TELEREHABILITATION FOR NECK PAIN: A COCHRANE REVIEW

J. Fandim¹, L. Costa¹, T. Yamato¹, L. Almeida¹, C. Maher², B. Dear³, S. Kamper⁴, B. Saragiotto¹

Background: Neck pain is a frequently reported complaint of the musculoskeletal system. Non-pharmacological interventions are recommended as first line management for neck pain. Telerehanilitation is an emerging area with a promising way of providing healthcare. Despite the interest, it is still unclear whether telerehabilitation could lead to better clinical outcomes in neck pain patients.

Purpose: To evaluate the effectiveness of telerehabilitation for clinical outcomes compared to no treatment, waiting list, usual care, or other active interventions in patients with neck pain.

Methods: Searches were conducted at CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, PEDro, Lilacs and two trials registres up to May 2019. We included randomized controlled studies that investigated the effectiveness of telerehabilitation in adult patients with neck pain. We analysed telerehabilitation studies compared with no treatment, waiting list, usual care, or any other active intervention. Primary outcomes were pain intensity and physical function. Secondary outcomes were quality of life, return to work, psychological distress, pain-related psychological construct and adverse events in short, intermediate and long-term follow-up. Two independent reviewers screened duplicates, titles and abstracts, full text, extracted and assessed the risk of bias in the studies, and a third reviewer was consulted when there was a disagreement between reviewer. The Cochrane Collaboration risk of bias assessment tool was used to assess the risk of bias. We pooled the overall treatment using random-effect model meta-analysis. We combined results in a meta-analysis using mean difference (MD) or standardized mean difference (SMD) and 95% confidence intervals for continuous outcomes. The overall quality of evidence was assessed using the GRADE approach for each comparation and outcome.

Results: We included eight randomized controlled trials (n = 867 participants). Included studies were all performed in high-income countries. The most adhered risk of bias items were timing of outcome assessment, similarity at baseline and random allocation and the least adhered were patient, care provider and assessor blinding. There is very low quality of evidence that telerehabilitation compared to usual care may result in little to no difference in improving pain at short term (MD 2.3; 95% CI -6 to 10.5), intermediate term (MD -1.8; 95% CI -7.9 to 4.2) and long term (MD 6.3;CI 95% -1.2 to 13.8). There is very low quality of evidence that telerehabilitation may result in little to no difference in improving physical function at short term (MD -5.5; 95% CI -13.9 to 2.8) and intermediate term (MD -2.2; 95% CI -12.1 to 7.8). There is very low to low quality evidence that telerehabilitation compared to minimal intervention may result in a slight improvement in pain and physical function. No trials to date have reported adverse events.

Conclusion(s): Telerehabilitation has a similar effect to the usual care in improving pain and physical function. However, telerehabilitation demonstrated a small effect compared to minimal intervention for improving pain and physical function. There is still uncertainty evidence about the effectiveness of telerehabilitation for people with neck pain.

Implications: Despite the uncertainty evidence, telerehabilitation can improve some level of pain and physical function compared to minimal intervention.

Funding, acknowledgements: JF holds a PhD scholarship from CAPES, Brazil. The study is funded by São Paulo Research Foudation (FAPESP), Brazil.

Keywords: Physical digital practice, e-health, chronic pain

Topic: Musculoskeletal: spine

Did this work require ethics approval? No

Institution: UNICID

Committee: Comité de Ética em Humanos-Unicid

Reason: Synthesis of evidence