- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04182035
The Effectiveness of Patient-tailored Treatment in Patients With (Sub)Acute Neck Pain
Comparing the Effectiveness of Patient-tailored Treatment Versus Non Patient-tailored Treatment in Patients With Acute and Subacute Idiopathic Neck Pain
Study Overview
Status
Detailed Description
Non-specific neck pain (NSNP) is a widespread health problems and a major cause of pain and disability. This condition is complex, disabling and has a heterogeneous presentation, which makes NSNP difficult to treat. Currently, the best evidence supports combining different forms of manual therapy (mobilizations, manipulations and manual muscle techniques), and exercises. Yet, identifying the most effective treatment characteristics and dosages remain challenging. Central in the debate about best practice management of NSNP and NSLBP is the efficacy of tailored versus generic (non-tailored) treatment. To date, sufficient evidence for the application of specific physiotherapy modalities or therapy aiming at specific NSNP subgroups is lacking. Although more research has already been conducted for the lumbar spine, there is an ongoing quest to identify relevant subgroups and provide patients with an assessment-driven targeted intervention to achieve meaningful and long-lasting changes.
Attempts have been made to identify relevant and homogeneous subgroups for patients with NSNP. Several classification systems have been proposed, based on (1) prognosis or (2) the underlying mechanism(s) driving the disorder: (2a) pain mechanisms, (2b) features of movement/posture/muscle activation , and (2c) pathology/diagnosis. The main goal of subgrouping patients is to enhance treatment efficiency. Nevertheless, a profound clinical reasoning process is necessary to identify clinically relevant subgroups. By identifying accurate and useful diagnostic criteria for NSNP and NSLBP, more informed decisions regarding the management of these conditions could be made.
Clinicians and researchers are hopeful that tailoring treatment to subgroups of patients may positively impact on patient outcomes and more efficient usage of health-care resources. For the lumbar spine, tailoring treatment to different subgroups is already present in literature. For example, in patients with pain provoked by postures/movements, tailoring treatment to modify specific features of posture/movement is effective and patients allocated to subgroups respond better to matched rather than unmatched interventions. Yet, other studies showed no additional benefit. Despite the growing interest for tailoring treatment for NSNP, the definition of tailored/stratified care is broadly used and interpretation is diverse. In order to determine best practice for the individual patient, tailoring the treatment should account for the multidimensional nature of non-specific spinal complaints and respect the individual characteristics of the patient within its subgroup. Additionally, it must take into account that patients may present with features of multiple subgroups or evolve through subgroups during treatments.
Previous studies on NSLBP already showed that targeting treatment can reduce costs and may improve outcomes when specific groups are compared. Unfortunately, at this moment, no conclusive high-quality evidence is present for its superiority. In addition to the lumbar spine, research on stratified care for NSNP is scarce compared to NSLBP research. Despite its major prevalence and socioeconomic consequences, no recommended or validated classification systems to stratify care for NSNP and to target specific subgroups are available. This suggests that the treatment decision in this heterogeneous group mostly depends on the clinical reasoning process, which is often incomplete in research on NSNP.
In order to evaluate the best practice for NSNP, a classification system based on a profound clinical reasoning process, identifying clinically relevant subgroups should be implemented to guide treatment tailoring and to allow a holistic and individual approach, instead of oversimplifying non-specific spinal complaints as one condition.
GOAL :
To evaluate the effectiveness of a patient tailored treatment (PTT) combined with individualized education, compared to (1) a non-patient tailored treatment (NPTT) consisting of a generalized exercise program with education and (2) a control group for (sub)acute (recurrent) nonspecific complaints.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Marjolein Chys
- Phone Number: 0491439513
- Email: Marjolein.Chys@Ugent.be
Study Locations
-
-
België
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Ichtegem, België, Belgium, 8480
- Recruiting
- Marjolein Chys
-
Contact:
- Marjolein Chys
- Phone Number: 0491439513
- Email: Marjolein.Chys@Ugent.be
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Non-specific neck pain, pain located in the cervico-thoracic and posterior shoulder region; without dominant arm pain.
- NDI scores score ≥10 % (more than no disability) and ≤68 % (less than complete disability)
- (Sub)acute complaints: <3 months
- Recurrent complaints but no neck pain episode the previous 3 months.
- Mean pain intensity scores: NRS > 3/10
Exclusion Criteria:
- Structural pathology, confirmed by imaging (disk herniation, nerve root compression, radiculopathy, severe rheumatoid diseases, fractures, traumatic alterations…) Shoulder pathology, vestibular pathology.
- Risk stratification: Startback tool for neck pain: high risk group
- BMI > 30 kg/m²
- Other cardiovascular/metabolic/systemic/ neurological diseases, fibromyalgia or chronic fatigue syndrome
- Psychiatric illnesses, history of depression, serious catastrophizing thoughts and/or low treatment expectations.[52]
- Chronic complaints (>3 months) or traumatic onset of the complaints
- Probable or definite neuropathic pain (according to the classification of Finnerup et al.)
- History of surgery in the head/neck or shoulder region
- Hypermobile patients
- Pregnancy or given birth in the preceding year.
- History of recurrent/chronic low back pain
- Primary headache
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Factorial Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Patient-tailored treatment group
Objectives & approach: The subjects in the PTT group will receive the individual tailored treatment program combining best evidence active and passive treatment strategies (manual therapy, individual exercises) in combination with education tailored to the individual situation of the patient and selected home exercises.
9 individual therapy sessions will be performed, in combination with 9 additional home exercise sessions.. NRS and NDI-scores will be monitored before every treatment.
The therapist will register when the cut-off score of 30% NDI reduction is present in order to determine the evolution in pain/disability reduction.
The importance of self-efficacy will be emphasized and tailored home-exercises will be monitored and adjusted every week.
|
The subjects in the PTT group will receive the individual tailored treatment program combining best evidence active and passive treatment strategies (manual therapy, individual exercises) in combination with education tailored to the individual situation of the patient and selected home exercises.
9 individual therapy sessions will be performed, in combination with 9 additional home exercise sessions.. NRS and NDI-scores will be monitored before every treatment.
The therapist will register when the cut-off score of 30% NDI reduction is present in order to determine the evolution in pain/disability reduction.
The importance of self-efficacy will be emphasized and tailored home-exercises will be monitored and adjusted every week.
Education considering neck pain information
|
Active Comparator: Non patient-tailored treatment group
Objectives & approach: The NPTT will receive an individual (hands-off) treatment, which includes an active neck exercise program, non-tailored education and non-tailored home exercises, according to a previously published program with good results.53
The sessions will be performed once a week under supervision (9 therapy sessions, standard exercise program) and once a week by the patient at home (9 home exercise sessions, standard exercise program).
|
Education considering neck pain information
The NPTT will receive an individual (hands-off) treatment, which includes an active neck exercise program, non-tailored education and non-tailored home exercises, according to a previously published program with good results.53
The sessions will be performed once a week under supervision (9 therapy sessions, standard exercise program) and once a week by the patient at home (9 home exercise sessions, standard exercise program).
|
No Intervention: Control group
The subjects randomized to the control group will not receive any intervention, if necessary medication use is permitted and will be monitored using the iMTAQ.
Patients will be asked not to seek other treatment options (if possible).
If this is not possible, patients will be considered lost to follow-up.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in painscores in the neck region, overall pain score
Time Frame: Baseline, every supervised treatment (Week 1-9),follow up 3 weeks,3,6,12 months post treatment
|
Numeric Rating Scale (score 0-10; 0=no pain; 10=worst pain)
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Baseline, every supervised treatment (Week 1-9),follow up 3 weeks,3,6,12 months post treatment
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Change in disability
Time Frame: Baseline, every supervised treatment (9x), follow up 3 weeks,3,6,12 months post treatment
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Neck Disability Index (score0-50; 0=no disability; 50=maximal disability)
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Baseline, every supervised treatment (9x), follow up 3 weeks,3,6,12 months post treatment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Global Perceived Effect
Time Frame: After 3,6 & 9 supervised treatments, follow up 3 weeks,follow up 3,6,12 months
|
Global Perceived Effect Scale (score:1-7; 1=a lot better, 7= a lot worse)
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After 3,6 & 9 supervised treatments, follow up 3 weeks,follow up 3,6,12 months
|
Change in medical costs
Time Frame: At baseline, follow up 3 weeks,3,6,12 months post treatment
|
institute for Medical Technology Assessment (iMTA): Medical Costs Questionnaire
|
At baseline, follow up 3 weeks,3,6,12 months post treatment
|
Change in productivity costs
Time Frame: At baseline, follow up 3 weeks,3,6,12 months post treatment
|
institute for Medical Technology Assessment(iMTA): Productivity Costs Questionnaire
|
At baseline, follow up 3 weeks,3,6,12 months post treatment
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Barbara Cagnie, UGent
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- B670201941044
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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