Telemedicine versus conventional care for nonspecific neck pain: a randomized controlled study

TL;DR

A telemedicine program for neck pain is as effective as in-person care in reducing pain and disability, with added benefits of reduced travel.

Contribution

A structured telemedicine model with physiatrist follow-up is shown to be non-inferior to conventional care for nonspecific neck pain.

Findings

Both telemedicine and conventional groups showed similar reductions in pain and disability over three months.

Telemedicine participants saved significant travel distance and time compared to in-clinic visits.

Patient adherence and satisfaction were comparable between the two groups.

Abstract

Telemedicine (TM) can overcome travel barriers in nonspecific neck pain (NNP), yet a comprehensive, physiatrist-supervised TM model has not been directly compared to standard in-clinic care. The aim of this study was to determine whether a video-based exercise and remote follow-up program is as effective as conventional follow-up in reducing pain and disability in NNP.

This parallel-group randomized controlled trial (registered in ClinicalTrials.gov) included 68 adults (mean age = 40.52 years) with NNP who were randomly allocated 1:1 to the TM group (TG, n = 34) or control group (CG, n = 34). Both received identical exercises via prerecorded video (TG) or printed brochure (CG) to be performed for 3 months. TG visits were via video call; CG visits were in the clinic. Primary outcomes were pain measured by the visual analog scale (VAS) at baseline, day 15, month 1, and 3, and disability measured by the neck disability index (NDI) at baseline and month 3. Secondary outcomes were exercise adherence, patient satisfaction, and travel/time burden. Analyses followed the intention-to-treat principle using linear mixed models.

Both groups achieved clinically important VAS reductions (TG: 6.56 to 3.02, CG: 6.44 to 2.96). The only between-group difference appeared at day 15, favoring CG (p = 0.038) and the group × time interaction was nonsignificant overall (p = 0.111). NDI improved similarly in both groups (p = 0.473). Adherence in TG and CG (67.90% and 71.21%, respectively) and satisfaction (4.25 and 4.42, respectively) were comparable. TG participants avoided a mean of 38.88 km/175.74 min of travel across 3 virtual visits.

A structured TM program with remote physiatrist follow-up matches conventional outpatient care in managing NNP. Larger, long-term studies should define optimal support and assess cost effectiveness across diverse populations.

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