Does Continuing Education Improve Physical Therapists’ Effectiveness in Treating Neck Pain? A Randomized Clinical Trial

Background and PurposePhysical therapists often attend continuing education (CE) courses to improve their overall clinical performance and patient outcomes. However, evidence suggests that CE courses may not improve the outcomes for patients receiving physical therapy for the management of neck pain. The purpose of this study was to investigate the effectiveness of an ongoing educational intervention for improving the outcomes for patients with neck pain.ParticipantsThe study participants were 19 physical therapists who attended a 2-day CE course focusing on the management of neck pain. All patients treated by the therapists in this study completed the Neck Disability Index (NDI) and a pain rating scale at the initial examination and at their final visit.MethodsTherapists from 11 clinics were invited to attend a 2-day CE course on the management of neck pain. After the CE course, the therapists were randomly assigned to receive either ongoing education consisting of small group sessions and an educational outreach session or no further education. Clinical outcomes achieved by therapists who received ongoing education and therapists who did not were compared for both pretraining and posttraining periods. The effects of receiving ongoing education were examined by use of linear mixed-model analyses with time period and group as fixed factors; improvements in disability and pain as dependent variables; and age, sex, and the patient's initial NDI and pain rating scores as covariates.ResultsPatients treated by therapists who received ongoing education experienced significantly greater reductions in disability during the study period (pretraining to posttraining) than those treated by therapists who did not receive ongoing training (mean difference=4.2 points; 95% confidence interval [CI]=0.69, 7.7). Changes in pain did not differ for patients treated by the 2 groups of therapists during the study period (mean difference=0.47 point; 95% CI=−0.11, 1.0). Therapists in the ongoing education group also used fewer visits during the posttraining period (mean difference=1.5 visits; 95% CI=0.81, 2.3).Discussion and ConclusionThe results of this study demonstrated that ongoing education for the management of neck pain was beneficial in reducing disability for patients with neck pain while reducing the number of physical therapy visits. However, changes in pain did not differ for patients treated by the 2 groups of therapists. Although it appears that a typical CE course does not improve the overall outcomes for patients treated by therapists attending that course, more research is needed to evaluate other educational strategies to determine the most clinically effective and cost-effective interventions.

Download Full-text

Preliminary Examination of a Proposed Treatment-Based Classification System for Patients Receiving Physical Therapy Interventions for Neck Pain

Physical Therapy ◽

10.2522/ptj.20060192 ◽

2007 ◽

Vol 87 (5) ◽

pp. 513-524 ◽

Cited By ~ 83

Author(s):

Julie M Fritz ◽

Gerard P Brennan

Keyword(s):

Physical Therapy ◽

Neck Pain ◽

Classification System ◽

Interrater Reliability ◽

Physical Therapists ◽

Physical Therapist ◽

Neck Disability Index ◽

Mean Difference ◽

Classification Methods ◽

Therapy Interventions

Background and PurposeNeck pain frequently is managed by physical therapists. The development of classification methods for matching interventions to subgroups of patients may improve clinical outcomes. The purpose of this study was to describe a proposed classification system for patients with neck pain by examining data for consecutive patients receiving physical therapy interventions.Subjects and MethodsStandardized methods for collecting baseline and intervention data were used for all patients receiving physical therapy interventions for neck pain over 1 year. Outcome variables were the Neck Disability Index (NDI), numeric pain rating, and number of visits. Treatment was provided at the discretion of the physical therapist. After the completion of treatment, each patient was classified by use of baseline variables. The interventions received by the patient were categorized as being matched or not matched to the classification. Outcomes for patients who received matched interventions were compared with those for patients who received nonmatched interventions. The interrater reliability of the classification algorithm was examined with a subset of 50 patients.ResultsA total of 274 patients were included in this study (74% women; age [X̄±SD]=44.4±16.0 years). The most common classification was centralization (34.7%); next were exercise and conditioning (32.8%) and mobility (17.5%). The interrater reliability for classification decisions was high (kappa=.95, 95% confidence interval [CI]=0.87–1.0). A total of 113 patients (41.2%) received interventions matched to the classification. Receiving matched interventions was associated with greater improvements in the NDI (mean difference=5.6 points, 95% CI=2.6–8.6) and in pain ratings (mean difference=0.74 point, 95% CI=0.21–1.3) than receiving nonmatched interventions.Discussion and ConclusionThe development of classification methods for patients with neck pain may improve the outcomes of physical therapy intervention. This study was done to examine a previously proposed classification system for patients receiving physical therapy interventions for neck pain. Receiving interventions matched to the classification system was associated with better outcomes than receiving nonmatched interventions. Although the design of this study prohibited drawing conclusions about the effectiveness of the system, the results suggest that further research on the system may be warranted.

Download Full-text

Effectiveness of Progressive Resisted Exercise along with Conventional Exercise and Conventional Exercise Program alone in Subjects with Text Neck Syndrome

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i59b34412 ◽

2021 ◽

pp. 536-542

Author(s):

Divya Jain ◽

Swapna Jawade ◽

Neha Chitale

Keyword(s):

Neck Pain ◽

Pain Intensity ◽

Conventional Therapy ◽

Rating Scale ◽

Neck Disability Index ◽

Exercise Program ◽

Pain Rating ◽

Numerical Pain Rating Scale ◽

Neck Disability ◽

Pain Rating Scale

Background: "Text neck" is a term coined to describe the posture created by leaning forward for lengthy periods of time, such as when reading and texting on a cellphone which has been linked to stress injuries. Neck pain, upper back discomfort, shoulder pain, frequent headaches, and greater curvature of the spine are all dangerous indications of text neck. According to a survey, 35% of smartphone users suffer from text neck syndrome. People between the ages of 15 and 18 are more likely to have neck pain. This protocol has been created that describes the design of comparative study to evaluate effectiveness of progressive resisted exercise along with conventional exercise and conventional exercise program alone in text neck syndrome. Methods: The participants (n=80) will be recruited in the study suffering from text neck syndrome and meeting the inclusion criteria. Two groups will be formed such that patients in group A will be treated with conventional therapy and group B will be treated with progressive resisted exercise (PRE) along with conventional therapy. The protocol will cover 4 weeks of treatment. In the rehabilitation period, we will evaluate the pain intensity, strength of neck muscles and functional activity. Our outcome measures will be- Numerical pain rating scale (NPRS) and Neck disability index (NDI). Discussion: Efficacy of the intervention will be evaluated by analyzing the pain intensity by using Numerical pain rating scale (NPRS) and level of functional disability by using Neck disability index (NDI). The result of the study will significantly provide affirmation on either using combination therapy of PRE with conventional exercise or conventional exercise alone.

Download Full-text

Comparison of Sustained Natural Apophyseal Glides and Maitland Manual Therapy in Non-Specific Neck Pain on Numeric Pain Rating Scale and Neck Disability Index

Annals of King Edward Medical University ◽

10.21649/journal.akemu/2017/23.4.425.430 ◽

2017 ◽

Vol 23 (4) ◽

Author(s):

Fahad Tanveer ◽

Adnan Afzal ◽

Muhammad Adeel ◽

Sana Shahid ◽

Maham Masood

Keyword(s):

Neck Pain ◽

Manual Therapy ◽

Rating Scale ◽

Neck Disability Index ◽

Pain Rating ◽

Numeric Pain Rating Scale ◽

Neck Disability ◽

Pain Rating Scale

Download Full-text

Impact of Continuing Education Interventions on Clinical Outcomes of Patients With Neck Pain Who Received Physical Therapy

Physical Therapy ◽

10.2522/ptj.20050382 ◽

2006 ◽

Vol 86 (9) ◽

pp. 1251-1262 ◽

Cited By ~ 21

Author(s):

Gerard P Brennan ◽

Julie M Fritz ◽

Stephen J Hunter

Keyword(s):

Physical Therapy ◽

Neck Pain ◽

Continuing Education ◽

Clinical Outcomes ◽

Clinical Improvement ◽

Physical Therapists ◽

Improvement Project ◽

Clinical Databases ◽

Education Interventions ◽

Ongoing Project

Abstract Background and Purpose. Physical therapists frequently attend continuing education courses with the goal of providing better care, yet the effectiveness of continuing education for improving outcomes has not been examined. Subjects. Data were obtained for all eligible patients (n=1,365; mean age=42.1 years, SD=14.0 years; 69.9% female) with a chief complaint of neck pain who were treated in 13 physical therapy clinics over a 24-month period. Disability data (Neck Disability Index scores) from the initial and final therapy sessions were recorded from clinical databases. Methods. Thirty-four of 57 physical therapists employed within the 13 clinics attended a 2-day continuing education course. Eleven of the 34 attendees also participated in an ongoing clinical improvement project for patients with neck pain. Clinical outcomes were compared in the pre- and post-course periods for therapists attending or not attending the course, and for therapists participating or not participating in the ongoing project. Results. There were no differences in clinical outcomes based on attendance at the continuing education course. There was an interaction between time and participation in the ongoing project, such that participants achieved greater change in disability after the course. The percentage of patients achieving at least the minimum detectable amount of change in disability with treatment increased significantly for participants after the course. Discussion and Conclusion. Attendance at a 2-day continuing education course was not associated with improvement in clinical outcomes, but participation in an ongoing improvement project did result in greater clinical improvement for patients with neck pain. Further investigation of educational methods to improve clinical outcomes is needed. These results suggest that traditional continuing education formats may not be effective for improving patient care. [Brennan GP, Fritz JM, Hunter SJ. Impact of continuing education interventions on clinical outcomes of patients with neck pain who received physical therapy. Phys Ther. 2006;86:1251–1262.]

Download Full-text

Reliability, construct validity, and responsiveness of the neck disability index and numeric pain rating scale in patients with mechanical neck pain without upper extremity symptoms

Physiotherapy Theory and Practice ◽

10.1080/09593985.2018.1471763 ◽

2018 ◽

Vol 35 (12) ◽

pp. 1328-1335 ◽

Cited By ~ 15

Author(s):

Ian A. Young ◽

James Dunning ◽

Raymond Butts ◽

Firas Mourad ◽

Joshua A. Cleland

Keyword(s):

Neck Pain ◽

Construct Validity ◽

Upper Extremity ◽

Rating Scale ◽

Neck Disability Index ◽

Pain Rating ◽

Numeric Pain Rating Scale ◽

Neck Disability ◽

Pain Rating Scale ◽

Upper Extremity Symptoms

Download Full-text

COMPARISON OF EFFICACY OF MECHANICAL INTERMITTENT AND KALTENBORN CERVICAL TRACTION MOBILIZATION WITH BELT IN RADIATING NECK PAIN: A RANDOMIZED CLINICAL TRIAL

Journal of Musculoskeletal Research ◽

10.1142/s0218957717500233 ◽

2017 ◽

Vol 20 (04) ◽

pp. 1750023

Author(s):

Amala Sahasrabudhe ◽

Charu Eapen ◽

C. P. Zulfeequer

Keyword(s):

Physical Therapy ◽

Neck Pain ◽

Outcome Measures ◽

Rating Scale ◽

Pain Treatment ◽

Neck Disability Index ◽

Patient Specific ◽

Cervical Traction ◽

Neck Disability ◽

Manual Traction

Purpose: The aim of this paper is to see the effectiveness of cervical traction manual or mechanical as an adjunct to physical therapy in the treatment of radiating neck pain. Method: 50 subjects with radiating neck pain, 25 in each group were taken. Both groups received moist heat and cervical retraction exercises for five sessions. The KTr group received Kaltenborn manual traction and the Tr group received mechanical cervical traction. Outcome measures: Numeric Pain Rating Scale and cervical ROM were taken at baseline, after first treatment and at the end of 5th day. Neck disability index and Patient-Specific Functional Scale were taken at baseline and at the end of fifth session. Results: After 5 days of treatment, statistical improvements ([Formula: see text].05) were observed in all outcome measures in both groups. The immediate reduction in pain intensity and increased range of motion was observed in the KTr group. Conclusion: The study showed that both traction methods are equally effective when used as adjunct to physical therapy in radiating neck pain treatment. Immediate effects in reduction of pain and increase in the ROM are more in the manual traction group. Hence, manual cervical traction along with physical therapy can be considered as choice of treatment for immediate improvements in pain and ROM of the cervical spine.

Download Full-text

Psychometric Properties of the Neck Disability Index and Numeric Pain Rating Scale in Patients With Mechanical Neck Pain

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2007.08.126 ◽

2008 ◽

Vol 89 (1) ◽

pp. 69-74 ◽

Cited By ~ 335

Author(s):

Joshua A. Cleland ◽

John D. Childs ◽

Julie M. Whitman

Keyword(s):

Neck Pain ◽

Psychometric Properties ◽

Rating Scale ◽

Neck Disability Index ◽

Pain Rating ◽

Numeric Pain Rating Scale ◽

Neck Disability ◽

Pain Rating Scale

Download Full-text

Efficacy and safety of Shi-style cervical manipulation therapy for treating acute and subacute neck pain: study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-021-05062-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Mingcai Zhang ◽

Guoqing Du ◽

Congying Liu ◽

Wei Li ◽

Jiayu Yang ◽

...

Keyword(s):

Clinical Trial ◽

Neck Pain ◽

Clinical Observation ◽

Rating Scale ◽

Neck Disability Index ◽

Trial Registration ◽

Activity Measurement ◽

Manipulation Therapy ◽

Self Evaluation ◽

Cervical Manipulation

Abstract Background Neck pain is a common clinical disease, which seriously affects people’s mental health and quality of life and results in loss of social productivity. Improving neck pain’s curative effect and reducing its recurrence rate are major medical problems. Shi’s manipulation therapy has unique advantages and technical features that aid in the diagnosis and treatment of neck pain. Compared with first-line non-steroidal anti-inflammatory drug (NSAID) treatment of neck pain, Shi’s cervical manipulation lacks the relevant research basis of therapeutic advantage, safety, and satisfaction for treating acute and subacute neck pain. Herein, we aim to confirm our hypothesis in a clinical trial that the safety and efficacy of Shi’s cervical manipulation will be more effective, safer, and more satisfactory than NSAIDs to treat acute and subacute neck pain. Methods In this multicenter, positive-controlled, randomized clinical trial, traditional analgesic drug (NSAID) is used to evaluate and show that Shi’s manipulation is more effective, safe, and satisfactory for treating acute and subacute neck pain. Overall, 240 subjects are randomly divided into the trial and control groups, with both groups treated by the corresponding main intervention method for up to 12 weeks. Clinical data will be collected before the intervention and immediately after the first treatment; at 3 days and 1, 2, 4, 8, and 12 weeks after the intervention; and at 26 and 52 weeks after treatment follow-up of clinical observation index data collection. The clinical observation indices are as follows: (1) cervical pain is the primary observation index, measured by Numerical Rating Scale. The secondary indices include the following: (2) cervical dysfunction index, measured by patient self-evaluation using cervical Neck Disability Index; (3) cervical activity measurement, measured by the cervical vertebra mobility measurement program of Android mobile phone system; (4) overall improvement, measured by patient self-evaluation with SF-36; and (5) satisfactory treatment, determined by patient self-evaluation. Discussion We will discuss whether Shi’s cervical manipulation has greater advantages in efficacy, safety, and satisfaction of acute and subacute neck pain than traditional NSAIDs, to provide a scientific basis for the dissemination and application of Shi’s cervical manipulation. Trial registration China Registered Clinical Trial Registration Center ChiCTR1900021371. Registered on 17 February 2019

Download Full-text

Reliability and validity of the Mizo-version of neck disability index for non-specific neck pain in the rural North-East Indian population

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195929 ◽

2019 ◽

Vol 8 (1) ◽

pp. 317

Author(s):

Andrew Lalchhuanawma ◽

Divya Sanghi

Keyword(s):

Neck Pain ◽

Correlation Coefficient ◽

Rating Scale ◽

Neck Disability Index ◽

Reliability And Validity ◽

East Indian ◽

North East ◽

Study Results ◽

Significant Difference ◽

Neck Disability

Background: The Neck Disability Index (NDI) is an important self-assessment tool used extensively worldwide, in clinical practice with implications into scientific research fields. It is used to assess the extent of pain and levels of functional disability associated with neck pain. The NDI consists of 10 items where each item was scored from a scale of 0 to 5 giving the maximum score possible to 50. Though proven to be a reliable instrument in the English-speaking population, the NDI has never been validated and culturally adapted in the Mizo language among the rural north-east Indian region where English is not spoken as means of communication. The aim is to translate and cross culturally adapt the NDI into Mizo tawng (official language of Mizoram) with the objective of establishing reliability and validity of the M-NDI in patients with non-specific neck pain.Methods: A total of 49 subjects participated voluntarily from the rural primary health care, Lunglei district, Mizoram. Subject having chronic non-specific neck pain lasting more than 3 months were included after taking a written formal consent.Results: The internal consistency determined by Cronbach alpha, and the Intraclass Correlation Coefficient (ICC) using the test-retest reliability showed a good and an excellent reliability respectively (α=0.82, ICC=0.97, 95% CI= 0.95-0.98). Construct validity was determined between the variables-Numerical Pain Rating Scale (NPRS) and NDI by Pearson’s correlation coefficient and found to have a good correlation r=0.89 and significant difference at p<0.001.Conclusions: The study results concluded the Mizo version of NDI to be easy to understand, reliable and valid instrument for measuring disability and functional limitations of daily activities in non-specific neck pain in the Mizo speaking population.

Download Full-text