Introduction
Methods
Design and procedure
Participants
Variable | NSE (n = 76) | NSEB (n = 71) | PPA (n = 69) | p value |
---|---|---|---|---|
WAD grade 2/3 [n (%)] | 49/27 (64/36) | 33/38 (46/54) | 41/28 (58/42) | 0.08 |
Gender female [n (%)] | 57 (75) | 47 (66) | 38 (55) | 0.04 |
Age, mean (range) SD | 38 (18–62) 11.3 | 40 (19–63) 11.6 | 43 (19–63) 10.7 | 0.03 |
Months since injury, mean (range) SD | 19 (6–36) 8.7 | 20 (6–36) 8.9 | 20 (6–36) 10.3 | 0.69 |
Smoker [n (%)] | 17 (22) | 8/62 (11/89) | 12/55 (18/82) | 0.22 |
Educational level [n (%)] | 0.44 | |||
Educational level, elementary | 4 (5) | 6 (9) | 6 (9) | |
Educational level, high school | 38 (50) | 40 (57) | 34 (51) | |
Educational level, university | 31 (41) | 21 (30) | 24 (36) | |
Educational level, other | 3 (4) | 3 (4) | 3 (4) | |
Use of analgesic drugs yes [n (%)] | 40 (53) | 44 (62) | 45 (67) | 0.23 |
Employed [n (%)] | 61 (80) | 57 (80) | 52 (75) | 0.71 |
Physical activity level, IPAQ | 0.74 | |||
Physical activity level, low | 16 (30) | 14 (26) | 25 (34) | |
Physical activity level, medium | 26 (48) | 25 (45) | 26 (36) | |
Physical activity level, high | 12 (22) | 16 (29) | 22 (30) | |
Comorbidity yes [n (%)]a | 56 (74) | 52 (73) | 49 (71) | 0.76 |
Mental disorder/distress | 15 (20) | 20 (29) | 18 (27) | |
Gastrointestinal disease | 17 (23) | 18 (27) | 21 (32) | |
Respiratory disease | 17 (22) | 12 (18) | 6 (9) | |
Skin disease | 16 (21) | 12 (18) | 7 (11) | |
Cardiovascular disease | 8 (11) | 8 (11) | 6 (9) | |
Endocrine/metabolic disease | 9 (12) | 8 (12) | 11 (17) | |
Neurological/sensory disease (eye, ear) | 10 (13) | 4 (6) | 9 (13) | |
Digestive disease | 9 (12) | 8 (12) | 11 (17) | |
Number of comorbidities, mean (SD) | 1.8 (1.3) | 1.7 (1.4) | 1.8 (1.4) | 0.90 |
Pain catastrophizing (PCSc), mean (SD) | 19 (10) | 20 (13) | 17 (10) | 0.46 |
HADS, depression, mean (SD) | 4.5 (3.8) | 4.8 (4.3) | 5.0 (4.3) | 0.89 |
HADS, anxiety, mean (SD) | 5.8 (3.9) | 5.9 (5.1) | 6.3 (3.6) | 0.78 |
Neck disability (NDI), mean (SD) | 31 (12.5) | 34 (13.6) | 34 (13.7) | 0.39 |
Current pain, VAS, mean (SD) | 39 (24) | 46 (24) | 42 (26) | 0.26 |
Pain disability (PDI), mean (SD) | 19 (12) | 23 (16) | 20 (13) | 0.30 |
Work ability (WAI), mean (SD) | 35 (6) | 36 (7) | 35 (7) | 0.64 |
Kinesophobia (TSK), mean (SD) | 22 (5) | 22 (6) | 22 (6) | 0.99 |
Interventions and settings
Neck-specific exercise (NSE)
Neck-specific exercise with a behavioural approach (NSEB)
Physical activity prescription (PPA)
Outcomes
Factors potentially associated with HRQoL and change in HRQoL score
Statistics
Results
Adherence and drop-out analysis
Results of the randomized study
n
| Mean EQ-5D score | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Baseline | 95% CI | 3 months | 95% CI | 6 months | 95% CI | 12 months | 95% CI | p value | ||
NSE | 76 | 0.649 (0.217) | 0.599–0.698 | 0.685 (0.233) | 0.626–0.745 | 0.680 (0.258) | 0.611–0.749 | 0.708 (0.243) | 0.643–0.773 | 0.52 |
NSEB | 70 | 0.552 (0.307) | 0.478–0.625 | 0.686 (0.212) | 0.633–0.738 | 0.704 (0.250) | 0.638–0.771 | 0.673 (0.276) | 0.602–0.745 | < 0.01 |
PPA | 69 | 0.631 (0.249) | 0.570–0.692 | 0.622 (0.291) | 0.545–0.699 | 0.627 (0.285) | 0.547–0.707 | 0.618 (0.289) | 0.536–0.639 | 0.90 |
n
| Mean EQ-VAS | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Baseline | 95% CI | 3 months*** | 95% CI | 6 months | 95% CI | 12 months*** | 95% CI | p value | ||
NSE | 75 | 65 (16) | 60–69 | 70 (18) | 63–74 | 70 (21) | 65–76 | 70 (21) | 64–76 | 0.14 |
NSEB | 70 | 61 (20) | 54–65 | 66 (20) | 61–73 | 71 (20) | 66–78 | 71 (20) | 67–78 | < 0.01 |
PPA | 69 | 64 (18) | 60–69 | 61 (21) | 54–66 | 64 (20) | 59–70 | 62 (21) | 55–67 | 0.12 |
n
| Mean SF-36 physical component score | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Baseline | 95% CI | 3 months*** | 95% CI | 6 months | 95% CI | 12 months*** | 95% CI | p value | ||
NSE | 74 | 42.54 (6.41) | 40.66–44.41 | 45.44 (7.40) | 43.24–47.63 | 45.93 (7.93) | 43.24–47.23 | 46.01 (8.46) | 43.65–48.54 | < 0.01 |
NSEB | 70 | 43.02 (6.80) | 41.15–44.48 | 44.85 (6.76) | 42.98–46.91 | 45.46 (7.25) | 43.49–47.42 | 46.22 (7.56) | 44.15–48.28 | < 0.01 |
PPA | 69 | 42.14 (6.23) | 40.26–44.01 | 42.95 (9.20) | 40.23–45.68 | 43.89 (7.70) | 41.63–46.14 | 42.72 (8.47) | 40.21–45.23 | 0.33 |
n
| Mean SF-36 mental component score | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Baseline | 95% CI | 3 months*** | 95% CI | 6 months | 95% CI | 12 months | 95% CI | p value | ||
NSE | 74 | 47.89 (8.74) | 44.43–51.34 | 49.37 (12.74) | 44.35–54.38 | 49.75 (9.63) | 45.98–53.53 | 50.71 (10.82) | 46.56–54.87 | 0.38 |
NSEB | 70 | 47.17 (10.73) | 43.97–50.37 | 49.20 (10.05) | 46.14–52.26 | 49.48 (11.23) | 46.16–52.80 | 48.71 (13.44) | 44.54–52.89 | 0.21 |
PPA | 65 | 46.50 (12.03) | 41.83–51.17 | 47.37 (11.42) | 43.02–51.73 | 46.09 (13.57) | 40.85–51.32 | 46.21 (12.74) | 41.39–51.04 | 0.91 |
Factors associated with the HRQoL scores and change scores
Baseline score
Factors associated with | Baseline EQ-5D score (R2 = 0.52) | Baseline EQ-VAS (R2 = 0.43) | Baseline SF-36 PCS (R2 = 0.59) | Baseline SF-36 MCS (R2 = 0.45) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
b (SE) |
β
|
p
| b (SE) |
β
|
p
| b (SE) |
β
|
p
| b (SE) |
β
|
p
| |
WAI | 0.01 (0.00) | 0.34 | < 0.01 | 0.80 (0.22) | 0.30 | < 0.01 | 0.27 (0.08) | 0.28 | < 0.01 | n.a | n.a | n.a |
HADS depression | − 0.02 (0.01) | − 0.325 | < 0.01 | − 1.27 (0.33) | − 0.29 | < 0.01 | − 0.42 (0.11) | 0.27 | < 0.01 | − 1.14 (0.26) | − 0.24 | < 0.01 |
HADS anxiety | n.a | n.a | n.a | n.a | n.a | n.a | n.a | n.a | n.a | − 0.50 (0.21) | − 0.19 | 0.02 |
Comorbidities, numbers | 0.03 (0.01) | 0.125 | 0.03 | n.a | n.a | n.a | n.a | n.a | n.a | n.a | n.a | n.a |
PDI | − 0.004 (0.02) | − 0.228 | 0.01 | n.a | n.a | n.a | − 0.87 (0.43) | − 0.18 | 0.04 | − 0.18 (0.80) | − 0.21 | 0.03 |
PCSc | − 0.004 (0.02) | − 0.174 | 0.01 | n.a | n.a | n.a | n.a | n.a | n.a | n.a | n.a | n.a |
SES | − 0.001 (0.001) | − 0.195 | 0.02 | n.a | n.a | n.a | 0.02 (0.01) | 0.13 | 0.09 | n.a | n.a | n.a |
Age | n.a | n.a | n.a | n.a | n.a | n.a | − 0.71 (0.31) | − 121 | 0.02 | n.a | n.a | n.a |
NDI | n.a | n.a | n.a | n.a | n.a | n.a | − 0.42 (0.9) | − 0.44 | < 0.01 | 0.44 (0.16) | 0.27 | 0.01 |
Pain VAS | n.a | n.a | n.a | − 0.16 (0.53) | − 0.21 | < 0.01 | n.a | n.a | n.a | n.a | n.a | n.a |
Factors associated with | EQ-5D change score (R2 = 0.42) | EQ-VAS change (R2 = 0.41) | SF-36 PCS change (R2 = 0.45) | SF-36 MCS change (R2 = 0.38) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
b (SE) |
β
|
p
| b (SE) |
β
|
p
| b (SE) |
β
|
p
| b (SE) |
β
|
p
| |
Educational level | 0.07 (0.03) | 0.19 | 0.01 | n.a | n.a | n.a | n.a | n.a | n.a | n.a | n.a | n.a |
HADS depression change | 0.03 (0.01) | 0.36 | < 0.01 | 3.00 (0.57) | 0.44 | < 0.01 | n.a | n.a | n.a | 0.86 (0.25) | 0.32 | 0.01 |
PCSc change | 0.01 (0.0) | 0.22 | 0.02 | n.a | n.a | n.a | n.a | n.a | n.a | n.a | n.a | n.a |
VAS change | 0.002 (0.0) | 0.18 | 0.03 | n.a | n.a | n.a | n.a | n.a | n.a | n.a | n.a | n.a |
WAI change | n.a | n.a | n.a | 1.01 (0.58) | 0.30 | 0.01 | 0.18 (0.09) | 0.18 | 0.057 | 0.33 (0.14) | 0.25 | 0.02 |
NDI change | n.a | n.a | n.a | n.a | n.a | n.a | 0.28 (0.05) | 0.54 | < 0.01 | 0.12 (0.07) | 0.17 | 0.01 |