This study is a single-blinded randomized controlled trial comprising thirty-five patients with NSCNP. They were recruited from the general out-patient department and physiotherapy department of 2 tertiary hospitals in Lagos state Nigeria. Inclusion criteria were the participants with a recurrent history of NSCNP of more than 3 months without any specific condition detected as the primary reason for the complaint, with pain level greater than or equals to 5/10. The participants with the previous history of spinal surgery, history of trauma to the neck, spinal deformity, and specific neck pain as a result of malignancy, narcotic drugs, and a previous history of physiotherapy intervention were excluded from the study.
3.1. Procedure
Participants’ physical characteristics, including age, sex, occupation, height, and weight were recorded before commencing the study. Baseline assessment of pain, neck disability, depression, anxiety, and sleep disturbance was done using numerical pain rating scale (NPRS), neck disability index (NDI), hospital anxiety depression scale (HADS), and insomnia severity index (ISI), respectively. Informed written consent was obtained from the participants while ethical approval was obtained from the Health Research and Ethics Committee of Lagos University Teaching Hospital, Nigeria with approval number (ADM/DST/HREC/APP/1535).
Out of the 47 participants screened for this study, 6 were found ineligible regarding the inclusion criteria and were excluded from the study. The 41 eligible participants were randomly assigned to 3 groups (1, 2, and 3), using the computer-generated random number sequence (Figure 1). The participants in group 1 received MET to the neck for 15 seconds (10), infrared radiation (IRR) and NCE (7). The participants in group 2 received NSE for 30 minutes (16), IRR, and NCE while group 3 received NCE and IRR to the neck. However, only 35 participants completed this study, 6 participants did not complete the study due to different reasons (Figure 1). The participants did this exercise two times a week for 8 weeks. Assessment of pain, neck disability, depression, anxiety, and sleep disturbance was done at baseline, end of 4th and 8th weeks.
Figure 1.
Flow of the participants for the study
3.2. Protocol for Neck Stabilization Exercise
Chin tuck, cervical extension, shoulder shrugs, shoulder rolls, scapular retraction 15 repetitions each for 30 minutes (16, 17).
3.3. Protocol for Muscle Energy Technique
The participant was in the supine lying position. The therapist was at the end of the bed near the participant’s head. The therapist assessed the movements of the cervical spine that were restricted. The therapist localized the joint or the body tissue into the position of the initial range of motion resistance to a specific movement. Once the therapist feels the restriction, the participant’s cervical spine was positioned in that range and then a resistive force was applied. In this regard, the patient was asked to isometrically contract for 5 seconds, but not to overcome the force of the therapist; then the counterforce by the therapist was ceased slowly and the participant was asked to relax. The therapist then took the joint to a new barrier and the same procedure was repeated 3 times (10, 18).
3.4. Protocol for Neck Care Education
Participants were advised to relax, activate, and adopt stress-coping skills, workplace ergonomics, and self-care strategies (19). The NPRS is an 11-point scale for patient’s self-report of pain. The NPRS can be administered verbally or graphically for self-completion, scores ranged from 0 - 10 points, with higher scores indicating greater pain intensity. It has a construct validity ranging from 0.86 to 0.95 (20).
3.4.1. The NDI
This is a self-administered questionnaire listing activities that can be compromised by neck pain. The NDI consists of 10 items to measure disability secondary to neck pain. The score ranges from 0 - 50, with 0 - 4 representing no disability and 34 and above representing severe disability with test-retest reliability of 0.55 (21).
3.4.2. The ISI
This is a self-administered questionnaire, which is an outcome measure to determine the severity of sleep disorder. It is a 7-point scale listing the problems associated with falling and staying asleep. The score range from 0 - 28 with a reliability of 0.74 (22).
3.4.3. The HADS
This is a widely used self-report questionnaire for detecting overall states of anxiety and depression in non-psychiatric medical contexts (23). It consists of 14 items, which are statements to be scored on 4-point Likert scale (0 - 3), generating ‘anxiety’ or ‘depression’ scores ranging from 0 to 21 (total score = 0 - 42). It has a reliability of 0.73 for anxiety and 0.77 for depression.
3.5. Data Analysis
Statistical Package for Social Science (SPSS Inc., Chicago, Illinois, USA) version 22.0 for windows package was used for data analysis. Quantitative data were expressed as mean and standard deviation (SD). Baseline and 8-week intervention values were recorded using Wilcoxon sign rank test and paired t-test. Analysis of variance (ANOVA) test and Kruskal Wallis test were used to summarize baseline, end of 4th week and 8th week values post-intervention. Least significant difference (LSD) post hoc analysis was done to compare the mean changes in the three groups in order to determine the significant difference at the alpha level of 0.05.
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