The comparison between the effects of pain education interventions with online and face-to-face exercise and the control group received biomedical education + standardized physical therapy in patients with chronic nonspecific neck pain during COVID-19: protocol for a parallel-group randomized controlled trial.

BACKGROUND: Various psychological issues and serious health concerns during the imposed lockdown by coronavirus disease 2019 (COVID-19) have induced many changes in the treatment of patients. More effective self-management strategies through tele-rehabilitation are suggested to be applied for patients with chronic neck pain to reduce referrals to health cares and disability support through COVID-19. Also, the pain neuroscience education (PNE) approach is an educational method used by health professionals to assist patients in understanding the biology, physiology, and psychosocial factors affecting their pain experience and aligning with the cognitions and beliefs associated with pain and recurrent disability. PNE combined with tele-rehabilitation could be a new solution to encourage patients to manage their condition by themselves and increase the continuity of practice instead of face-to-face sessions. OBJECTIVE: This randomized control trial (RCT) aims to investigate the effects of PNE with online and face-to-face exercise interventions, and the control group received biomedical education + standardized physical therapy on neck pain and disability, psychological factors, and function in non-traumatic chronic neck pain. METHODS/DESIGN: Patients with non-traumatic chronic neck pain (patient-centered care and active involvement of patients and the public) will be recruited via flyers displayed in hospitals and universities to participate in an RCT with two experimental and one control group designed to investigate the effects of PNE with online and face-to-face exercise interventions, and the control group received biomedical education + standardized physical therapy on neck pain and disability, psychological factors, and function in non-traumatic chronic neck pain. The outcomes will be measured at baseline, after PNE, and after 3 months of an exercise intervention. All outcomes are presented as mean ± SD, and statistical significance was set at α level of < 0.05. The normal distribution of the variables was verified by the Kolmogorov-Smirnov test, following a descriptive analysis. DISCUSSION: It seems that PNE plus online and face-to-face exercise interventions are appropriate educational models for the treatment of patients with neck pain during COVID-19. Also, online training seems to encourage patients to continue their treatment. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20150503022068N5. Registered on 09 September 2021.

Comparison the Effect of Pain Neuroscience and Pain Biomechanics Education on Neck Pain and Fear of Movement in Patients with Chronic Nonspecific Neck Pain During the COVID-19 Pandemic.

INTRODUCTION: Self-management education is the basis of any intervention for persons with chronic musculoskeletal pain. Given the biopsychosocial nature of chronic musculoskeletal pain, an educational approach based on the biopsychosocial model would seem to be an appropriate educational model for the treatment of these people during coronavirus disease 2019 (COVID-19). The aim of this study was to compare the effect of pain neuroscience education (PNE) and pain biomechanics education, using online and face-to-face sessions on pain and fear of movement, in people with chronic nonspecific neck pain during COVID-19. METHODS: In this multicenter assessor-blinded randomized controlled trial, 80 patients (both male and female) with chronic nonspecific neck pain (based on the inclusion criteria of the study) participated in educational sessions (face-to-face and online) from the beginning September until the end of October 2021. The participants were randomly divided into two groups (through the selection of numbers from 1 to 80, hidden in a box), with one group receiving PNE (treatment group) and the other group receiving pain biomechanics education (control group). Pain and fear of movement before and after the intervention were measured on the Numerical Pain Rating Scale and the Tampa Scale of Kinesiophobia, respectively. A 2 × 2 variance analysis (treatment group × time) with a mixed-model design was applied to statistically analyze the data. RESULTS: No significant change in pain (P = 0.23) was observed between the two groups (P = 0.24, Cohen's d = 0.17, 95% confidence interval [CI] - 0.21 to 0.35), while changes in the fear of movement variable were reported to be significant (P = 0.04, Cohen's d = 0.34, 95% CI 0.11-0.51), in favor of PNE. Intra-group change was seen only in the PNE group for the fear of movement variable (P = 0.04; 14.28%↓). CONCLUSION: In our study population PNE did not affect the pain index, leading to the conclusion that PNE should not be used as the only treatment, but possibly in combination with other active/passive therapy to enhance the results for patients with nonspecific chronic neck pain. Moreover, online treatment may help clinicians to increase their interaction with patients during COVID-19 lockdown.