The Effectiveness of the Exercise Program Applied by Telerehabilitation Method in Individuals With Chronic Neck Pain

Study Overview
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Brief Summary
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Neck pain is a common musculoskeletal problem occurring as one of the first conditions causing decreased quality of life and disability. An estimated 67.5% of people experience neck pain in their lives (5, 6). When the adult population is considered (15-74 years old), the prevalence ranges from 5.9% to 38.7%. Causes of neck pain are largely variable, and include working in unsuitable ergonomic positions, sitting for a long time, and keeping the neck in abnormal physiological position for a long time. Various factors are effective in the chronic stage of neck pain. Neck pain is associated with decreased strength and endurance of the cervical muscles. It was observed that deep flexor muscles are weak and superficial flexor muscle activity is increased in patients with neck pain; and that exercise is effective in reducing neck pain because strength, endurance, and flexibility can be regained in the structures around the damaged tissue. There are several approaches that were found to be effective in the treatment of neck pain. These treatment strategies include physical therapy modalities, manual therapy, therapeutic exercise (stretching, strengthening, and endurance exercises) and home exercise programs. Home exercise programs are used to expand the clinic-based physical therapy approaches to treat neck pain. It was stated that it is now compulsory to develop new rehabilitation models and practices to cope with global increase in elderly population, limited resources allocated to public health, and changes in population needs. Telerehabilitation is recommended as a solution to provide physical therapy services; however, it was reported in previous studies that more studies are required in this field to accept its effectiveness. The purpose of the present study is to examine the effects of 4-week exercise protocol established with stretching, strengthening the scapula muscles for the neck and upper body, neck and core stabilization exercises by ensuring the follow-up of the patients with Telerehabilitation Method on patients' neck pain, Daily Life Activities (DLA), and quality of life by comparing its effects with individuals who apply only home program.

Official Title
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The Effectiveness of the Exercise Program Applied by Telerehabilitation Method in Individuals With Chronic Neck Pain

Conditions
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Neck Pain

Intervention / Treatment
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* Other: Exercise Program Applied by Telerehabilitation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: voluntary individuals suffering from neck pain for at least 3 months over the age of 18 have a minimum score of 3/10 according to the Numeric Pain Rating Scale who fill out the pain preliminary information form, and who will agree to participate in the study through this form. Exclusion Criteria: Pregnant women, History of malignancy Congenital deformities or surgery history in the neck or shoulder area perception problems for verbal commands not having internet access not having equipment to make video calls

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Supervised Exercise Group<br>Telerehabilitation will be applied in this group, which will last 4 weeks, and include the following processes Exercises that will be performed every Monday will be taught and applied face-to-face under the supervision of the therapist with online videoconferencing method. Then, videos of weekly exercises that will be prepared by the therapist will be transmitted online to patients. Patients will be asked to perform these exercises 4 days a week in the same week, on Wednesdays, Fridays and Sundays. Also, a video call will be made on Fridays to evaluate whether the movements are done effectively and correctly, and questions of patients (if any) will be answered. Patients will be informed by the physiotherapist that they should send messages on Wednesdays and Sundays to show that they are doing the exercises. The exercise program of new week will be taught every Monday for 4 weeks, the prepared video will be sent, and the program will be advanced and completed. | Other: Exercise Program Applied by Telerehabilitation<br>* Patients will be evaluated 3 times for 4 weeks throughout the study; before the study commences, at the end of 2th and 4th week Exercises will be planned to last for 15 minutes a day, and will be progressed and changed weekly throughout the study period. To the exercise program; It will be created as a progressive program by including stretching, normal range of motion movements, neck, core and scapular stabilization and strengthening exercises and the same program will be given to both groups.<br>|
| Active Comparator: Exercise Group<br>Exercise recommendations will be made to this group. Videos and photographs of weekly exercises prepared by the therapist will be sent online to the patient every Monday for 4 weeks, patients will be advised to repeat these exercises 4 days a week. | Other: Exercise Program Applied by Telerehabilitation<br>* Patients will be evaluated 3 times for 4 weeks throughout the study; before the study commences, at the end of 2th and 4th week Exercises will be planned to last for 15 minutes a day, and will be progressed and changed weekly throughout the study period. To the exercise program; It will be created as a progressive program by including stretching, normal range of motion movements, neck, core and scapular stabilization and strengthening exercises and the same program will be given to both groups.<br>|
| No Intervention: Control Group<br>No exercise application will be done in this group.Evaluation tests will be applied for 4 weeks only online. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rating Scale | Numeric Pain Rating Scale (NPRS) will be used to evaluate pain subjectively. NPRS is used to evaluate pain. The patient is asked to rate the severity of pain over 10, 0 showing no pain, and 10 showing the worst pain score. Validity and validation of the use of NPRS to evaluate chronic pain in the literature with face-to-face and telepresentation methods. Its reliability has been reported | 4 weeks | 
| Deep Neck Flexor Endurance Test | Patients are asked to lie on a flat ground in the form of a hook during the online video conference. They are then asked to move their jaws closer to their chests in the Chin Tuck Position, raise their heads approximately 2.5 cm, and remain in this position. If patients experience any pain and fatigue or put their heads back on the floor, the test is terminated. The physiotherapist keeps track of the patient during this period. Two measurements are made, and the long-lasting result is recorded. The validity and reliability of the evaluation has been demonstrated by the online video videoconferencing method. | 4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neck Disability Index (NDI) | The level of disability associated with the neck pain will be evaluated with the Neck Disability Index. The NDI consists of 10 sections that include pain sensitivity, personal care, weight lifting, reading, headaches, concentration, work/job, driving, sleep, and social activities. Each question has 6 answer options measuring the severity of pain or limitation. Scoring is done between 0 and 5. The highest score is 50, and the minimum score in 0. According to the total score; 0-4 means no limitation, 5-14 means slight limitation, 15-24 moderate limitation, 25-34 severe limitation, 34 and above completely limitation . The Turkish validity and reliability study of the survey was conducted. | 4 weeks | 
| World Health Organization Quality of Life Scale-Short Form (WHOQOL-Bref) | There are two versions of this scale as the long (WHOQOLS-100) and short (WHOQOLS-27) form. The scale measures the bodily, spiritual, social, and environmental well-being of the individual, and consists of 26 questions. The Turkish version consists of 27 questions. The 27th question is the national question determining the Environmental Area Score. The scale can be applied to non-elderly adults . The field scores are calculated between 4 and 20 because each field refers to the quality of life in the relevant field independently from each other. As the score increases, the quality of life increases. The Turkish validity and reliability study of the scale was conducted . | 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Neck pain, telerehabilitation