EFFECTS OF EIGHT WEEKS OF NECK STABILISATION AND DYNAMIC EXERCISES ON SELECTED CLINICAL AND PSYCHOSOCIAL VARIABLES AMONG PATIENTS WITH NON-SPECIFIC NECK PAIN

Abstract

Non-specific Neck Pain (NsNP) constitutes a burden to the bearers and a management challenge to physiotherapists globally. Effectiveness of neck stabilisation and dynamic exercises in the management of NsNP has been documented but it is not clear which of the exercise regimen is more effective in alleviating its associated clinical and psychosocial factors. This study was carried out to compare the effectiveness of neck stabilisation and/or dynamic exercises on pain intensity, functional disability, fear avoidance beliefs, depression and anxiety among patients with NsNP. Eighty-eight consenting individuals with NsNP participated in this single-blind randomised controlled trial. They were consecutively recruited from outpatient physiotherapy clinics of National Orthopaedic Hospital, Dala and Aminu Kano Teaching Hospital, Kano, Nigeria. Participants were randomly assigned into one of three intervention groups: Neck Stabilisation Exercise Group (NSEG; n=30), Neck Dynamic Exercise Group (NDEG; n=29) and Neck Stabilisation and Dynamic Exercise Group (NSDEG; n=29). Treatment was administered thrice weekly for eight consecutive weeks. Variables were assessed at baseline, end of fourth and eighth week. Clinical variables: Pain intensity and functional disability were assessed using Visual Analogue scale and Neck disability index Questionnaire respectively. Psychosocial variables: Fear avoidance beliefs, depression and anxiety were assessed using Fear Avoidance Belief Questionnaire, Beck Depression Inventory and Beck Anxiety Inventory respectively. Data were analysed using descriptive statistics, analysis of variance, Kruskal-Wallis and post-hoc tests at p=0.05. Age of participants in NSEG (46.8±12.4 years), NDEG (48.6±11.6 years) and NSDEG (45.1±13.4 years) were comparable. There was no significant difference in participants’ scores on pain intensity, functional disability, fear avoidance beliefs, depression and anxiety across the three groups at baseline. At the end of the fourth week, scores for pain intensity (4.8±1.3; 5.8±1.4; 5.6±1.7), fear avoidance beliefs [28.0 (10.0); 35.0 (7.0); 34.0 (10.0)] and anxiety [13.0 (8.0); 18.0 (7.0) 13.0 (10.0)], for NSEG, NDEG and NSDEG respectively were significantly different across the three groups, while scores for functional disability [18.0 (7.0); 15.0 (7.5); 16.0 (7.5)] and depression [12 (6.0); 12 (6.0); 12 (6.0)] were not. At the end of eighth week, scores for pain intensity (2.7±1.27; 4.1±0.9; 4.5±1.4), functional disability [12.0 (2.0); 14.0 (6.7), 14.0 (6.5], fear avoidance beliefs [22.0 (9.0); 30.5 (7.8); 30.0 (14.5)] and depression [11.5 (5.0); 12.0 (2.8); 12.0 (5.0)] in NSEG, NDEG and NSDEG respectively, were significantly different, while scores of anxiety [13.0 (9.8); 14.0 (7.0); 12.0 (5.0)] were not. Post-hoc tests showed that NSEG had more significant reduction in pain intensity, functional disability and fear avoidance beliefs at end of weeks 4 and 8 and in depression at week 8 than the other two groups. Neck stabilisation is the most effective regimen in the management of non-specific neck pain.