Download PDF
physioscience 2015; 11(03): 91-98
DOI: 10.1055/s-0035-1553461
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Effekte physiotherapeutischer Gruppenbehandlung mit Schmerzmanagement und gezielter Aktivierung bei chronischem Nackenschmerz

Effects of Pain-Specific Group Physiotherapy with Pain Management and Selective Mobilisation in Chronic Neck Pain
A. Dieterich
,
D. Seeger
,
M. Pfingsten
,
D. Falla
,
F. Petzke
Further Information

Publication History

05 November 2014

26 February 2015

Publication Date:
21 August 2015 (online)

    Permissions and Reprints

Zusammenfassung

Hintergrund: Chronische Nackenschmerzen sind weitverbreitet. Um diese Gesundheitsbelastung zu reduzieren, werden effektive, ökonomische Behandlungsformen benötigt.

Ziel: Nachweis der Effekte eines schmerzspezifischen Gruppen-Physiotherapieprogramms.

Methode: Retrospektive Datenauswertung. Die Gruppen-Physiotherapie bestand aus 10 60-minütigen Einheiten mit „Graded Activity“ und Edukation über 5 Wochen + 1 Einheit nach 4 Wochen zur Förderung des Selbstmanagements. Beim 1., 10. und 11. Termin wurden der Neck Disability Index (NDI), der Marburger Fragebogen zum habituellen Wohlbefinden (MFHW) und die Schmerzempfindungsskala (SES) erhoben. 59 % der Gruppenteilnehmer nahmen auch das Angebot instrumentierter Kraft- und Beweglichkeitsmessungen wahr. Unterschiede zwischen Termin 1, 10 und 11 wurden mithilfe der Analysis of Variance (ANOVA) für Messwiederholungen analysiert. Messwerte am individuell ersten und letzten Termin wurden mit t-Tests verglichen.

Ergebnisse: Die Daten von 34 Teilnehmern (26 Frauen, 18 Männer) im Alter von 54 (Standardabweichung [SD]: 16) Jahren zeigten eine Verbesserung des NDI um 33 % (P < 0,0001) und des Wohlbefindens um 63 % (P < 0,01). Die affektive Schmerzwahrnehmung verminderte sich um 27 % (P < 0,05), der somatosensorische Schmerz um 16 % (P < 0,05). Die instrumentierten Kraft- und Beweglichkeitsmessungen bei 20 Teilnehmern (15 Frauen, Alter 55 [SD: 19] Jahre) erzielten signifikante Verbesserungen.

Schlussfolgerung: Die vorgestellte Gruppen-Physiotherapie für Patienten mit Nackenschmerz unterschiedlicher Diagnose erwies sich als effektive Intervention.

Abstract

Background: Chronic neck pain is a widespread health problem. Effective, economic interventions are needed to alleviate this health burden.

Objective: Documentation of the effects of a pain-specific physiotherapy group program.

Methods: Retrospective data evaluation; the physiotherapy group consisted of 10 sessions (each 60 min) of graded activity and education over 5 weeks, + 1 session 4 weeks later to enhance self-management. At the 1st, the 10th and the 11th session, patients filled the Neck Disability Index (NDI), the Marburger Fragebogen zum habituellen Wohlbefinden (MFHW) and the Schmerzempfindungsskala (SES). 59 % of the participants took also part in the offered instrumented measurements of neck range of motion and strength. Differences between the 1st, the 10th and the 11th session were analysed using repeated measures ANOVA. Measurement differences between the individually first and last sessions were estimated with t-tests.

Results: Data from 34 participants (26 women) aged 54 (SD 16) years indicated an improvement of the NDI by 33 %, P< 0.0001, and of wellbeing by 63 %, P< 0.01. Affective pain feeling reduced by 27 %, P< 0.05, somatosensory pain feeling by 16 %, P< 0.05. The instrumented motion and strength measurements of 20 participants (15 female, aged 55 (SD 19) indicated significant improvements.

Conclusion: The presented group physiotherapy for neck pain patients with inhomogeneous diagnoses was an effective intervention.

Schlüsselwörter

Nackenschmerz - Physiotherapie

Key words

neck pain - physiotherapy
 

  • Literatur

  • 1 Borisut S, Vongsirinavarat M, Vachalathiti R et al. Effects of strength and endurance training of superficial and deep neck muscles on muscle activities and pain levels of females with chronic neck pain. Journal of Physical Therapy Science 2013; 25: 1157-1162
    CrossrefPubMedGoogle Scholar
  • 2 Boudreau SA, Falla D. Chronic neck pain alters muscle activation patterns to sudden movements. Experimental Brain Research 2014; 232
    PubMedGoogle Scholar
  • 3 Bowering K, Butler DS, Fulton IJ et al. Motor Imagery in People with a History of Back Pain, Current Back Pain, Both, or Neither. Clinical Journal of Pain 2014; 30: 1070-1075
    CrossrefPubMedGoogle Scholar
  • 4 Cagnie B, Derese E, Vandamme L et al. Validity and reliability of ultrasonography for the longus colli in asymptomatic subjects. Manual Therapy 2009; 14: 421-426
    CrossrefPubMedGoogle Scholar
  • 5 Cramer H, Lauche R, Hohmann C et al. Yoga for chronic neck pain: a 12-month follow-up. Pain Medicine 2013; 14: 541-548
    CrossrefPubMedGoogle Scholar
  • 6 Daenen L, Varkey E, Kellmann M et al. Exercise, not to Exercise or how to Exercise in Patients with Chronic Pain? Applying Science to Practice. The Clinical Journal of Pain 2015; 2: 108-114
    PubMedGoogle Scholar
  • 7 De Boer MJ, Steinhagen HE, Versteegen GJ et al. Mindfulness, acceptance and catastrophizing in chronic pain. PLoS one 2014; 9: e87445
    CrossrefPubMedGoogle Scholar
  • 8 Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). DEGAM-Leitlinie Nackenschmerzen. 2009 www.awmf.org/uploads/tx_szleitlinien/053-007l_S3_Nackenschmerzen_2009.pdf (22.02.2015)
    PubMedGoogle Scholar
  • 9 Evans R, Bronfort G, Schulz C et al. Supervised exercise with and without spinal manipulation performs similarly and better than home exercise for chronic neck pain: a randomized controlled trial. Spine 2012; 37: 903-914
    CrossrefPubMedGoogle Scholar
  • 10 Falla D, Rainoldi A, Merletti R et al. Myoelectric manifestations of sternocleidomastoid and anterior scalene muscle fatigue in chronic neck pain patients. Clinical Neurophysiology 2003; 114: 488-495
    CrossrefPubMedGoogle Scholar
  • 11 Falla D, Jull G, Hodges PW. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Experimental Brain Research 2004; 157: 43-48
    CrossrefPubMedGoogle Scholar
  • 12 Falla D, Jull G, Edwards S et al. Neuromuscular efficiency of the sternocleidomastoid and anterior scalene muscles in patients with chronic neck pain. Disability and Rehabilitation 2004; 26: 712-717
    CrossrefPubMedGoogle Scholar
  • 13 Falla D, Jull G, Rainoldi A et al. Neck flexor muscle fatigue is side specific in patients with unilateral neck pain. European Journal of Pain 2004; 8: 71-77
    CrossrefPubMedGoogle Scholar
  • 14 Falla D, Farina D. Muscle fiber conduction velocity of the upper trapezius muscle during dynamic contraction of the upper limb in patients with chronic neck pain. Pain 2005; 116: 138-145
    CrossrefPubMedGoogle Scholar
  • 15 Falla D, Jull G, Hodges P et al. An endurance-strength training regime is effective in reducing myoelectric manifestations of cervical flexor muscle fatigue in females with chronic neck pain. Clinical Neurophysiology 2006; 117: 828-837
    CrossrefPubMedGoogle Scholar
  • 16 Falla D, O’Leary S, Farina D et al. The change in deep cervical flexor activity after training is associated with the degree of pain reduction in patients with chronic neck pain. The Clinical Journal of Pain 2012; 28: 628-634
    CrossrefPubMedGoogle Scholar
  • 17 Falla D, Lindstrøm R, Rechter L et al. Effectiveness of an 8-week exercise programme on pain and specificity of neck muscle activity in patients with chronic neck pain: a randomized controlled study. European Journal of Pain 2013; 17: 1517-1528
    PubMedGoogle Scholar
  • 18 Fejer R, Ohm Kyvik K, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. European Spine Journal 2006; 15: 834-848
    CrossrefPubMedGoogle Scholar
  • 19 Gallagher L, McAuley J, Moseley GL. A randomized-controlled trial of using a book of metaphors to reconceptualize pain and decrease catastrophizing in people with chronic pain. Clinical Journal of Pain 2013; 29: 20-25
    CrossrefPubMedGoogle Scholar
  • 20 Gilpin HR, Moseley GL, Stanton TR et al. Evidence for distorted mental representation of the hand in osteoarthritis. Rheumatology (Oxford) 2015; 54: 678-682
    CrossrefPubMedGoogle Scholar
  • 21 Goode AP, Freburger J, Carey T. Prevalence, practice patterns, and evidence for chronic neck pain. Arthritis Care Research (Hoboken) 2001; 62: 1594-1601
    PubMedGoogle Scholar
  • 22 Guez M. Chronic neck pain. An epidemiological, psychological and SPECT study with emphasis on whiplash-associated disorders. Acta Orthopaedica Supplementum 2006; 77: 3-33
    PubMedGoogle Scholar
  • 23 Hüppe M, Maier C, Gockel H et al. Behandlungserfolg auch bei höherer Schmerzchronifizierung? Eine Auswertung des Mainzer Stadienmodells auf Basis der QUAST-Analysestichprobe. Der Schmerz 2011; 25: 77-88
    CrossrefPubMedGoogle Scholar
  • 24 Hurwitz EL, Carragee EJ, van der Velde G et al. Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 2008; 4S: S123-S152
    PubMedGoogle Scholar
  • 25 Hüter-Becker A. Bewegungsentwicklung und Bewegungskontrolle. Stuttgart: Thieme; 2005
    Google Scholar
  • 26 Javanshir K, Amiri M, Mohseni-Bandpei MA et al. Ultrasonography of the Cervical Muscles: A Critical Review of the Literature. Journal of Manipulative and Physiological Therapeutics 2010; 33: 630-637
    CrossrefPubMedGoogle Scholar
  • 27 Javanshir K, Mohseni-Bandpei MA, Rezasoltani A et al. Ultrasonography of longus colli muscle: A reliability study on healthy subjects and patients with chronic neck pain. Journal of Bodywork and Movement Therapies 2011; 15: 50-56
    CrossrefPubMedGoogle Scholar
  • 28 Kay TM, Gross A, Goldsmith CH et al. Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews 2012; CD004250
    PubMedGoogle Scholar
  • 29 Kristjansson E. Reliability of ultrasonography for the cervical multifidus muscle in asymptomatic and symptomatic subjects. Manual Therapy 2004; 9: 83-88
    CrossrefPubMedGoogle Scholar
  • 30 Larsson B, Björk J, Elert J et al. Fibre type proportion and fibre size in trapezius muscle biopsies from cleaners with and without myalgia and its correlation with ragged red fibres, cytochrome-c-oxidase-negative fibres, biomechanical output, perception of fatigue, and surface electromyography during repetitive forward flexions. European Journal of Applied Physiology 2001; 84: 492-502
    CrossrefPubMedGoogle Scholar
  • 31 Linton SJ, Ryberg M. Do epidemiological results replicate? The prevalence and health-economic consequences of neck and back pain in the general population. European Journal of Pain 2000; 4: 347-354
    CrossrefPubMedGoogle Scholar
  • 32 Mann K. Effektivität eines multimodalen, aktivierenden Gruppen-Konzeptes zur Behandlung chronischer Halswirbelsäulenbeschwerden: eine kontrollierte, prospektive, randomisierte Studie [Dissertation]. Göttingen: Universität Göttingen; 2007
    Google Scholar
  • 33 Merskey H, Bogduk N (eds) Classification of chronic pain – Descriptions of chronic pain syndromes and definitions of pain terms. Seattle: IASP Press; 2002
    Google Scholar
  • 34 Nielsen PK, Andersen LL, Olsen HB et al. Effect of physical training on pain sensitivity and trapezius muscle morphology. Muscle & Nerve 2010; 41
    PubMedGoogle Scholar
  • 35 O’Riordan C, Clifford A, Van De Ven P et al. Chronic neck pain and exercise interventions: frequency, intensity, time, and type principle. Archives of Physical Medicine and Rehabilitation 2014; 95: 770-783
    CrossrefPubMedGoogle Scholar
  • 36 Salo P, Ylönen-Käyrä N, Häkkinen A et al. Effects of long-term home-based exercise on health-related quality of life in patients with chronic neck pain: a randomized study with a 1-year follow-up. Disability and Rehabilitation 2012; 34: 1971-1977
    CrossrefPubMedGoogle Scholar
  • 37 Scholich SL, Hallner D, Wittenberg RH et al. Schmerzverarbeitungspattern bei chronischen Rückenschmerzen Pilotstudie. Der Schmerz 2011; 25: 184-190
    CrossrefPubMedGoogle Scholar
  • 38 Wand BM, Keeves J, Bourgoin C et al. Mislocalization of sensory information in people with chronic low back pain: a preliminary investigation. Clinical Journal of Pain 2013; 29: 737-743
    CrossrefPubMedGoogle Scholar
  • 39 Zeybeker B. Effektivität kognitiver und verhaltenstherapeutischer Aspekte bei der physiotherapeutischen Behandlung chronischer/chronifizierender Schmerzen. Manuelletherapie 2010; 14: 203-211
    Article in Thieme ConnectPubMedGoogle Scholar