A multi-component intervention (NEXpro) reduces neck pain: a randomized controlled trial among Swiss office workers

BACKGROUND: Whiplash trauma can result in a range of symptoms, including chronic neck pain, headache, facial pain, upper back pain, and tinnitus, which comprises whiplash-associated disorder (WAD). Intermediate cervical plexus block (iCPB) is a novel intervention that targets the upper cervical nerves and anecdotal reports suggest benefits in WAD. OBJECTIVES: We hypothesized that the cervical plexus may have a role in the pathogenesis of WAD and blocking the cervical plexus may provide analgesia. STUDY DESIGN: Prospective observational trial. SETTING: Tertiary pain medicine unit at a university teaching hospital. METHODS: Adult patients who presented with refractory chronic neck pain following whiplash were included in a prospective observational trial. The pragmatic trial studied the effectiveness of 2 sequential cervical plexus blocks (iCPB with local anesthetic [iCPB-LA] and iCPB with steroid and LA mixture [iCPB-Steroid]) in refractory chronic neck pain following whiplash. Patients who reported < 50% relief at 12 weeks after iCPB-LA were offered iCPB-Steroid. Primary outcome was “neck pain at its worst in the last 24 hours” at 12 weeks. Secondary outcomes included change in neck disability index, employment status, and mood. RESULTS: After excluding cervical zygapophyseal joint dysfunction, 50 patients underwent the iCPB-LA between June 2020 and August 2022. Five patients reported > 50% relief (durable relief) at 12 weeks and 3 patients were lost to follow-up. Forty-two patients received iCPB-Steroid. iCPB-Steroid was associated with significant reduction in neck pain, neck disability, and improvement in mood at 12 weeks when compared to the block with LA. In addition, iCPB-Steroid was associated with significant reduction in neck pain and disability at 24 weeks. Due to functional improvement, 34 patients (34/50, 78%) were able to maintain employment. LIMITATIONS: This is an open-label, observational, single-center study in a limited cohort under a single physician. Cervical facet joint dysfunction was ruled out clinically and radiologically. CONCLUSIONS: Cervical plexus may play a central role in the pathogenesis of WAD. iCPB could potentially be a treatment option in this cohort. KEY WORDS: Intermediate cervical plexus block, whiplash, trigemino-cervical complex, whiplash-associated disorder, neck pain, chronic headache

The study aimed to investigate the effectiveness of post-isometric relaxation (PIR) compared to self-stretching (SS) in working-age individuals with chronic non-specific neck pain. A parallel-group study was conducted with 50 patients who were randomized to either the self-stretching (SS, n = 25) or post-isometric relaxation (PIR, n = 25) group and received interventions three times a week for four weeks. In addition to these interventions, all patients were prescribed transcutaneous electrical nerve stimulation (TENS). Outcome measures were neck pain, the neck disability index (NDI), hand grip strength (HGS), and cervical spine range of motion (ROM). Data were collected at baseline and after four weeks of outpatient rehabilitation. Repeated measures ANOVA was used to determine within-group differences, and an independent t-test compared between-group differences. There were no significant differences between the groups at baseline in neck pain intensity. Following both interventions, pain intensity and functional disability decreased, cervical spine ROM increased, and HGS improved (p < 0.05). Between-group analysis showed that participants in the PIR group achieved lower pain intensity (p = 0.032, Cohen’s d = 0.81), greater neck extension ROM (p = 0.001, Cohen’s d = 0.96), and lower neck disability index (p = 0.004, Cohen’s d = 0.85) compared to the SS group. In conclusion, both PIR and SS interventions effectively reduced neck pain, increased range of motion, and decreased the neck disability index in working-age individuals. Neither technique showed superiority in increasing neck ROM and HGS. However, PIR was superior to SS in reducing neck pain and NDI, indicating potential benefits from integrating these interventions during treatment sessions.

Background: The prevalence of neck pain and neck dysfunction is high in general population. However, there is little literature on the relationship and factors affecting neck pain and neck dysfunction. Objective: To investigate the correlation between neck and shoulder pain, headaches, neck and shoulder dysfunction, and sleep quality in adults with chronic neck pain, and factors affecting neck pain and neck dysfunction. Design: Cross-sectional study Methods : The sample included 114 subjects, who had complained of chronic neck pain for more 12 weeks. We conducted a Pearson’s correlation between neck and shoulder pain, headaches, neck and shoulder dysfunction and sleep quality and a regression analysis of the related variables, thereby ana­lyzing factors affecting neck pain and neck dysfunction. Results : In the present study, in adults with chronic neck pain, neck pain was positively correlated with the Neck Disability Index (NDI), Shoulder Pain and Disability Index (SPADI)-Pain score, and SPADI-Total score (p<.05). The NDI was positively correlated with neck pain, SPADI-Pain score, and SPADI-Total score, as well as with Pittsburgh Sleep Qulity Index(PSQI-K) (p<.05). Among the factors affecting neck pain, shoulder disability as assessed by the SPADI was a significantly associated with neck pain, while shoulder pain and shoul­der disability determined by the SPADI were identified as significant variables among the factors affecting neck disability. Conclusion : These results indicated that as neck pain worsened , shoulder pain and neck and shoulder dysfunction also increased, which suggested that shoulder disability affected neck pain. In addition, as the neck dysfunction increased, neck pain and shoulder pain and shoulder dysfunction increased, and sleep quality deteriorated, which suggested that shoulder pain and shoulder disability affected neck disability.

Background Poor posture is traditionally associated with various musculoskeletal disorders. Consequently, educators in the musculoskeletal field have been teaching postural observation as part of the physical assessment. Forward head posture (FHP) is hypothesized to be associated with neck pain; however, evidence in this topic remains inconclusive. Purpose To investigate the association between FHP and neck pain intensity, disability, and cervical kinematics in individuals with neck pain compared to asymptomatic individuals. A secondary aim of this study was to explore the possible effect of a head-mounted display (HMD) used in a virtual reality (VR) assessment on FHP. Methods The study was conducted with 43 volunteers (20 asymptomatic individuals, 23 individuals with neck pain) aged 19 to 62. FHP was assessed by measuring craniovertebral angle on profile photographs. Secondary outcome measures included pain intensity, the neck disability index (NDI) questionnaire, and neck kinematics using specialized VR software. Results There were no significant differences between individuals with neck pain and asymptomatic individuals in FHP (craniovertebral angle = 48.24°±7.29; 48.90°±5.89, respectively, p > .05). The neck pain group demonstrated a restricted range of motion and slower neck movements (p < .05). We found no significant correlation between FHP and visual analog scale, NDI, and most neck kinematic measures. Conclusions Our findings cannot support a clinically applicable association between FHP and neck pain. Additionally, individuals with neck pain had a lower range of motion and slower neck movements.

Background: Correct sitting posture reduces the risk of slouched posture, protruded chin and prevents the neck pain from disability. Objective: The study was to determine the effect of postural correction exercises in rural area school going children. Methodology Design quasi experimental design, 25subjects, age group10-14 years with neck pain from government high school& talent high school, vellithiruppur, Erode, Tamil Nadu. Interventions were subjects received sitting posture modification and home care exercise advices (Isometric neck exercises, free exercises and postural correction) for 3 weeks. Outcome measures were Neck disability index and Visual analogue scale. Results: Results obtained are NDI- Pre-test Mean, S.D 21.8 ± 0.825688; Post-test Mean, S.D 0.020618, VAS- Pre-test Mean, S.D 04.9 ± 1.986503; Post-test Mean, S.D 01.4 ± 0.026543 shows there was significance difference between pre-test; post test data for NDI and VAS. Conclusion: There was significant reduction in neck pain and neck disability after postural correction and exercises in school going children with neck pain in rural area.

We would like to thank the author for the close interest in our study and his thoughtful comments regarding our recent publication [1]. After reviewing our article, we partially agree with the critical remarks in the letter to the editor. We focused on the young patient to the age of 32 and measured the neck pain history, CROM and cervical torque. Several studies on either CROM or cervical strength, including the proposed study of Cagnie et al. [2], were cited and discussed. We are sorry that we did not include the excellent three review articles on cervical neck pain that were suggested in the letter to the editor [3–5]. We know that our data are not in line with the existing opinion on this topic, but we take the view that this is an important reason why our data are worth publishing. Our study has obvious limitations regarding our “control group”, a point, which we discussed in the second paragraph of the discussion. To minimize possible criticism regarding our groups, we closer described both groups in Table 1 in the original publication. The pain history showed two large groups with highly significant differences of neck pain intensity, frequency, history and neck disability Index. Interestingly, these highly significant differences did not lead to the expected differences in the objectively measured CROM and cervical torque. The author correctly noted that the “control group” should not be described by “healthy” or “normal” and that the title could be misleading. The cervical measurement system (CMS) goniometer was bought from the Frei AG, Kirchzarten, Germany. The question concerning the “radiating” pain of the “neck pain group” cannot retrospectively be answered, as a further differentiation in radiculopathy, referred pain or radiating in the arm was not analyzed. After consultation of a statistician, we are sorry to admit that we did not apply the right statistical tests on the correct data of means and standard deviations that were given in the text and in the Tables. The statistical analysis was redone: the normality of variables was evaluated with the Kolmogorov–Smirnov test showing a non-normal distribution of all parameters. Therefore, the differences of the “neck pain” and “control” group were analyzed using the Mann–Whitney U Test for non-normally distributed interval variables. The correlation between cervical spine biomechanics and pain intensity, pain frequency and pain history was obtained with the Spearman’s rank-order correlation for non-normally distributed data. The following interpretation of the correlation coefficient was used: 0.00–0.19, “very weak/questionable correlation”; 0.20–0.39 “weak”; 0.40–0.59 “moderate”; 0.60–0.79 “strong”; 0.80–1.0 “very strong”. The statistical analysis showed significant differences of the patients’ age, height, and weight and inpatient treatment in the last 3 months. A very weak negative correlation between the “neck pain intensity/neck pain frequency” and the range of motion for extension and left/right rotation was found. A very weak correlation of the “neck pain history” and left/right flexion was found. A very weak negative correlation of “neck pain intensity” and “neck pain frequency” and the extension torque and the left/right torque was found. The very weak correlation of cervical biomechanics and “pain intensity”, “pain frequency” and “history of neck pain” is shown in Table 1. Table 1 Correlation of cervical biomechanics and “pain intensity”, “pain frequency” and “history of cervical pain” All in all, we are sorry for not using the right statistical tests beforehand. The unchanged means and standard deviations described two clinically different groups with highly significant differences of the neck pain intensity, frequency, history and neck disability index, while statistically only a partly very weak correlation of cervical biomechanics and neck pain was found. We take the view that it is less comfortable but important to publish data that are not in line with the current literature. The question why to provide therapeutic exercise if there is no impairment cannot be answered with this study as we did not analyze the existing effect of therapeutic exercise on the neck pain, CROM and cervical strength. As we wrote in the discussion, we believe that the known positive effect of physiotherapy training for neck pain cannot solely be described by the easily measurable increasing maximal isometric strength. Further studies of functional MRI scans during different exercise forms could give an answer to the correlation of muscle function and neck pain [6]. We are in line with the opinion expressed in the letter to the editor that we have to critically appraise our work and aim for high research standards to provide a valid evidence base.

Background: Neck pain is a common complaint that often occurs in the community with a total prevalence of 86%. Non-specific neck pain cause problems such as: range of motion limitation, increased neck disability, and increased in the angle of forward head posture.Objective: The purpose of this study was to determine the effectiveness of adding joint mobilization and stabilization exercise to ultrasound therapy (UST) intervention and stretching exercise in reducing neck pain and disability in non-specific neck pain.Methods: This study is an experimental study with a randomized controlled trial group design. Study participants were randomly divided into two groups. The control group (n=14) was given UST + stretching exercise while the treatment group (n=14) was given UST + stretching exercise + joint mobilization + stabilization exercise. This study measures the effectiveness of therapy in terms of reducing pain as measured by a visual analogue scale, as well as neck disability with the Indonesian version of the Modified Northwick Park neck pain Questionnaire (MNPQ).Results: The results of the comparison test between groups showed that there was a significant difference (p&lt;0.05) in the reduction in pain and disability scores between the control and treatment groups.Conclusion: The addition of joint mobilization and neck stabilization exercises to the intervention of ultrasound therapy and stretching training was more significant than the administration of ultrasound therapy and stretching training alone in reducing neck pain and disability in non-specific neck pain.

Translation and psychometric testing. To cross-culturally adapt the Neck Disability Index (NDI) into the Hindi language, the local language of India, and to investigate the psychometric properties of the Neck Disability Index-Hindi (NDI-H) version in patients with neck pain. The NDI is the most used self-reported outcome measure for neck pain. The previous NDI-H version did not obtain advance permission from Mapi trust to translate this scale. As a result, this scale's availability is limited. Following established guidelines, the NDI was translated and culturally adapted into Hindi. A total of 120 chronic neck pain patients (20 for cognitive interviews and 100 for psychometric testing) participated in this study. The content validity, construct validity, internal consistency, test-retest reliability, and responsiveness of the NDI-H were all evaluated. The intraclass correlation coefficient was computed to determine test-retest reliability. Internal consistency was assessed using Cronbach α. The NDI's factor structure was investigated using principal component factor analysis. The Neck Pain and Disability Scale, Numeric Pain Rating Scale, and Anxiety and Depression scales were used to test criterion validity. The receiver operating characteristic curve analysis was used to determine the cut-off point and the area under the curve. The NDI-H demonstrated good test-retest reliability (intraclass correlation coefficient = 0.92) and excellent internal consistency (Cronbach α = 0.90). The one-factor structure was revealed by the factor analysis. The NDI has a strong relationship with the Neck Pain and Disability Scale and Numeric Pain Rating Scale, as well as the Anxiety and Depression scales. The cut-point for detecting a change was 9.3. The NDI was successfully translated into Hindi in this study. The NDI-H is a reliable and valid and responsive instrument that can be used to treat patients with chronic neck pain in clinical and research settings.

Interactive effects from self-reported physical and psychosocial factors in the workplace on neck pain and disability in female office workers

Prospective randomized controlled trial. To study the outcome of anterior cervical decompression and fusion combined with a structured physiotherapy program compared with the same physiotherapy program alone for patients with cervical radiculopathy. Knowledge concerning the effects of interventions for patients with cervical radiculopathy is scarce due to a lack of randomized studies. Sixty-three patients were randomized to surgery with postoperative physiotherapy (n = 31) or physiotherapy alone (n = 32). The surgical group was treated with anterior cervical decompression and fusion. The physiotherapy program included general/specific exercises and pain-coping strategies. The outcome measures were disability (Neck Disability Index), neck and arm pain intensity (visual analogue scale), and the patient's global assessment. Patients were followed for 24 months. The result from the repeated-measures analysis of variance showed no significant between-group difference for Neck Disability Index (P = 0.23). For neck pain intensity, the repeated-measures analysis of variance showed a significant between-group difference during the study period in favor of the surgical group (P = 0.039). For arm pain intensity, no significant between-group differences were found according to the repeated-measures analysis of variance (P = 0.580). Eighty-seven percent of the patients in the surgical group rated their symptoms as "better/much better" at the 12-month follow-up compared with 62% in the nonsurgical group (P < 0.05). At 24 months, the corresponding figures were 81% and 69% (P = 0.28). The difference was significant only at the 12-month follow-up in favor of the surgical group. Significant reduction in Neck Disability Index, neck pain, and arm pain compared with baseline was seen in both groups (P < 0.001). In this prospective, randomized study of patients with cervical radiculopathy, it was shown that surgery with physiotherapy resulted in a more rapid improvement during the first postoperative year, with significantly greater improvement in neck pain and the patient's global assessment than physiotherapy alone, but the differences between the groups decreased after 2 years. Structured physiotherapy should be tried before surgery is chosen. 2.

Retrospective cohort study. The goal of the present study was to determine whether neck pain responds differently to anterior cervical discectomy and fusion (ACDF) between patients with cervical radiculopathy and/or cervical myelopathy. Many patients who undergo ACDF because of radiculopathy/myelopathy also complain of neck pain. However, no studies have compared the response of significant neck pain to ACDF. Patients undergoing one to three-level primary ACDF for radiculopathy and/or myelopathy with significant (Visual Analogue Scale [VAS] ≥ 3) neck pain and a minimum of 1-year follow-up were included. Based on preoperative symptoms patients were split into groups for analysis: radiculopathy (R group), myelopathy (M group), or both (MR group). Groups were compared for differences in Health Related Quality of Life outcomes: Physical Component Score-12, Mental Component Score (MCS)-12, Neck Disability Index, VAS neck, and VAS arm pain. Two hundred thirty-five patients met inclusion criteria. There were 117 patients in the R group, 53 in the M group, and 65 in the MR group. Preoperative VAS neck pain was found to be significantly higher in the R group versus M group (6.5 vs. 5.5; P = 0.046). Postoperatively, all cohorts experienced significant (P < 0.001) reduction in VAS neck pain, (ΔVAS neck; R group: -2.9, M: -2.5, MR: -2.5) with no significant differences between groups. However, myelopathic patients showed greater improvement in absolute MCS-12 scores (P = 0.011), RR (P = 0.006), and % minimum clinically important difference (P = 0.013) when compared with radiculopathy patients. This greater improvement remained following regression analysis (P = 0.025). Patients with substantial preoperative neck pain experienced significant reduction in their neck pain, disability, and physical function following ACDF, whether treated for radiculopathy or myelopathy. However, in this study, only myelopathy patients had significant improvements in their mental function as represented by MCS improvements. 3.

The cultural adaptation of Neck Disability Index (NDI), the validity and reliability of Turkish version. The aim of this study was to conduct a study concerning the cultural adaptation of NDI and investigate the validity and reliability of its Turkish version in patients with neck pain. The NDI is a reliable evaluation instrument for disability but there is no published Turkish version. Eighty-eight patients with neck pain for at least 3 months were included in the study. NDI, The Neck Pain and Disability Scale, and Visual Analogue Scale (VAS) were completed by all subjects. Test-retest reliability was determined by using intraclass correlation coefficient and Pearson correlation analysis. For the determination of concurrent validity, the relation between NDI and VAS was examined by Pearson correlation analysis and for the determination of construct validity, the relation between NDI and Neck Pain and Disability Scale was investigated. Intraclass correlation coefficient score for test-retest reliability was 0.979 (95% confidence interval = 0.968-0.986). For concurrent validity, the relation between NDI and VAS was investigated, the r value for test and retest was 0.508 and 0.620, respectively (P < 0.0001). For construct validity, the relation between NDI and the Turkish version of Neck Pain and Disability Scale was investigated, the r value for test and retest was 0.659 (P < 0.0001) and 0.728 (P < 0.0001), respectively. The results suggest that the Turkish version of the NDI validated in this study is an easy to understand, reliable, and valid instrument for the measurement of the limitation of activities of daily living and pain caused by neck disorders in the Turkish-speaking population.

Objective: To expore the correlation between neck disability, neck pain and muscle strength in cervical pondylosis of office worker, and to provide scientific basis for the prevention and treatment of cervical spondylosis. Methods: In April 2021 ,234 patients with cervical spondylotic myelopathy treated in the Subsidiary Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine from April 2015 to April 2017 were selected, the correlation between Neck Disability Index (NDI) score, neck pain and muscle strength was analyzed using the Spearman rank correlation method. Mann-Whitney U test was used to compare the difference of maximum muscle strength of isometric contraction. Results: NDI score was negatively correlated with neck flexion, extension, and muscle strength in the left and right flexion directions (r(s)=-0.164, -0.169, -0.222, -0.176, P=0.012, 0.010, 0.001 , 0.007). In mild and moderate functional disorder patients, the muscle strength in flexion, extension and left and right flexion direction was greater, the difference was statistically significant (P <0.01). Conclusion: There is a negative correlation between cervical functional disorder and cervical muscle strength in office workers, suggesting that strengthening cervical muscle strength may be a way to improve cervical spine function.

Structural and construct validity of the Whiplash Disability Questionnaire in adults with acute whiplash-associated disorders

Background. Temporomandibular disorders (TMDs) are a heterogeneous group of musculoskeletal conditions affecting the masticatory muscles, the temporomandibular joint (TMJ), and associated structures. Anatomical and neurophysiological links between the cervical spine and the temporomandibular system suggest that functional impairment in one region may be associated with impairment in the other. Objectives. This exploratory cross-sectional study aimed to investigate the association between neck disability and jaw functional limitation in individuals diagnosed with TMD and to describe the relationship between neck pain intensity and these outcomes. Materials and methods. Fifty volunteers diagnosed with disc displacement with reduction by a dentist according to the DC/TMD Axis I clinical criteria (without imaging) were included. Neck disability was assessed with the Neck Disability Index (NDI), jaw functional limitation using the 8-item Jaw Functional Limitation Scale (JFLS-8), and average neck pain intensity over the previous month using a 10 cm visual analog scale (VAS). Data were analysed using Spearman's rank correlation and multiple linear regression, with age entered as a continuous variable. As no a priori sample size calculation was performed, the findings should be interpreted as exploratory. Results. A statistically significant, positive, but modest association was observed between neck disability and jaw functional limitation (ρ = 0.343, 95% CI 0.06 to 0.57; p = 0.015). In the multiple linear regression model (F(3,46) = 4.645, p = 0.006; adjusted R² = 0.182), female sex (β = −0.318, p = 0.018) and higher JFLS-8 score (β = 0.276, p = 0.042) were associated with higher NDI scores; age was not a significant predictor (β = 0.180, p = 0.179). Neck pain VAS was not included as a regression predictor and was not significantly associated with NDI in bivariate analyses. Conclusion. In this cross-sectional sample of individuals with TMD, female sex and higher jaw functional limitation scores were associated with higher neck disability scores. The findings support the clinical relevance of assessing both the temporomandibular and the cervical regions in patients with TMD. Because of the cross-sectional design and limited sample size, no causal inferences can be drawn.