Program of therapeutic exercises associated with electrotherapy in patients with chronic neck pain: Protocol for a randomized controlled trial.

Conservative treatment is the most common clinical management for the proper rehabilitation of patients with chronic neck pain, and there is a trend towards the use of therapeutic exercise. However, some uncertainty about the efficacy of therapeutic exercises remains, and it is necessary to conduct more studies with high methodological rigor, especially in regard to multimodal treatment, as in the combination of therapeutic exercises with electrotherapy. Thus, the objective of this study will be to evaluate the clinical effects of adding high- and low-frequency transcutaneous electrical nerve stimulation (TENS) in a program of specific therapeutic exercises for the treatment of patients with chronic neck pain. Sixty participants will be randomized into three groups: therapeutic exercise + placebo TENS group (n = 20), therapeutic exercise + high-frequency TENS group (n = 20), and therapeutic exercise + low-frequency TENS group (n = 20). Eight treatment sessions will be performed, and participants will be evaluated before and after the eight sessions and four weeks after the end of treatment. The Numerical Rating Pain Scale, Neck Disability Index, Pain-Related Catastrophizing Thoughts Scale, and Tampa Scale for Kinesiophobia will be used for participant evaluations. In the statistical analysis, a linear mixed model will be applied considering interaction between time and group factors. The addition of this electrotherapeutic modality to a therapeutic exercise program is expected to generate clinical improvements for patients with chronic neck pain, and if the results demonstrate benefits in the treatment group, this form of care could be used.

Intra- and inter-reliability of fleximetry in individuals with chronic shoulder pain.

OBJECTIVE: To evaluate the intra- and inter-rater reliability of fleximetry in the measurement of range of motion (ROM) in individuals with chronic shoulder pain. DESIGN: Reliability study. SETTING: Physiotherapy clinic. PARTICIPANTS: Thirty individuals of both genders, ages between 18 and 45 years, with chronic shoulder pain. MAIN OUTCOME MEASURES: Fleximetry was used to measurement shoulder ROM (flexion, hyperextension, abduction, medial and lateral rotation, and horizontal abduction and adduction). Two examiners performed the evaluations of the shoulder ROM at two time points (interval of one week between them). RESULTS: In the intra-rater reliability, substantial to excellent reliability was found, with intraclass correlation coefficient (ICC) values ranging from 0.79 to 0.92, standard error of the measurement (SEM) values ranging from 5.70 to 8.72°, and minimum detectable change (MDC) values varying between 15.80 and 25.18°. Regarding the inter-rater reliability, moderate to excellent reliability was observed, with ICC values ranging from 0.68 to 0.96, SEM values ranging from 4.98 to 11.53°, and MDC values ranging from 13.82 to 31.97°. CONCLUSION: The use of the fleximeter to measure shoulder ROM presents acceptable reliability values in individuals with chronic shoulder pain, which supports the use of this method of evaluation in research and clinical practice.