underwent two types of active physiotherapy intervention.

Materials and methods: This study was a sub-analysis of a randomized controlled trial assessing whether the addition of Interactive Behavioral Modification Therapy (a cognitively informed physiotherapy treatment) to a Progressive Neck Exercise Program improved outcome in patients with chronic neck pain. Regression analyses were performed to determine the extent to which demographics, changes in pain, and changes in certain cognitive factors were related to changes in disability.

Results: In the progressive neck exercise group, changes in levels of pain intensity were the only factor significantly related to change in disability, explaining 33% of the variance. In the interactive behavioral modification therapy group, changes in pain intensity, and catastrophizing together explained 54% of the variance in change in disability. Only changes in catastrophizing displayed a significant β value in the final model.

Conclusions: Different processes appear to underpin changes in disability in patients undergoing cognitively informed physiotherapy to those undergoing a primarily exercise-based approach.

Implications for rehabilitation

• Certain cognitive factors are known to be related to levels of disability in patients with chronic neck pain

• Specifically targeting these factors results in more patients making a clinically meaningful reduction in disability

• Different processes appear to underpin reductions in disability when people with neck pain are treated with cognitively informed physiotherapy to when treated with exercise alone, which may account for why more patients improve when treated in this manner.

• Reductions in catastrophizing appear to be particularly important and efforts should be made to assess and treat catastrophic thoughts in people with chronic neck pain.

Keywords:

• Neck pain
• chronic pain
• physical therapy modalities
• catastrophization
• exercise

Acknowledgements

The authors would like to thank all of the staff involved in data collection at North Manchester General Hospital, Fairfield General Hospital and Royal Oldham Hospital.

Disclosure statement

The authors report no declarations of interest. (Please note that Dr Woby was not employed in his current role as Director of Research and Development when the study was funded)

Additional information

Funding

This work was supported by the Pennine Acute Hospitals Department of Research and Development [Grant number KM960].