Neck pain is incredibly common. Anecdotally speaking, it often seems to be a close second to low back pain among patients seen in rehabilitation clinics. A recent study in the Archives of Physical Medicine & Rehabilitation tested whether a mobile app could provide an effective, non-pharmacologic option for neck pain management (1).
We’ve recently seen a number of rehabilitation apps for patients with musculoskeletal pain, particularly postoperative patients. This study from South Korea explored the feasibility of a simple app intervention for improving neck pain. Thirty young office workers (24-35) were recruited, later narrowed to twenty-three workers. They were all given a smartphone app, not named in the study, but the health app was reportedly designed by clinicians, a physical therapist, and a “marketing consultant.” There unfortunately aren’t many other clues in the study about exactly what app was utilized, although it did offer the following features: classification of neck pain and a corresponding neck exercise program for each pain type.Prior to starting the study, their baseline pain scores (VAS), neck disability index, cervical range of motion and several other outcome measures were evaluated. Motion capture data through a special camera setup was also used to also measure cervical movements prior to and after the interventions.
Patients were then self-categorized through the app into 4 different neck pain groups: Mobility, Centralization, Exercise and Conditioning, and Reduce Headache, using a unique app algorithm. This classification system has reportedly been utilized in the past for therapists to classify neck pain types (2). The most common neck pain type in the study was Centralization (pain with radicular symptoms out of the neck). Following classification, they were instructed through the app to perform roughly 10 mins of app-guided neck exercises 3 days a week for 8 weeks. Exercises included 10 different routines, 5 for the specific neck pain type, and 5 for general strengthening. Verification that patient’s actually did the exercises was self-reported through the app during each session.
At the end of the study, visual analog pain scores improved on average by 29mm (clinically significant) as well as 8.45% improvement in neck disability index scores. Quality of life measurements also improved. Cervical range of motion did reportedly improve, but not to a clinically significant degree.
The authors theorized that the lack of improvement in cervical range of motion may be due to either (1) few patients enrolled in the “mobility” wing of the study or (2) a limited focus on stretch exercises in preferences for strengthening exercises.
Weakness noted by the authors, which I would agree with, include the small sample size, lack of a control group, and lack of long-term efficacy data. Aside from the sample size, these all may be relatively straight-forward to include on a future study, and would certainly help improve the data on the use of such a health app. With the growing focus on non-pharmacologic options for managing all kinds of pain, this study does dangle an intriguing option for therapy. Hopefully, it will be followed by larger, well designed study to further refine the app and prove it works.