Effects of Qigong and Exercise Therapy Among Patients With Chronic Neck Pain
Condition: Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      A randomized controlled, multicenter trial comparing qigong and exercise therapy concerning
      pain intensity, treatment expectations, disability, neck movements and quality of life in
      subjects with non-specific, long-term NP after three and twelve months.
    

Detailed description: 
      A randomized controlled, multicenter trial comparing qigong and exercise therapy concerning
      pain intensity, treatment expectations, disability, neck movements and quality of life in
      subjects with non-specific, long-term NP. A comparison will be performed between the two
      randomized treatment groups in these variables before and after three and 12 months.

      Participants were recruited via an advertisement in a local newspaper. Inclusion: Men and
      women between 18-65 years of age with nonspecific, long term neck pain (<3 months).Exclusion
      criteria were chronic tension-type headache, migrain, traumatic neck injuries, neurologic
      signs or symptoms. rheumatic diseases, fibromyalgia or other severe physiologic or physical
      diserases and difficulties in understand the Swedish language.

      The enrollment of participants, the randomization procedure and the performance of
      measurements were conducted by four independent physiotherapists. Randomization was done in
      blocks of 30 according to a sealed envelope technique. Assessments were made before treatment
      (baseline), immediately after treatment and at six and 12-month follow-ups. All participants
      answered questionnaires about demographic data, pain (duration and intensity) and disability.
      Pain intensity was rated as current NP and average NP during the week before the assessment,
      measured with a visual analogue scale (VAS - measured in millimeters with the end points 0 =
      no pain and 100 = unbearable pain) (Carlsson, 1983). Neck Movements was measured with cervico
      Thorac Ratio (CTR) (Norlander 2995), Disability was measured with the Neck Disability Index
      (NDI) (Vernon, 1991), which consists of a ten-item, scaled questionnaire where the total
      scores are recalculated into percent (0%, no disability; 100%, maximum disability). The items
      assess NP according to intensity, personal care, lifting, reading, headache, concentration,
      work, driving, sleeping and recreation. Quality of Life was measured with the SF-36
      questionnaire (Sullivan1995).

      Study participants One hundred and twenty-two subjects with long-term, non-specific NP were
      randomized to the interventions of qigong (n=60) and exercise therapy (n=62). Eighty-six
      (70%) were women and 36 (30%) men, with a mean age of 44 years

      The participants were allocated randomly to receive qigong or exercise therapy. In each
      group, the participants received ten to 12 treatments over a period of three months, and each
      treatment session lasted one hour. A treatment-specific guideline was developed for each
      treatment. Treatments were provided by experienced physiotherapists; the physiotherapist
      responsible for qigong had nothing to do with exercise therapy and vice versa. An attendance
      list was kept during the intervention period, and all participants were informed that they
      had to attend at least eight of the 12 sessions to be included for analysis in the study.

      Qigong was done according to medical qigong, which is a modality of traditional Chinese
      medicine and is a way of affecting and directing qi (energy) for medical benefit. There are
      several medical qigong techniques, one being the Biyun method . Each qigong practice included
      body posture adjustment and gentle movement, meditation (concentration) and purposeful
      relaxation, breathing regulation practices and self-administered massage. In this study,
      qigong was practiced in groups of ten to 15 participants. Each qigong session started with
      information about the philosophy of medical qigong, which was followed by a general warm-up
      with soft movements for the whole body and then 14 selected qigong exercises according to the
      Biyun method. The participants were recommended to practice different qigong exercises at
      home every day.

      Exercise therapy was carried out individually, and the training program was adjusted for each
      participant. A physiotherapist instructed the participant throughout the training program,
      which focused mainly on the cervical and shoulder/thoracic regions. Each training session
      started with a warm-up on a stationary bicycle for about ten minutes, followed by 40 minutes
      of dynamic exercises. These exercises consisted of active movements aimed to cover the full
      range of motion in all neck directions and muscle exercises aimed to maintain/increase
      circulation, endurance and strength. The muscle exercises were carried out against gravity or
      with added resistance (for example with weights, rubber expander, dumbbells and pulley
      apparatus) and ended with stretching the muscles in the neck, shoulders and upper limbs. The
      amount of load was individualized and kept within pain tolerance (aimed not to increase
      pain). The load at the muscle exercises was to achieve between 30 and 70% of maximum muscle
      capacity and was gradually increased as endurance and strength were gained.
    

Intervention name(s): Qigong therapy; Exercise therapy
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Medical qigong; Regular exercise
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Expectations; Outcomes; Qigong; Exercise therapy; Disability; Neck movements,