Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jun 23, 2021
Date Accepted: Nov 12, 2021
App-based relaxation exercises for patients with chronic neck pain – null results of a pragmatic randomized trial
ABSTRACT
Background:
Chronic neck pain is a highly prevalent condition. Learning a relaxation technique is recommended by numerous guidelines for chronic neck pain. Smartphone apps can provide relaxation exercises but their effectiveness, especially in a selfcare setting, is unclear.
Objective:
The aim of this pragmatic randomized trial was to evaluate whether app-based relaxation exercises including audio-based autogenic training, mindfulness meditation, or guided imagery were more effective in reducing chronic neck pain than usual care alone.
Methods:
Smartphone owners aged 18 to 65 years, having chronic (>12 weeks) neck pain and the previous week’s average neck pain intensity ≥ 4 on the numeric rating scale (NRS, 0 = no pain, 10 = worst possible pain) were randomized into either an intervention group to practice app-based relaxation exercises or a control group (usual care plus app for data entry only). For both groups, the follow-up data were collected through the app-based diaries and questionnaires. The primary outcome was the mean neck pain intensity during the first 3 months based on daily measurements. Secondary outcomes included neck pain based on weekly measurements, pain acceptance, neck pain related stress, sick leave days, pain medication intake and adherence all measured until 6-month follow-up. For primary analysis, an ANCOVA adjusted for baseline neck pain intensity was used.
Results:
We screened 748 participants and enrolled 220 participants (mean 38.9 (SD 11.3) years, baseline neck pain 5.7 (SD 1.3) points). Mean neck pain intensity of both groups decreased over 3 months, however, no statistically significant difference between groups were found (intervention: 4.1 [95%CI 3.8;4.4]; control: 3.8 [3.5;4.1], group difference: 0.3 [-0.2;0.7]; p=0.231). In addition, no statistically significant differences between groups regarding the neck pain intensity after 6 months, responder rate, pain acceptance, pain medication intake and sick leave days were observed. There were no serious adverse events considered related to the trial intervention. In week 12, only 40% of the participants in the intervention group (n=44) still practiced the exercises with the app.
Conclusions:
The study app did not effectively reduce chronic neck pain and keep participants engaged in exercising in a self-care setting. Future studies on app-based relaxation interventions should take into account the most recent scientific findings for behavior change techniques. Clinical Trial: ClinicalTrials.gov NCT02019134
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