Chronic neck and shoulder pain- associations between psychological factors and home based exercises in women

neck-stretchChronic neck and shoulder conditions share similar characteristics and consequences as other chronic conditions. The 1 year prevalence of neck pain in the general population is 25%. In complex chronic pain multiple factors such as social, psychological and neurobiological, come into consideration. Psychological factors have been linked to the perception of and adjustment to chronic pain. Psychological factors such as anxiety and depression, poor self-efficacy and catastrophizing are can increase the severity and complexity of a pain condition.

A recent study by Karlsson et al (2016) has looked at the links between maintaining a structured home based exercise program and psychological factors such as fear avoidance behaviour, fear of movement, self-efficacy and catastrophizing in women with neck and shoulder pain.

In systematic reviews, physical exercise has been found to be beneficial in chronic neck pain. To maintain adherence to an exercise program for 12 months in the presence of pain, requires psychological factors to be considered to ensure that a behavioural change is maintained.

The study prescribed a structured exercise program that was carried out 3 x/ week at home. There was ongoing contact with Physiotherapists and the follow ups were carried out at 4-6 months and at 12 months.

The outcomes of the study indicate that there are essential psychological components to consider ensuring ongoing adherence to a home based physical exercise program in neck and shoulder pain.
• High levels of fear of movement and fear avoidance behaviour in the presence of pain was shown to impair the ability to perform physical activities indicating a much lower compliance with treatment and perhaps indicates an exercise intervention that is not home based.
• Participants with low fear avoidance beliefs and low self-efficacy at baseline (BL) were associated more highly with positive effects of exercise than other psychological factors.
• Higher pain acceptance at baseline was also associated with participants who adhered to the program for 12 months.
• Outcomes of the study indicate that low fear avoidance beliefs are associated with decreased shoulder pain at 4-6 months and disability with exercise.
• Pain self-efficacy levels that are high at BL have been associated with increased benefits of maintaining a home based exercise program with positive relationships of reduced pain and disability at end of study.

In considering the prevalence of chronic neck and shoulder pain in society at 1 year mark, the study indicates that pain self-efficacy and fear avoidance behaviours need to be taken into consideration when prescribing home based exercise to ensure long term adherence with outcomes of reduced pain and disability.

 

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Ref :Karlsson Linn,Gerdle Bjorn,Takala Esa-Pekka, Andersson Gerhard, and Larsson Britt .Associations between psychological factors and the effect of home based physical exercise in women with chronic neck and shoulder pain Sage Open Medicine Vol4;1-12. 2016
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The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of SIRA or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.

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