Changes in Multiple Aspects of Pain Outcomes After Rehabilitation

Abstract

Objectives: To examine changes in pain outcomes to fully evaluate the effect of adding sensorimotor training to manual therapy and exercise in patients with chronic neck pain and sensorimotor deficits. Concordance was examined between pain distribution and pain intensity and patient-reported outcomes. Methods: Participants (n=152) were randomly allocated into four intervention groups: One group received local neck treatment (NT) comprising manual therapy and exercise and the other three groups received additional sensorimotor training (either joint position sense/oculomotor exercises, balance exercises or both). Treatment was delivered twice a week for six weeks. Pain and patient-reported outcomes were measured at baseline, post-treatment and 3-, 6- and 12-month follow-ups. Results: There were greater changes in pain location, extent and intensity at 6- and 12-month follow-ups in the sensorimotor training groups compared to the NT group (P<0.05). A greater number of patients in the sensorimotor training groups gained ≥ 50% reduction in pain extent and intensity relative to the NT group at 6- and 12-months (P<0.05). Clinical improvement in pain extent was concordant with pain intensity (adjusted kappa=056-0.66, %agreement=78.3-82.9, P<0.001) and disability (adjusted kappa=0.47-0.58, %agreement=73.7-79.0, P<0.01) at 3-, 6- and 12-month follow-ups, but not with function and well-being. The concordance tended to decline with time. Discussion: Multiple aspects of the pain experience improved in the longer term by adding sensorimotor training to NT for patients with neck pain and sensorimotor deficits. The concordance between pain and patient-reported outcomes was not always evident and varied over time, suggesting the need for multidimensional assessments of pain.