Chronic Non-specific Neck Pain Research Articles

Psychometric properties of the Persian version of the pain anxiety symptom scale (PASS-20) in chronic non-specific neck pain patients.

Pain-related anxiety has been linked to avoidance behaviour, maintenance of pain and disability. A valid and reliable tool is required to evaluate pain-related anxiety among Persian speaking adults with chronic non-specific neck pain (CNSNP). This study aimed to evaluate psychometric properties of the Persian pain anxiety symptom scale-20 (PASS-20) according to the consensus-based standards for the selection of health measurement instruments (COSMIN) checklist in Iranian adults with CNSNP. 198 individuals with CNSNP completed the PASS-20. The factorial structure (confirmatory factor analysis (CFA), exploratory factor analysis (EFA)), test-retest reliability (intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC)), internal consistency (Cronbach's alpha), and construct validity (convergent and known-group validity) were assessed. The correlation between PASS-20 with pain catastrophizing scale (PCS), Tampa Scale for Kinesiophobia (TSK), neck disability index (NDI), Beck Depression Inventory (BDI), visual analog scale (VAS) (Spearman's rank correlation) were examined. Known-group validity of PASS-20 was evaluated by comparing the difference between the PASS-20 scores of the known groups based on level of disability, pain intensity and gender using non-parametric tests. The CFA showed almost the best fit with the original version. The subscales and total score demonstrated good internal consistency (Cronbach's α: 0.70-0.92) and high test-retest reliability (ICC: 0.94-0.97). PASS-20 had significant moderate correlations with PCS, TSK, NDI, VAS and a significant low correlation with BDI. Regarding known-group validity, the total score of Persian PASS-20 was higher in CNSNP with higher levels of pain and disability and in the female gender. The Persian PASS-20 has acceptable psychometric properties in adults with CNSNP. The results of the factor analysis supported the four-factor structure comparable to the original version. 921672004.

Differences in Structural Brain Characteristics Between Individuals with Chronic Nonspecific Neck Pain and Asymptomatic Controls: A Case-Control Study.

BackgroundNeck pain is a prevalent and costly problem, but its underlying mechanisms are poorly understood. Neuroimaging studies show alterations in brain morphometry in chronic musculoskeletal pain, but reports on neck pain are scarce.ObjectiveThis study investigates (1) differences in brain morphometry between individuals with chronic nonspecific neck pain and asymptomatic individuals and (2) associations between brain morphometry and patient-reported outcomes.MethodsSixty-three participants (33 pain, 11 female, mean [SD] age 35 [10] years; 30 control, 12 female, age 35 [11] years) underwent magnetic resonance imaging. Brain regions of interest (ROIs) were determined a priori, outcomes included cortical thickness and volume. Between-group differences were determined using cluster-wise correction for multiple comparisons and analyses of pain-related ROIs.ResultsBetween-group differences in volume were identified in the precentral, frontal, occipital, parietal, temporal, and paracentral cortices. ROI analyses showed that parahippocampal cortical thickness was larger in the neck pain group (p=0.015, 95% CI: −0.27 to −0.03). Moderate to strong associations between volume and thickness of the cingulate cortex, prefrontal cortex, and temporal lobe and neck pain duration, pain intensity, and neck disability were identified (p-values 0.006 to 0.048).ConclusionAlterations in brain morphology that are associated with clinical characteristics inform the mechanisms underlying chronic nonspecific neck pain and may guide the development of more effective treatment approaches.

Effect of Proprioceptive Exercises along with Ergonomic Intervention on Middle Deltoid and Serratus Anterior Fatigue in Dentists with Non-Specific Chronic Neck Pain

There are several risk factors in dentistry that among them repetitive movements, being in a position for a long time due to muscle imbalances, and work-related musculoskeletal disorders which can cause problems such as limited mobility, fatigue, job loss or even changing jobs. Muscle imbalance between the stabilizers and mobilizers of the neck and shoulders in dentists leads to increased work-related disorders, superficial muscle fatigue, and deep muscle atrophy, which in turn, leads to many health problems such as neck pain and disability. To prevent such disorders, a high endurance of the cervical stabilizer muscles is essential for repetitive movements in the distal and shoulder region. In this study, the exercise program, including postural exercises, simultaneous training of shoulder-neck, scapular movements, and co-contraction were designed for 48 dentists. The statistical analysis showed that there was a significant decrease in the median frequency slope of the middle deltoid muscle (p = 0.004) and for the group who received the proprioception training along with posture correction exercises and exercise therapy (p = 0.004). Neck pain increased in the control group who received no exercises, after six weeks (p = 0.165). Six weeks of corrective exercises with ergonomic intervention balance muscles activity and can be used to decrease musculoskeletal disorders and muscle fatigue in person with Non-Specific Chronic Neck Pain.

The effect of therapeutic exercise and vegan diet on pain and quality of life in young female patients with chronic non-specific neck pain

Background and purposeIn recent years, dietary practices have begun to be used in painful conditions. This study aimed to investigate the effect of a vegan diet and therapeutic exercise in patients with chronic non-specific neck pain.Materials and methodsA total of 45 young female patients with chronic non-specific neck pain, aged 18–25 years, participated in the study. Body mass index and body fat percentage were measured with bioelectrical impedance analysis. Pain severity was assessed using the Visual Analogue Scale, quality of life with the short form-36 scale, kinesiophobia with the Tampa scale of kinesiophobia and neck disability with the Neck Disability Index.ResultsThe pain severity reduced in the diet group and exercise group after treatment (p = 0.001). After treatment, Neck Disability Index score decreased in the diet group and exercise group (p = 0.001). Tampa scale of kinesiophobia score decreased in the diet group and exercise group (p = 0.001). The eight domains of the short form-36 scale score increased in the diet group and exercise group (p < 0.05). No difference was found in the body mass index and fat percentage in all groups before and after treatment (p˃ 0.05).ConclusionA vegan diet and therapeutic exercise are beneficial to patients with chronic non-specific neck pain in terms of pain severity and quality of life.

Therapeutic Yoga for the Management of Chronic Nonspecific Neck Pain: Current Evidence and Mechanisms.

Chronic nonspecific neck pain (CNNP), which is neck pain in the absence of attributable structural and neurological findings, is often challenging for medical and rehabilitation professionals to treat. Conventional treatments such as medications and physical therapy often fail to provide lasting relief, which leads patients to pursue complementary therapies such as yoga. This review discusses the evidence from nine studies, including four randomized controlled trials, which suggests that a supervised yoga program may decrease pain intensity, disability, and mood symptoms in adults with CNNP. Cervical range of motion and quality of life (both physical and mental) may also improve with yoga intervention, although this is less consistent across studies. Evidence of yoga's superiority to other exercise-based practices such as pilates was conflicting. Adverse effects of yoga, such as exacerbation of neck pain, were relatively uncommon, minor, and often transient. This article also comprehensively reviews the pathophysiology of CNNP, therapeutic mechanisms of yoga, and limitations in the evidence (including risk-of-bias assessment). Future studies should attempt to: (1) compare the effectiveness of different lineages of yoga for individuals with CNNP, (2) determine the optimal length and duration of these yoga interventions, (3) better characterize the physical and psychological mechanisms of yoga, (4) compare yoga to other exercise- and mindfulness-based practices, (5) evaluate the effect of yoga on sleep in the CNNP population, and (6) explore the applicability/efficacy of virtual yoga instruction.

Effect of Lower Trapezius, Middle Trapezius and Serratus Anterior Muscles Strengthening on Pain, Muscle Strength and Functional Status in individuals with Non-Specific Chronic Neck Pain

Background: Chronic non-specific neck pain is the most common chronic musculoskeletal paincondition, causing significant pain, disability, and lost productivity. On-specific neck pain is not just a clinical problem, it can develop into a complex disorder where physical, psychological, social compensation and other possible forces interact to cause and lead to maintained disability. Neck pain is present with weakness and muscular imbalance. It has a close relationship between muscle prone to tightness and those prone to inhibition. In the case of neck pain, there is tightness of upper trapezius (UT) muscle leading to middle trapezius (MT), lower trapezius (LT) and serratus anterior (SA) muscles weakness. There is evidence that scapulothoracic muscles weakness may also be associated with neck pain. Individuals with neck pain were having significantly weaker Lower Trapezius, Middle Trapezius and Serratus Anterior muscles strength than asymptomatic individuals.Context and Purpose: There is emerging evidence that scapulothoracic muscles weakness often is associated with neck pain and it has a close relationship between muscle prone to tightness and those prone to inhibition. In the case of neck pain, prolonged tightness of upper trapezius muscle can lead to middle trapezius, lowertrapezius, and serratus anterior muscles weakness. The purpose of the study is to find out the effect of LT, MT and SAmuscles strengthening along with the conventional treatment on pain, muscle strength and functional status in non-specifi cchronic neck pain. Results: There was significant effect on LT, MTand SA muscles strengthening in reducing pain, improving strength and functional status in individuals with non-specific chronic neck pain. Conclusion: Strengthening exercises to LT, MT and SA muscles along withconventional therapy is effective in reducing pain, improving muscle strength and functional status inindividuals with nonspecific chronic neck pain.

Association Between Forward Head Posture and Scapular Dyskinesis in Patients with Non-Specific Chronic Neck Pain

Association Between Forward Head Posture and Scapular Dyskinesis in Patients with Non-Specific Chronic Neck Pain

Cognitive functional therapy as a complementary treatment for posture and disability of chronic neck pain: secondary analysis of a randomized controlled trial

Purpose: The aim of this study was to compare the effects of scapular stabilization exercise with and without cognitive functional therapy (CFT) on disability and scapular kinematics in people suffering from chronic neck pain. Methods: A total of 72 patients with chronic non-specific neck pain were randomized into scapular stabilization exercise alone, n = 24, combined (scapular stabilization exercise + CFT), n = 24, and a control group, n = 24. Scapular kinematic and disability were measured at baseline and after the intervention. Results: Statistically significant differences in neck pain and disability scale (NPAD) were found when the multimodal physiotherapy group including a cognitive functional approach was compared with stabilization exercises group at 6 weeks (effect size (95%CI) = –1.63 (–2.55, –.71); P = 0.019). Regarding the neck disability index (NDI), a significant between-group difference was observed at six-week (effect size (95%CI) = –2.69 (–3.80, –1.58); P = 0.007), with the superiority of effect in multimodal physiotherapy group. A significant between-group difference was observed in the scapular upward rotation and scapular osterior tilt at 30°, 60°, 90° and 120° of shoulder adduction. Conclusions: A group-based multimodal rehabilitation program including scapular stabilization exercise plus cognitive functional therapy was superior to group-based stabilization exercises alone for decreasing disability and, improving scapular kinematic in patients with chronic neck pain

Effect of Combined Manual Therapy and Therapeutic Exercise Protocols on the Postural Stability of Patients with Non-Specific Chronic Neck Pain. A Secondary Analysis of Randomized Controlled Trial.

Postural stability is a little-studied factor in non-specific chronic neck pain; the causes that can alter it are unknown. The relationship with chronic pain could be a determining factor for its deficit. The aim of this study was to investigate the relationship between sustained pain and a postural stability deficit. A randomized and blinded clinical trial (double-blind; placebo control; 12 weeks follow-up) was conducted with a total of 69 subjects divided into three groups, two experimental (manual therapy and specific exercise) and a control treatment, and carried out over a treatment period of three weeks with a follow-up after 12 weeks. Their postural stability was assessed through the overall balance index (OBI). The postural stability of subjects with non-specific chronic neck pain improved in the experimental treatments. There were no statistically significant differences between the experimental groups. This trial found that manual therapy and therapeutic exercise significantly improved OBI compared to the control group. Trial registration: Brazilian Clinical Trial Registry, RBR-2vj7sw.

Association Between Muscle Morphology Changes, Cervical Spine Degeneration, and Clinical Features in Patients with Chronic Nonspecific Neck Pain: A Magnetic Resonance Imaging Analysis

The primary objective of the present study was to investigate the correlations among cervical paraspinal muscle morphology changes (fatty infiltration [FI] and muscle atrophy), cervical degeneration, and clinical features in patients with chronic nonspecific neck pain (CNSNP). The magnetic resonance imaging data for 55 consecutive patients (average age, 35.80 years) with CNSNP were analyzed in the present cross-sectional study. The muscle morphology changes in 7 groups of paraspinal muscles, indicated by the adjusted cross-sectional area (aCSA) and FI ratio (FI%), were measured from C3/4 to C6/7. The correlations of these changes with disc degeneration, cervical balance (C2-C7 angle and cervical alignment), and clinical features (severity of neck pain and related disability and frequency of acute neck pain recurrence) were evaluated. Significant correlations between FI% and aCSA and the grade of disc degeneration were observed in specific muscle groups at each level (P < 0.05). Morphological changes in the deep extensors and superficial paraspinal muscles were significantly associated with the cervical balance parameters (P < 0.05). The FI% showed a significant positive correlation, and the aCSA showed a significant negative correlation with the severity of neck pain and related disability (P < 0.05). Correlations between the morphological changes and the frequency of acute neck pain recurrence were also present in specific muscles (P < 0.05). Correlations among the muscle morphology changes, cervical degeneration, and clinical features were established for patients with CNSNP. Muscle volume changes and FI might affect CNSNP diversely through different paraspinal muscle groups. These results imply a complex contribution of muscle morphological changes to cervical degeneration and the clinical course of CNSNP.

Neck proprioception assessment with a laser beam device: reliability in participants without neck pain and differences between participants with and without neck pain

BackgroundProprioception deficits have previously been reported in patients with non-specific chronic neck pain (NSCNP), with a comprehensive and valid battery of tests still required. This study aimed to investigate the test-retest and inter-rater reliability of cervical proprioception in participants without NSCNP and to examine differences in proprioception between participants with and without NSCNP. Twenty participants without NSCNP and 20 age- and sex-matched participants with NSCNP were recruited. Proprioception tests were sequentially performed in random order, in four head-to-neutral movement directions (starting positions at mid-flexion, mid-extension and mid-right/mid-left rotation head-neck positions and end position at neutral head-neck posture) and two head-to-target movement directions (starting position from neutral head-neck posture and end positions at right and left 45° rotation), with a laser beam device secured onto their forehead. Participants performed all tests in sitting at a 1-m distance from a whiteboard. The average deviations of the laser beam mark from set targets marked on the whiteboard represented proprioception deficits. The two-way random, absolute agreement model of the intraclass correlation coefficient (ICC), the standard error of the measurement (SEM) and the smallest detectable difference (SDD) were used as measures of reliability. Between-group differences were examined with the independent samples t test.ResultsThe reliability of the laser beam device in participants without neck pain varied from poor to good. The following tests demonstrated good reliability: test-retest ‘Head-to-neutral from flexion’ (ICC: 0.77–0.78; SDD: 5.73–6.84 cm), inter-rater ‘Head-to-neutral from flexion’ (ICC: 0.80–0.82; SDD: 6.20–6.45 cm) and inter-rater ‘Head-to-neutral from right/left rotation’ (ICC: 0.80–0.84; SDD: 5.92–6.81 cm). Differences between participants with and without NSCNP were found only in head-to-neutral from flexion (4.10–4.70 cm); however, those were within the limits of the SDD values of the HtN from flexion test.ConclusionsThe laser beam device can be reliably used in clinical practice only in the aforementioned head-neck movement directions, based on the findings of the present study. The between-group differences noted involved only the head mid-flexion to neutral test, possibly denoting proprioception deficits only in this movement direction, for reasons that require further evaluation.

Effects of neck stabilization and isometric neck exercises on non-specific chronic neck pain: A pilot study

Purpose: This study evaluated and compared the efficacy of neck stabilization and isometric neck exercises on pain-related disability sleep disturbance, psychological status and cardiopulmonary parameters in patients with non-specific chronic neck pain.

Pilot study on the effects of a culturally-sensitive and standard pain neuroscience education for Hausa-speaking patients with chronic neck pain

Purpose To pilot feasibility and assess preliminary effectiveness of standard and culture-sensitive Pain Neuroscience Education (PNE) among Hausa-speaking patients with Chronic Neck Pain (CNP). Methods Adverts (online & clinic-based) were used to recruit Hausa-speaking patients with nonspecific CNP in Kano, Nigeria. Selected participants were randomized to culture-sensitive PNE (CSPNE), standard PNE (PNE), or control groups. Each group received bi-weekly sessions of exercise therapy for 6 weeks. Two sessions of PNE plus a home-based session were administered before exercise therapy in the PNE groups. Primary (pain-intensity and disability) and secondary (pain-knowledge, pain catastrophizing, and quality of life) outcomes were measured. The study was pre-registered (PACTR201902788269426). Results Fifty-three (out of 64) participants met the inclusion criteria. The majority of them were recruited through radio adverts (83%). Interventions were successfully administered and data collection was completed for the participants. About 15% and 17% drop-out rate was recorded before intervention (post-randomization) and during follow-up, respectively. Main results indicated that significant within-group improvements in disability and pain knowledge scores were found in favor of the PNE groups. Conclusion Culture-sensitive and standard PNE plus exercise therapy are feasible for Hausa patients with CNP, and current findings indicate support for reducing disability and increasing pain knowledge among them. Implications for rehabilitation Both standard PNE and culture-sensitive PNE are feasible for administration as interventions for Hausa-speaking patients with CNP. Radio adverts may be necessary for patients recruitment in addition to specialists’ referrals. Culturally sensitive PNE materials may be more desirable as an intervention option due to the low literacy level among the Hausa population.

Effects of Exercises Therapy on Chronic Non-Specific Neck Pain: A Systematic Review

Effects of Exercises Therapy on Chronic Non-Specific Neck Pain: A Systematic Review

Comparison of kinematic similarity index during gait between adults with and without nonspecific chronic neck pain

BackgroundIndividuals with nonspecific chronic neck pain (NP) walk with a stiffer spine. However, there is a lack of understanding on kinematic similarities on the limbs during gait between individuals with and without NP. Research questionAre there differences in gait parameters and the kinematic similarity index (SI) between individuals with and without NP? MethodsEighteen individuals with NP and 17 controls participated in this study. A three-dimensional motion capture system and two force plates were utilized to measure kinematic changes of the upper and lower limbs during gait. The gait parameters included cadence, speed, stride length, and step width. The SI calculations were compared based on the response vectors from the NP group and the prototype response vectors from the control participants. The SI values at 5% intervals of the entire gait cycle were compared between groups. ResultsAlthough the gait parameters were not significantly different between groups, the SI values of the control group were significantly higher than the NP group during gait (0.98 ± 0.02 vs. 0.95 ± 0.03), especially at the midstance (10–30 %) and swing (80–90 %) phases. Also, the standard deviation of the SI decreased in the control group when compared to the NP group (0.02 ± 0.01 vs. 0.04 ± 0.02). SignificanceThe SI was a useful measure to differentiate similarities between groups in the gait cycle at specific phases. These results indicated that the NP group demonstrated a greater variation of walking patterns during the midstance and swing phases and displayed altered compensatory gait. Clinicians need to consider the similarities of the kinematic changes for the NP group to aid in detection of limb motion differences and the resulting gait dysfunction.

Efficacy of Yijinjing combined with Tuina for patients with non-specific chronic neck pain: study protocol for a randomized controlled trial

BackgroundNon-specific chronic neck pain (NCNP) is a common musculoskeletal disorder which has caused a huge economic burden due to its expensive health costs and high re-occurrence rate. Yijinjing and Tuina are widely used for non-specific chronic neck pain in China. But there is little scientific evidence to evaluate their efficacy for NCNP. The aim of this research is to compare the efficacy of Yijinjng combined with Tuina versus Tuina for patients with NCNP.Methods/designA randomized controlled trial in which 102 patients with non-specific chronic neck pain will be recruited and randomly allocated to either the Tuina group or the Yijinjng combined with Tuina group in a 1:1 ratio. The interventions for both groups will be carried out three times a week for 8 weeks. The patients in the two groups will receive follow-up 1 month after the intervention. The primary outcome will be the changes in the visual analog scale (VAS). Secondary outcomes will be measured by the Neck Disability Index (NDI), Self-Rating Anxiety Scale (SAS), and Tissue Hardness and Active Range of Motion (AROM). The data will be analyzed at the baseline, 4 weeks during the intervention, at the end of the intervention, and 1 month after the intervention. The significance level sets as 5%. The safety of interventions will be evaluated after each treatment session.DiscussionThe purpose of this trial is to determine whether Yijinjing combined with Tuina is not inferior to Tuina for patients with NCNP. This study will provide clinicians and stakeholders much-needed knowledge for a complementary and alternative therapy for patients with non-specific chronic neck pain.Trial registrationChiCTR registry (ChiCTR) 2000036805. Registered on August 25, 2020

Pain Neuroscience Education Combined with Therapeutic Exercises Provides Added Benefit in the Treatment of Chronic Neck Pain.

Background: Chronic neck pain is common in the adult general population. Although the etiology of chronic neck pain is under debate, it is clear that chronic neck pain is multifactorial, with both physical and psychosocial contributors. Objective: To determine whether adding pain neuroscience education (PNE) to therapeutic exercises improved their pain–disability index, pain catastrophizing, fear–avoidance beliefs, and pain self-efficacy in subjects with chronic nonspecific neck pain. Methods: This study was a three-arm randomized control trial. Seventy-two patients with chronic nonspecific neck pain were allocated to three groups: therapeutic exercises alone (n = 24), combined (therapeutic exercises + PNE; (n = 24), and a control group (n = 24). Each program took place three times a week, lasting for six weeks. The disability index, pain catastrophizing, fear–avoidance beliefs, and pain self-efficacy measured by the Neck Pain and Disability Scale (NPAD), Pain Catastrophizing Scale (PCS), Fear–Avoidance Beliefs Questionnaire (FABQ), and Pain Self-Efficacy Questionnaire (PSEQ), respectively. Participants were assessed before and after the six-week intervention, and there was no further follow-up. Results: For the outcomes NPAD, PSC, and FABQ, combined intervention demonstrated more significant improvements than therapeutic exercises alone (p ≤ 0.05), whereas no differences were observed between the two intervention groups for PSEQ (p = 0.99). In addition, significant differences were favoring experimental groups versus control for all outcomes (p ≤ 0.001). Conclusion: Therapeutic exercises combined with pain neuroscience education reduced the pain–disability index, pain catastrophizing, and fear–avoidance beliefs more than therapeutic exercises alone in patients with chronic neck pain. For pain self-efficacy, there was no statistically significant difference between the two intervention groups; however, the combined group had a more significant effect than therapeutic exercises alone. Further studies with longer periods and follow-up are required.

Effects of Dry Needling of the Upper Trapezius Active Trigger Points on Pain and Pain Pressure Threshold in Women With Chronic Non-Specific Neck Pain

Background and Objectives: The purpose of the present study was to examine the effectiveness of dry needling as local treatment of upper trapezius trigger points related to chronic neck pain on pain and pain pressure threshold in women with chronic nonspecific neck pain. Methods: Thirty females with an active myofascial trigger point of the upper trapezius muscle were randomly divided into two groups: dry needling with passive stretch (n=15) and passive stretch alone (n=15). They received 5 sessions of the intervention for three weeks. The outcomes were pain intensity and pain pressure threshold. Every outcome was recorded at baseline and 2 days after the fifth session. Results: Significant improvement in pain and pain pressure threshold was observed in both groups (P=0.0001) after the treatment. The results of the independent t-test showed a significant difference in measurements between the dry needling and passive stretch groups (P&lt;0.05). Conclusion: Dry needling with passive stretch can be more effective on pain and pain pressure threshold than passive stretching alone in short term in women with nonspecific neck pain.

Assessment of the responsiveness of four scales in geriatric patients with chronic neck pain.

The purpose of this study was to evaluate the responsiveness of Copenhagen Neck Functional Disability Scale (CNFDS), Neck Disability Index (NDI), Neck Bournemouth Questionnaire (NBQ), Neck Pain and Disability Scale (NPDS) in geriatric patients with non-specific chronic neck pain. A total of 52 geriatric patients with non-specific chronic neck pain were included in the present study. All participants were included in a physical therapy and rehabilitation program for five sessions per week that lasted 3 weeks. All participants were evaluated before and after the treatment. Pain and disability were assessed with the Visual Analog Scale-pain (VAS-pain), VAS-disability, muscle spasm, CNFDS, NDI, NBQ, NPDS scales. Additionally, patient satisfaction scores were questioned both before and after the treatment. Following the 3-week physical therapy and rehabilitation program, significant improvements were detected in the VAS-pain, VAS-disability, muscle spasm, CNFDS, NDI, NBQ, and NPDS scores (p < 0.05). Responsiveness values were found to be as follows: CNFDS [effect size (ES) = 0.78; standardized response mean (SRM) = 0.90], NDI (ES = 0.66; SRM = 1.18), NBQ (ES = 0.82; SRM = 0.97) and NPDS (ES = 0.87; SRM = 0.98). Our study demonstrated that CNFDS, NDI, NBQ, and NPDS are responsive scales in determining treatment-related changes in geriatric patients with non-specific neck pain. These results also suggest that all of these four scales can be used in the assessment of treatment induced changes in geriatric patients with chronic neck pain.

Expert consensus on the important chronic non-specific neck pain motor control and segmental exercise and dosage variables: An international e-Delphi study.

Chronic non-specific neck pain is highly prevalent, resulting in significant disability. Despite exercise being a mainstay treatment, guidance on optimal exercise and dosage variables is lacking. Combining submaximal effort deep cervical muscles exercise (motor control) and superficial cervical muscles exercise (segmental) reduces chronic non-specific neck pain, but evaluation of optimal exercise and dosage variables is prevented by clinical heterogeneity. To gain consensus on important motor control and segmental exercise and dosage variables for chronic non-specific neck pain. An international 3-round e-Delphi study, was conducted with experts in neck pain management (academic and clinical). In round 1, exercise and dosage variables were obtained from expert opinion and clinical trial data, then analysed thematically (two independent researchers) to develop themes and statements. In rounds 2 and 3, participants rated their agreement with statements (1-5 Likert scale). Statement consensus was evaluated using progressively increased a priori criteria using descriptive statistics. Thirty-seven experts participated (10 countries). Twenty-nine responded to round 1 (79%), 26 round 2 (70%) and 24 round 3 (65%). Round 1 generated 79 statements outlining the interacting components of exercise prescription. Following rounds 2 and 3, consensus was achieved for 46 important components of exercise and dosage prescription across 5 themes (clinical reasoning, dosage variables, exercise variables, evaluation criteria and progression) and 2 subthemes (progression criteria and progression variables). Excellent agreement and qualitative data supports exercise prescription complexity and the need for individualised, acceptable, and feasible exercise. Only 37% of important exercise components were generated from clinical trial data. Agreement was highest (88%-96%) for 3 dosage variables: intensity of effort, frequency, and repetitions. Multiple exercise and dosage variables are important, resulting in complex and individualised exercise prescription not found in clinical trials. Future research should use these important variables to prescribe an evidence-informed approach to exercise.