Key messages
– We do not know if psychological and educational interventions (which are designed to modify thoughts, behaviours, and emotions) through telerehabilitation (getting therapies designed to help people recover and regain their movement (also known as rehabilitation services) using telephones or computers) have an effect on pain, but they likely improve function (how well people can move their necks).
– Doing exercise and physical activity through telerehabilitation may slightly reduce neck pain compared to minimal treatment (for example, no treatment, or advice).
– There is not enough strong evidence to say how well telerehabilitation works, and more high-quality studies are needed.
What did we want to find out?
Neck pain is common and can limit daily activities. Telerehabilitation means getting rehabilitation services (therapies designed to help people recover and regain their movement) through technology, such as telephone calls, video calls, or mobile apps. This can help people receive care without visiting a clinic. We wanted to find out whether receiving care through telerehabilitation reduces neck pain and improves function (how well people can move their necks).
We wanted to find out if telerehabilitation is more effective than:
– minimal intervention (such as usual care, education only, or being on a waiting list);
– a similar treatment delivered in a clinic in-person (called matched non-telehealth treatment); and
– a different in-person treatment (called unmatched treatment).
We looked at reducing pain, improving function, quality of life, and mental health in people with different types of neck pain.
We also wanted to check if telerehabilitation causes serious unwanted effects or if people stopped treatment because of any issues.
What did we do?
We searched for studies that compared telerehabilitation to minimal treatment, in-person rehabilitation, or other treatments in adults with neck pain.
What did we find?
We found 13 studies with 1042 people, most of whom were women. The studies were conducted in China, Denmark, Germany, Greece, Italy, the Netherlands, South Korea, Thailand, and Turkey.
Telerehabilitation was delivered using telephone calls, apps, recorded videos, video calls, and websites. Programmes lasted between one day and 48 weeks.
Main results
We are not sure how effective telerehabilitation is. The best estimate at this time suggests that it might help slightly compared to minimal intervention.
Chronic (lasting longer than 12 weeks) neck pain
Psychological or educational telerehabilitation (which are designed to modify thoughts, behaviours, and emotions) may make little to no difference (but the evidence is very uncertain), may not improve quality of life, or may not reduce depression. However, it probably improves function and probably reduces anxiety slightly compared to minimal intervention.
Exercise-based telerehabilitation may slightly reduce pain, but the evidence is very uncertain if it has an effect on function or quality of life compared to minimal intervention.
One study tested multicomponent telerehabilitation (a mix of different treatments). The evidence suggests it may not help reduce pain compared to minimal intervention.
Few studies reported unwanted effects, and none provided details about people stopping treatment due to problems.
What are the limitations of the evidence?
We are uncertain about the benefits of telerehabilitation because:
– there were not enough studies comparing it to other treatments;
– the quality of studies varied; and
– most studies were small, making it difficult to get clear results.
More well-designed research is needed to know if telerehabilitation is effective for neck pain.
How up to date is this evidence?
The evidence is current as of 11 April 2024.
阅读完整摘要
Neck pain is a very common condition, ranked fourth in terms of years lived with disability worldwide. Telerehabilitation has been growing in popularity with advances in technologies and telecommunication. Despite the potential benefits and the increased number of trials, there is uncertainty about the effectiveness of telerehabilitation in people with non-specific neck pain.
研究目的
To evaluate the benefits and harms of telerehabilitation to improve pain and function compared to no treatment, waiting list, usual care, or any other active intervention in people with acute, subacute, and chronic non-specific neck pain.
检索策略
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, five other databases, and two trial registers to 11 April 2024 without language or publication status restrictions. We screened reference lists of relevant potential studies.
纳入排除标准
We included randomised controlled trials of telerehabilitation in adults with non-specific neck pain. We classified telerehabilitation interventions into three categories: 1. telehealth delivery of psychological or education interventions; 2. telehealth delivery of exercise or physical activity interventions; and 3. telehealth delivery of multicomponent interventions. We included trials comparing telerehabilitation with minimal intervention, matched non-telehealth treatment, and unmatched treatment controls. The primary outcomes were pain intensity, function, health-related quality of life, anxiety, depression, any adverse events, withdrawals due to adverse events, and short-term serious adverse events. The secondary outcomes were return to work, self-efficacy, fear avoidance, pain catastrophising, and adherence.
资料收集与分析
Two review authors independently screened relevant records, extracted data, and assessed risk of bias in included studies. We extracted data using a standardised form. We pooled trial results using a random-effects model meta-analysis. We combined results in a meta-analysis using mean difference (MD with pain and disability outcomes expressed on a 0 to 100 scale) or standardised mean difference (SMD), and 95% confidence intervals (CI) for continuous outcomes at immediate-, short-, intermediate-, and long-term follow-up. Otherwise, we report the data with a narrative summary. We assessed heterogeneity using the I2 value and Chi2 test, and assessed the certainty of the evidence using the GRADE approach.
主要结果
We included 13 randomised controlled trials (1042 participants). Most studies included women (71%), aged 21 to 60 years (mean 39 years, standard deviation 11 years). Studies used different modalities for telerehabilitation, such as telephone, smartphone applications, pre-recorded videos, videoconference, and websites. The studies were conducted in China, Denmark, Germany, Greece, Italy, the Netherlands, South Korea, Thailand, and Turkey. The telerehabilitation interventions lasted from one day to 48 weeks. Most studies had a low risk of selection bias, attrition bias, and reporting bias. All studies had a high risk of performance bias related to blinding of participants and therapists, and detection bias for outcome assessment.
Chronic neck pain
Telerehabilitation (psychological or education) versus minimal intervention
We found very low-certainty evidence that there may be little to no difference between telerehabilitation (psychological or education) and minimal intervention in pain intensity at short-term follow-up, but the evidence is very uncertain (MD −8.4, 95% CI −23.9 to 7.1; 2 studies, 170 participants). We found moderate-certainty evidence that telerehabilitation (psychological or education) probably improves function when compared to minimal intervention at short-term follow-up (MD 6.0, 95% CI 0.9 to 11.1; 1 study, 53 participants). We found low-certainty evidence that telerehabilitation (psychological or education) may not improve health-related quality of life related to the Physical Component when compared to minimal intervention at short-term follow-up (mean: 47.4 with telerehabilitation versus 45.1 with minimal intervention; 1 study, 117 participants) and health-related quality of life related to Mental Component at short-term follow-up (mean: 45.4 with telerehabilitation versus 47.2 with minimal intervention; 1 study, 117 participants). We found moderate-certainty evidence that telerehabilitation (psychological or education) probably reduces anxiety slightly compared to minimal intervention at short-term follow-up (MD −4.5, 95% CI −8.9 to −0.1; 1 study, 53 participants). We found low-certainty evidence that there may be little to no difference between telerehabilitation (psychological or education) and minimal intervention for depression at short-term follow-up (MD −2.3, 95% CI −6.5 to 1.9; 1 study, 53 participants). No study in this comparison reported withdrawal due to adverse events or serious adverse events.
Telerehabilitation (exercise and physical activity) versus minimal intervention
We found low-certainty evidence that telerehabilitation (exercise and physical activity) may reduce pain intensity when compared to minimal intervention at short-term follow-up (MD −20.4, 95% CI −21.9 to −19.1; 3 studies, 146 participants). We found very low-certainty evidence that telerehabilitation may improve function compared to minimal intervention at short-term follow-up, but the evidence is very uncertain (MD 5.0, 95% CI 0.5 to 9.4; 3 studies, 146 participants). We found very low-certainty evidence that there may be little to no difference between telerehabilitation (exercise and physical activity) and minimal intervention in quality of life (Physical Component) at short-term follow-up (SMD −0.06, 95% CI −0.7 to 0.6; 2 studies, 64 participants) or quality of life (Mental Component) at short-term follow-up (SMD −0.3, 95% CI −0.8 to 0.2; 2 studies, 64 participants), but the evidence is very uncertain. No study in this comparison assessed anxiety, depression, withdrawal due to adverse events, or serious adverse events.
Telerehabilitation (multicomponent interventions) versus minimal intervention
We found low-certainty evidence that there may be little to no difference between telerehabilitation (multicomponent) and minimal intervention in pain intensity at short-term follow-up (MD −1.0, 95% CI −5.9 to 3.9; 1 study, 213 participants). No study in this comparison assessed function, health-related quality of life, anxiety, depression, withdrawals due to adverse events, and serious adverse events.
作者结论
The current available evidence is inconclusive due to its very low certainty, and thus the question of the effectiveness of telerehabilitation interventions for non-specific neck pain remains unanswered.
