Supervised versus minimally supervised exercises on pain,
function, and quality of life of individuals with chronic non-specific
neck pain: a non-inferiority randomized clinical trial
chronic pain; neck pain; exercise therapy.
Abstract:
Objective: The purpose of this study was to investigate the non-
inferiority of a minimally supervised versus supervised exercise
program (with equal doses of training) over 8 weeks, focusing on
neck disability, pain intensity, catastrophizing, muscle strength,
kinesiophobia, and quality of life in individuals with chronic
nonspecific neck pain (CNSNP). Methods: This was a single-
center, non-inferiority randomized controlled trial with two arms
conducted. The trial enrolled 76 individuals with CNSNP who
met clinical criteria (grade I or II according to the Neck Pain Task
Force, lasting more than three months, pain intensity ≥ 3 on the
Numeric Rating of Pain Scale, and disability ≥ 5 points on the
Neck Disability Index) and were aged between 18 and 50 years.
They participated in an eight-week supervised or minimally
supervised multimodal exercise program. Outcome measures
were assessed at baseline, 8 weeks, and 16 weeks. The primary
outcome was the Neck Disability Index score. Secondary
outcomes included pain intensity (assessed using the Numeric
Rating Scale and Pressure Pain Threshold), neck range of
motion (measured with a mobile inclinometer application),
muscle isometric strength (evaluated using a hand
dynamometer), endurance (tested with the craniocervical flexion
test), quality of life (assessed using the Short Form-36),
kinesiophobia (measured with the Tampa Scale for
Kinesiophobia), catastrophizing (evaluated using the Pain
Catastrophizing Scale), self-efficacy (assessed with the Chronic
Pain Self-Efficacy Scale), and global perceived effect. Impact:
This protocol focused on the minimally supervised exercise
program and was particularly relevant given challenging
circumstances (e.g., the COVID-19 pandemic, accessibility
issues, and commuting challenges). The study highlighted the
benefits of the minimally supervised approach. If successful, the
findings of this study will clarify the importance of minimally
supervised interventions for CNSNP, providing an additional
approach for health professionals.