OBJECTIVES: To examine changes in pain outcomes to fully evaluate the effect of adding sensorimotor training to manual therapy and exercise in patients with chronic neck pain and sensorimotor deficits. Concordance was examined between pain distribution and pain intensity and patient-reported outcomes.
METHODS: Participants (n=152) were randomly allocated into 4 intervention groups: One group received local neck treatment (NT) comprising manual therapy and exercise and the other 3 groups received additional sensorimotor training (either joint position sense/oculomotor exercises, balance exercises or both). Treatment was delivered twice a week for 6 weeks. Pain and patient-reported outcomes were measured at baseline, posttreatment, and 3-, 6- and 12-month follow-ups.
RESULTS: There were greater changes in pain location, extent, and intensity at 6- and 12-month follow-ups in the sensorimotor training groups compared with the NT group ( P <0.05). A greater number of patients in the sensorimotor training groups gained =50% reduction in pain extent and intensity relative to the NT group at 6 and 12 months ( P <0.05). Clinical improvement in pain extent was concordant with pain intensity (adjusted kappa=056 to 0.66, %agreement=78.3 to 82.9, P <0.001) and disability (adjusted kappa=0.47 to 0.58, % agreement=73.7 to 79.0, P <0.01) at 3-, 6- and 12-month follow-ups, but not with function and well-being. The concordance tended to decline with time.
DISCUSSION: Multiple aspects of the pain experience improved in the longer term by adding sensorimotor training to NT for patients with neck pain and sensorimotor deficits. The concordance between pain and patient-reported outcomes was not always evident and varied over time, suggesting the need for multidimensional assessments of pain.
| Discipline Area | Score |
|---|---|
| Rehab Clinician (OT/PT) |  |
| Physician |  |
Physician rater
Patients with chronic neck pain and sensorimotor dysfunction who receive sensorimotor training in addition to manual therapy and therapeutic exercise experience greater improvements in pain location, extent, intensity, and disability at 12 months compared with those who receive only local neck treatment. This highlights the importance of multidimensional assessments of pain and a multicomponent treatment approach for chronic neck pain with sensorimotor deficits.
Physician rater
Incorporating sensorimotor training (i.e., cervical joint position sense/oculomotor training and/or balance training) leads to significant improvements in long-term (1-year follow-up) pain outcomes in patients with chronic neck pain and sensorimotor deficits compared with patients receiving usual care (manual therapy and exercise). This highlights the potential benefits of a comprehensive approach to the management of chronic neck pain.
Rehab Clinician (OT/PT) rater
This was an interesting study. The results add to the body of knowledge on the topic of neck pain, and potentially more broadly, on best practices in managing various pain states, including chronic/persistent pain. This study aids me as an orthopaedic and sports physiotherapist who has, for the last several years, employed sensorimotor training in addition to manual therapy and exercise in patients with a variety of conditions and impairments, including neck pain, with generally positive results. Its results further support the integration of sensorimotor training with more conventional treatments, including manual therapy and exercise, in patients with neck pain and, potentially, other conditions and impairments.
, McMaster University