Effectiveness of individualized physical therapy in treating subjects with neck pain
Wang, Wendy Tzyy-Jiuan
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There is sparse scientific evidence in support of physical therapy for patients with neck dysfunction. Clinical studies investigating treatment effectiveness of neck pain have come under criticism for their unclear or nonstandardized treatment protocols, insensitive outcome measures, and inappropriate statistical procedures. The purpose of this study was to determine the effectiveness of an individualized physical therapy intervention in treating mechanical neck pain based on a clinical reasoning algorithm. Treatment effectiveness was examined by assessing changes in impairment, physical performance, and disability in response to intervention. A quasi-experimental, nonequivalent, pretest-post-test control group design was used in this study. One treatment group of patients with neck pain who received physical therapy treatment and one control group of subjects with neck pain who did not receive treatment were included. Thirty patients (15 males and 15 females, mean age: 50.8 years) with neck pain were enrolled in the treatment group and completed the physical therapy intervention. Twenty-seven subjects (7 males and 20 females, mean age: 49.1 years) with neck pain were included in the control group. Both groups completed the initial and follow-up tests with a duration of 4 weeks in between. There were no significant differences between groups in physical characteristics as well as the baseline test scores of the six outcome measures. Intervention for patients in the treatment group was an eclectic approach rendered by an experienced manual physical therapist. A description of the intervention strategy was delineated with an algorithm which convey the information about a clinical decision-making process for treating neck pain. Six dependent variables including cervical range of motion, numeric pain rating, timed weighted overhead endurance, the supine capital flexion test, the Patient-Specific Functional Scale, and the Neck Disability Assessment Scale were used to measure the treatment outcome. Results of six mixed ANOVAs with follow-up tests showed a significant improvement of all outcome measures in the treatment group (p < 0.01). After an average 4-week physical therapy intervention, patients demonstrated statistically significant increases of cervical range of motion, decreases of pain, increases of physical performance measures, and decreases in the level of disability as compared to the control group who showed no differences in all six outcome variables between the initial and follow-up test scores. Therefore, an organized and systematic physical therapy intervention was effective in improving the status of patients with neck pain.