Telemedicine for Nonspecific Neck Pain

Neck pain is a very common public health problem worldwide. It is defined as pain perceived between the upper nuchal line and the spinous process of the first thoracic vertebra. This pain can sometimes be reflected to the head, trunk and upper extremities. Nonspecific neck pain refers to neck pain for which no specific cause or underlying disease can be identified. It is generally used to refer to neck pain that cannot be attributed to conditions such as infection, tumor, osteoporosis, fracture, structural deformity, inflammatory disorder or radicular symptoms. Although many interventions have been recommended for neck pain in the American Physical Therapy Association (APTA) clinical practice guideline, the only interventions recommended based on strong evidence are coordination, strengthening, endurance exercises, cervical mobilization/manipulation and patient education. Other interventions are based on weak or moderate evidence. In neck pain syndromes, exercise therapy is primarily recommended for neck pain without signs of major structural pathology. In fact, exercise therapy has surpassed physical therapy modalities compared to the past. While exercise, mobilization, and manipulation treatments for non-specific neck pain have the greatest support in the literature, there is little evidence for the effectiveness of thermal treatments and electrical therapies, with no evidence of more than a temporary benefit.

This study aims to compare the telemedicine method, in which asynchronous exercise videos (tele-exercise) and educational videos containing recommendations (tele-education) are sent to patients' phones, and patients are followed up by physicians via remote video calls (tele-consultation), with the conventional follow-up method, in which patients are given a brochure containing the same exercises and recommendations, and patients are followed up by physicians via face-to-face meetings in the hospital.

Participants will consist of patients diagnosed with non-specific neck pain for at least 3 months. Patients will be randomly assigned to one of two groups: Group A (Telemedicine Group) and Group B (Conventional Follow-up Group). The study content will be explained to the patients on the first day at the hospital and they will be asked to sign a voluntary consent form. Patients in Group A will receive a pre-recorded neck exercise video and an educational video sent to their phones by the physician. These patients will exercise at home three times a day for 3 months. They were told to mark the exercise diary provided to them when they do their exercises for 2 weeks. They will have remote check-ups via video call on the 15th day, 30th day and 3rd month to monitor pain intensity and provide support. Patients in Group B will receive an exercise brochure and an educational brochure provided by the physician in person at the clinic. These patients will also be advised to exercise at home three times a day for 3 months. For 2 weeks period they were told to mark the exercise diary provided to them when they do their exercises. They will have clinical check-ups on the 15th day, 30th day and 3rd month to monitor pain intensity and provide support. The primary outcome measures are pain intensity measured using the Visual Analog Scale (VAS) and neck function assessed using the Neck Disability Index (NDI). Secondary outcome measures are adherence to the exercise program monitored through an exercise diary, patient satisfaction assessed on a Likert scale from 0 to 5, and distance in kilometers and time in hours or minutes (spent on the road to hospital) for Group B.

VAS and NDI will be measured initially for both groups through face-to-face assessments, and total distance and time spent on transportation will be calculated for Group B. In 15th day, VAS will be administered through video interviews (Group A) and face-to-face assessments (Group B). In addition, completed exercise diaries will be collected via WhatsApp (Group A) or clinic visits (Group B). In 30th day, VAS and in 3rd month VAS, NDI and patient satisfaction will be assessed through video interviews (Group A) and face-to-face assessments (Group B).

Participants will be unaware of the procedures used in the other group and the outcome assessor will be blinded to group assignments during the statistical analysis to prevent bias. Adherence will be monitored through exercise diaries and qualitative feedback will be collected through surveys or interviews to understand patient experiences and compliance difficulties. Sample size will be determined based on power analysis.

The primary hypothesis (H1) is that Group A will show greater improvement in pain reduction and neck function than Group B due to the more accurate implementation of video exercises and advice than visual exercises and advice. The secondary hypothesis (H2) is that Group A will show higher adherence and satisfaction due to the ease of video-based exercises and the lack of a hospital visit.

This study will be the first scientific study to compare the telemedicine method with the conventional method. If the telemedicine method shows an effectiveness this method can be widely used in the future, this will provide great convenience for both clinicians and patients, reduce the density in hospital polyclinics and reduce the risk of contamination in healthcare areas. Telemedicine applications that can be performed remotely in diseases that do not involve serious pathology provide significant advantages to both individuals and health insurance systems in terms of time (time spent on the road, waiting time in the hospital, etc.) and financial expenses (transportation and healthcare expenses, etc.). In addition, these methods reduce air pollution by reducing traffic density and gasoline consumption, thus minimizing environmental impacts. The spread of telemedicine applications also stands out as an effective medical option in unexpected quarantine conditions such as pandemics.