Billis Ε1, Mourikis S1, Fiotakis M1, Tsekoura M1, Giannioti M1, Dimitriadis Z1, Xergia S1, Matzaroglou C1, Fousekis K1
1Technological Educational Institute (TEI) of Western Greece, Physiotherapy, Aigio, Greece
Background: Mechanical neck pain is a highly prevalent musculoskeletal condition for both, middle-aged and older adults, accounting for a large societal cost worldwide. Therapeutic exercise is one of the first line conservative physiotherapy approaches recommended for such conditions across international guidelines. Group-based exercise programs are a popular and evidenced exercise-delivered method for various musculoskeletal problems of the elderly, including knee osteoarthritis, osteoporosis, sarcopenia and spinal problems. However, their effectiveness on chronic mechanical neck pain have not yet been explored.
Purpose: To investigate the effects of two different group-based therapeutic exercise programs across a sample of community-dwelling older adults with chronic mechanical neck pain.
Methods: Volunteers recruited from a large elderly community-based center of a large Greek city were invited to participate. Subjects had to be community-dwellings aged over 60 years-old, have chronic (over 3 months) self-reported neck pain and at least mild disability, scored over 5/50 on the self-reported Neck Disability Index (NDI). Participants were randomized to one of two groups: mobilisation and stabilization exercise (MobStabEx) group or postural exercise (PostEx) group. The MobStabEx program encompassed deep neck flexor muscle activation exercises, endurance and range of movement (ROM) neck and upper limb exercises. The PostEx group included general and specific neck, thoracic and trunk postural exercises. Both programs involved 30-minute sessions, 2-times weekly for 8 weeks. Primary outcome included NDI scores. Secondary outcomes included neck ROM (measured with bubble inclinometer), Numeric Pain Rating Scale (NPRS), deep neck flexor muscle endurance (utilizing pressure a biofeedback device) and the Hospital Anxiety and Depression Scale (HADS). All participants were tested at baseline and post-intervention. Time-group interactions for each dependent variable were examined with a two-way mixed ANOVA model, whereas independent samples and paired samples t tests were utilized for across and within group differences, respectively.
Results: 22 chronic neck pain elderly were randomly assigned to MobStabEx group (n=12, 12 females, mean age 70,67±6,51 years) and PostEx (n=10, 9 females, mean age 74,2±6,56 years) group. Intra- and inter-tester reliability for all clinical outcomes tested in the pilot were satisfactory (ICCs and Kappa ranges: 0,566-0,894). For each group-based program, all variables (NDI, NPRS, pressure stabilizer scores, neck flexion and rotation ROM) except for extension and side flexion ROM yielded statistically significant improvements (p>0,05) post intervention for each group. However, there were no significant group x time interactions for any of the outcomes measured, thus, not indicating any superiority of any of the groups.
Conclusion(s): Findings provide encouraging data regarding the effects of two group-based progressive exercise programs in community-dwelling older adults people with self-reported neck pain. Such programs seem to benefit ROM, pain, disability and overall function. However none of the group-based exercise programs seemed superior to the other.
Implications: An 8 weeks' group-based physiotherapy program either in the form of specific ROM and stability exercises for the deep cervical musculature or in the form of upper quadrant postural exercises seem to be effective for improving neck pain, flexion and rotation ROM, muscular control and neck function across a sample of community-dwelling older adults.
Keywords: Group-based exercises, neck pain, elderly
Funding acknowledgements: None
Purpose: To investigate the effects of two different group-based therapeutic exercise programs across a sample of community-dwelling older adults with chronic mechanical neck pain.
Methods: Volunteers recruited from a large elderly community-based center of a large Greek city were invited to participate. Subjects had to be community-dwellings aged over 60 years-old, have chronic (over 3 months) self-reported neck pain and at least mild disability, scored over 5/50 on the self-reported Neck Disability Index (NDI). Participants were randomized to one of two groups: mobilisation and stabilization exercise (MobStabEx) group or postural exercise (PostEx) group. The MobStabEx program encompassed deep neck flexor muscle activation exercises, endurance and range of movement (ROM) neck and upper limb exercises. The PostEx group included general and specific neck, thoracic and trunk postural exercises. Both programs involved 30-minute sessions, 2-times weekly for 8 weeks. Primary outcome included NDI scores. Secondary outcomes included neck ROM (measured with bubble inclinometer), Numeric Pain Rating Scale (NPRS), deep neck flexor muscle endurance (utilizing pressure a biofeedback device) and the Hospital Anxiety and Depression Scale (HADS). All participants were tested at baseline and post-intervention. Time-group interactions for each dependent variable were examined with a two-way mixed ANOVA model, whereas independent samples and paired samples t tests were utilized for across and within group differences, respectively.
Results: 22 chronic neck pain elderly were randomly assigned to MobStabEx group (n=12, 12 females, mean age 70,67±6,51 years) and PostEx (n=10, 9 females, mean age 74,2±6,56 years) group. Intra- and inter-tester reliability for all clinical outcomes tested in the pilot were satisfactory (ICCs and Kappa ranges: 0,566-0,894). For each group-based program, all variables (NDI, NPRS, pressure stabilizer scores, neck flexion and rotation ROM) except for extension and side flexion ROM yielded statistically significant improvements (p>0,05) post intervention for each group. However, there were no significant group x time interactions for any of the outcomes measured, thus, not indicating any superiority of any of the groups.
Conclusion(s): Findings provide encouraging data regarding the effects of two group-based progressive exercise programs in community-dwelling older adults people with self-reported neck pain. Such programs seem to benefit ROM, pain, disability and overall function. However none of the group-based exercise programs seemed superior to the other.
Implications: An 8 weeks' group-based physiotherapy program either in the form of specific ROM and stability exercises for the deep cervical musculature or in the form of upper quadrant postural exercises seem to be effective for improving neck pain, flexion and rotation ROM, muscular control and neck function across a sample of community-dwelling older adults.
Keywords: Group-based exercises, neck pain, elderly
Funding acknowledgements: None
Topic: Musculoskeletal; Health promotion & wellbeing/healthy ageing; Older people
Ethics approval required: Yes
Institution: Technological Educational Institute of Western Greece
Ethics committee: Ethical Committee of the School of Health and Caring Professions
Ethics number: 13079/20-4-2018
All authors, affiliations and abstracts have been published as submitted.
