Stretching and muscle-performance exercises for chronic nonspecific neck pain: who may benefit most?

ABSTRACT

Background

Although exercise is the mainstay of treatment for neck pain (NP), uncertainty remains over optimal decision-making concerning who may benefit most from such, particularly in the long term.

Objective

To identify the subgroup of patients with nonspecific NP most likely to benefit from stretching and muscle-performance exercises.

Methods

This was a secondary analysis of treatment outcomes of 70 patients (10 of whom dropped out) with a primary complaint of nonspecific NP in one treatment arm of a prospective, randomized, controlled trial. All patients performed the exercises, twice weekly for 6 weeks, and a home exercise program. Blinded outcome measurements were collected at baseline, after the 6-week program, and at a 6-month follow-up. Patients rated their perceived recovery on a 15-point global rating of change scale; a rating of “quite a bit better” (+5) or higher was defined as a successful outcome. Clinical predictor variables were developed via logistic regression analysis to classify patients with NP that may benefit from exercise-based treatment.

Results

NP duration since onset≤6 months, no cervicogenic headache, and shoulder protraction were independent predictor variables. The pretest probability of success was 47% after the 6-week intervention and 40% at the 6-month follow-up. The corresponding posttest probabilities of success for participants with all three variables were 86% and 71%, respectively; such participants were likely to recover.

Conclusion

The clinical predictor variables developed in this study may identify patients with nonspecific NP likely to benefit most from stretching and muscle-performance exercises in the short and long terms.

KEYWORDS:

• Clinical prediction rules
• chronic nonspecific neck pain
• stretching exercise
• muscle performance exercise
• cervicogenic headache

Acknowledgments

The authors would like to thank all the patients who participated in the study, as well as our colleagues from the Clalit Health Services Physical Therapy Outpatient Units of the Northern District, Haifa, and Western Galilee for their support throughout this study. This work was supported by National Insurance Institute of Israel [grant number: 12/2018]; Israel Physiotherapy Society [grant number: 06/2015]; and University of Haifa [grant number: 2015].

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The work was supported by the The National Insurance Institute of Israel [12/2018]; Israel Physiotherapy Society [06/2015]; University of Haifa [2015].