Post-operative exercise improves pain, disability and spinal function following microdiscectomy.

Question: Does multimodal treatment produce better outcomes for chronic neck pain than a home exercise program or advice on management? Design: Prospective randomised intervention study. Setting: Workplaces in Finland. Subjects: Aged 30-60 years, permanently employed, height more than 140cm, with non-specific, recurrent or chronic neck trouble lasting longer than three months. Exclusion criteria were neural tissue involvement, severe cervical spine instability, known anomalies in cervical structures, osteoporosis, fresh fractures, recent major operation, severe diseases, infection, refusal to cooperate. Interventions: All subjects attended the same lecture on home management of neck pain. Multimodal treatment: cervicothoracic stabilising training, relaxation training, behavioural support, eye fixation exercises and postural control training, delivered twice weekly for 45 minutes for 12 weeks by two trained physiotherapists. Loading and range of movement was progressed. Home exercises: Written information on neck exercises, with training in home exercises in two sessions one week apart. Subjects diarised subsequent exercise compliance. Advice: Written information on neck exercises. No training was given. Main outcome measures: Measures were taken prior to intervention and at three and 12 months. Pain was recorded on a visual analogue scale (VAS). Total benefit from treatment was recorded on a five point scale (5 equalling maximum benefit) at three and 12 months post intervention. Main results: Seventy-six consecutive patients were enrolled, with 25 subjects assigned to each active intervention, and 26 subjects assigned to the control group. Eleven subjects withdrew by three months and another three by 12 months. At three and 12 months follow-up, the multimodal treatment group reported significantly higher total benefit (mean scores at respective follow-up periods 4.6, 4.2) than the active exercise group (3.8, 3.8), and the control group (3.3, 3.4). Average baseline VAS score was 51mm. At three months follow-up, pain scores on VAS were significantly lower in both active groups compared with the control (multimodal group 22mm, home exercise group 23mm, control group 39mm). This difference was not maintained at 12 months follow-up. Conclusion: Multimodal treatment was more effective than home exercises or advice alone in improving self-perceived benefit for patients with chronic neck problems. Commentary This is a good quality study from which physiotherapists can learn a number of things. Two features are highlighted. The first is that all the three trial interventions are currently advocated for the management of chronic neck pain. This study adds to the growing body of evidence that the popularly touted recommendations of merely providing the …