Scapular exercise combined with cognitive functional therapy is more effective at reducing chronic neck pain and kinesiophobia than scapular exercise alone: a randomized controlled trial

Abstract

Objective: The aim of this study was to compare the effectiveness of scapular exercises alone and combined with cognitive functional therapy in treating patients with chronic neck pain and scapular downward rotation impairment. Design: Single-blind randomized controlled trial. Setting: Outpatient. Subjects: A total of 72 patients (20–45 years old) with chronic neck pain were studied. Intervention: Allocation was undertaken into three groups: scapular exercise ( n = 24), scapular exercise with cognitive functional therapy ( n = 24) and control ( n = 24) groups. Each programme lasted three times a week for six weeks. Main outcomes: The primary outcome measure was pain intensity measured by the visual analogue scale scores. The secondary outcome measures included kinesiophobia and muscles activity. Results: Statistically significant differences in pain intensity were found when multidisciplinary physiotherapy group including a cognitive functional approach was compared with the scapular exercise alone group at six weeks (effect size (95% CI) = −2.56 (−3.32 to −1.80); P = 0.019). Regarding kinesiophobia, a significant between-group difference was observed at six-week (effect size (95% CI) = −2.20 (−2.92 to −1.49); P = 0.005), with the superiority of effect in multidisciplinary physiotherapy group. A significant between-group differences was observed in muscle activity. Also, there were significant between-group differences favouring experimental groups versus control. Conclusion: A group-based multidisciplinary rehabilitation programme including scapular exercise plus cognitive functional therapy was superior to group-based scapular exercise alone for improving pain intensity, kinesiophobia and muscle activation in participants with chronic neck pain.

Effect of Multi-Modal Therapies for Kinesiophobia Caused by Musculoskeletal Disorders: A Systematic Review and Meta-Analysis

“…After deduplication and applying the exclusion criteria, 12 studies [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ] of the total 1042 studies were included for analysis. The flow diagram could be seen in Figure 1 .…”

Letter to the editor concerning the article: Scapular exercise combined with cognitive functional therapy is more effective at reducing chronic neck pain and kinesiophobia than scapular exercise alone: A randomized controlled trial

“…We would like to thank the authors for publishing this article (Javdaneh et al 1 ). The researchers presented the results of a randomized controlled trial with the aim of investigating the effectiveness of scapular exercises alone and combined with cognitive functional therapy (CFT) in treating patients with chronic neck pain and scapular downward rotational impairment.…”

“…We wondered why disability was not included as a primary outcome, since this has been broadly used in chronic low back pain and CFT studies. 2–5 The recruitment period described by Javdaneh et al 1 ended in March 2020. Since the intervention lasted 6 weeks and the article was submitted on March 13, 2020, it is very impressive how quickly the authors were able to analyze data and write the manuscript.…”

“…There are three main components of CFT: making sense of pain, exposure with control, and lifestyle change. Javdaneh et al 1 describe pain neuroscience education as a cognitive component, which consists of explaining to the patient about the processes associated with a pain experience, without maintaining the focus on anatomical structures. 6 However, it is not clear whether the volunteers received this intervention individually or in a group.…”

“…Thus, the patient can better understand his condition and reframe his previous beliefs about pain. However, even though that Javdaneh et al 1 have pointed out the relevance of biopsychosocial aspects in the management of painful conditions, the cognitive component was approached in a unidirectional way, with explanations coming from the clinician to the patient, instead of reflective questions as proposed by the intervention. Besides, exercises focused on specific muscle activation deviate from the intervention proposal.…”