The Effectiveness and Cost-effectiveness of Doin (Conduction Exercise) for Chronic Neck Pain

Jaseng Medical Foundation124 enrolled

Overview

A multi-center randomized controlled trial assessing the comparative effectiveness and cost-effectiveness of Doin (conduction exercise) with acupuncture for chronic neck pain

A multi-center randomized controlled, parallel, assessor-blinded full-scale trial will be conducted based on the results of the pilot study to evaluate the comparative clinical effectiveness and cost-effectiveness of Doin (conduction exercise) with acupuncture for chronic neck pain patients compared to acupuncture alone as assessed using pain, functional disability, health-related quality of life, economic evaluation, and safety measures.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

124

Conditions

Chronic Neck Pain

Interventions

Doin with acupuncturePROCEDURE

Doin (conduction exercise) will be performed with the needles in situ by increasing the cervical range of motion (rotation) with physician guidance and isometric resistance exercise as indicated. Doin sessions will be conducted 2 times a week for 5 weeks (total 10 sessions).

AcupunctureDEVICE

Acupuncture will be performed with manual stimulation (needle twirling) to evoke de-qi sensation. Acupuncture sessions will be conducted 2 times a week for 5 weeks (total 10 sessions).

Eligibility

Sex: ALLMin age: 19 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Neck area pain duration of 6 months or longer * Current Numeric Rating Scale (NRS) for neck area pain of 5 or higher * Patients who have agreed to voluntarily participate in the clinical trial and given written informed consent Exclusion Criteria: * Patients diagnosed with serious pathology(s) which may cause neck pain (e.g. malignant tumor, spinal infection, inflammatory spondylitis) * Progressive neurologic deficit or severe neurologic symptoms (e.g. cauda equina syndrome, progressive muscle weakness) * Pathologies of non-spinal or soft tissue origin or high severity which may cause neck or radiating arm pain (e.g. malignant tumor, spinal infection, inflammatory spondylitis, fibromyalgia, rheumatic arthritis, gout) * Other chronic diseases which may interfere with treatment effect or interpretation of results (e.g. cardiovascular disorder, renal disease, diabetic neuropathy, dementia, epilepsy) * Current intake of steroids, immunosuppressant medicine, psychiatric medicine or other medication which may interfere with treatment results * Patients considered unsuitable or unsafe to receive acupuncture (e.g. patients with hemorrhagic diseases, blood clotting disorders, history of anti-coagulation medicine intake, severe diabetes with high risk of infection, severe cardiovascular diseases) * Patients who were treated with invasive interventions such as acupuncture or injections, or with medicine that may potentially influence pain such as NSAIDs (nonsteroidal antiinflammatory drugs) within the past week * History of cervical surgery within the past 3 months * Pregnancy or plans of pregnancy * Severe psychopathy * Participation in other clinical studies * Inability to give written informed consent * Other reasons rendering trial participation inappropriate as judged by the researchers

Locations (5)

Bucheon Jaseng Hospital of Korean Medicine

Bucheon-si, Gyeonggi-do, South Korea

Haeundae Jaseng Hospital of Korean Medicine

Busan, South Korea

Daejeon Jaseng Hospital of Korean Medicine

Daejeon, South Korea

Jaseng Hospital of Korean Medicine

Seoul, South Korea

Outcomes

Primary Outcomes

Difference between visual analogue scale (VAS) of neck pain for the past 3 days at 5 weeks post-baseline and baseline

VAS uses a 10cm line labeled at each end with scale anchors. In pain measurement using VAS, patients are asked to mark a point that represents their pain between the anchors of 'no pain' and 'worst pain possible' (labels may vary by study). Scores are recorded in millimeters with a total range of 0-100 millimeters.

Time frame: Week 5 post-baseline (screening)

Secondary Outcomes

Difference between visual analogue scale (VAS) of radiating arm pain for the past 3 days at each timepoint and baseline, respectively

Time frame: Week 1, 2, 3, 4, 5, 6 post-baseline (screening)

Difference between numeric rating scale (NRS) of neck pain for the past 3 days at each timepoint and baseline, respectively

In pain measurement using NRS, patients are asked to rate their pain by selecting a number from 0 to 10 that best represents their pain severity between the anchors of 0 which indicates 'no pain', and 10 which indicates 'worst pain possible'.

Time frame: Week 1, 2, 3, 4, 5, 6, Month 3, 6, 9, 12 post-baseline (screening)

Difference between numeric rating scale (NRS) of radiating arm pain for the past 3 days at each timepoint and baseline, respectively

Time frame: Week 1, 2, 3, 4, 5, 6, Month 3, 6, 9, 12 post-baseline (screening)

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.

Kyung Hee University Oriental Medicine Hospital at Gangdong

Seoul, South Korea

Difference between Neck Disability Index (NDI) at each timepoint and baseline, respectively

The NDI evaluates functional impairment and is a 10-item questionnaire developed to assess the level of disability due to neck pain. Each item is graded into 6 levels, each representing a score of 0-5. Higher scores indicate greater limitation relating to neck pain.

Time frame: Week 1, 6, Month 3, 6, 9, 12 post-baseline (screening)

Difference between Northwick Park Neck Pain Questionnaire (NPQ) at each timepoint and baseline, respectively

The NPQ evaluates functional impairment for the past 3 days in this study and is a patient reported outcome of subjective neck pain and pain reduction. The NPQ is a 9-item questionnaire developed to assess the level of disability due to neck pain. Each item is graded into 5 levels, each representing a score of 0-4. Higher scores indicate greater limitation relating to neck pain.

Time frame: Week 1, 6, Month 3, 6, 9, 12 post-baseline (screening)

Patient Global Impression of Change (PGIC)

PGIC grades the level of subjective improvement into 7 levels (1, very much improved; 2, much improved; 3, slightly improved; 4, no change; 5, slightly worse; 6, much worse; and 7, very much worse).

Time frame: Week 6, Month 3, 6, 9, 12 post-baseline (screening)

Physical examination

Pain upon movement in cervical range of motion (ROM) will be assessed.

Time frame: Week 1, 6 post-baseline (screening)

Difference between the 5 level version of EuroQol-5 Dimension (EQ-5D-5L) at each timepoint and baseline, respectively

EQ-5D is a tool developed for health-related quality of life (HRQoL) assessment, and is widely used in the health care sector. Scores range from -1, 'health worse than death' to 1, 'perfect health'. EQ-5D-5L has 5 dimensions covering current health status and functionality: mobility (M), self care (SC), usual activities (UA), pain/discomfort (PD), and anxiety/depression (AD), to be rated out of 5 grades (1, no problem; 2, slight problem; 3, some/moderate problem; 4, severe problem; 5, extreme problem).

Time frame: Week 1, 6, Month 3, 6, 9, 12 post-baseline (screening)

Difference between the EuroQol Visual Analogue Scale (EQ-VAS) at each timepoint and baseline, respectively

EQ-VAS uses a vertical 10cm line labeled at each end with scale anchors. EQ-VAS is used to indicate the patient's health state and patients are asked to mark a point that represents their health state between the anchors of 'worst health state' and 'best health state imaginable'. Scores are recorded in millimeters with a total range of 0-100 millimeters.

Time frame: Week 1, 6, Month 3, 6, 9, 12 post-baseline (screening)

Difference between the Short Form Health Survey 12 (SF-12) at each timepoint and baseline, respectively

SF-12 is a simplified version of SF-36. SF-12 assesses health-related quality of life (HRQoL) across 8 domains with 1-2 items per domain: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Higher scores indicate better HRQoL.

Time frame: Week 1, 6, Month 3, 6, 9, 12 post-baseline (screening)

Economic evaluation (medical costs)

Economic evaluation of medical costs will be performed to assess cost-effectiveness of the 2 groups.

Time frame: Week 1, 6, Month 3, 6, 9, 12 post-baseline (screening)

Economic evaluation (time-related costs)

Economic evaluation of time-related costs will be performed to assess cost-effectiveness of the 2 groups.

Time frame: Week 2 post-baseline (screening)

Economic evaluation (lost productivity costs)

Economic evaluation of lost productivity costs will be performed to assess cost-effectiveness of the 2 groups.

Time frame: Week 1, 2, 3, 4, 5, 6, Month 3, 6, 9, 12 post-baseline (screening)

Credibility and Expectancy Questionnaire

The credibility and expectancy questionnaire will be used to assess treatment expectation on a 9-point Likert scale. Participants will be asked to select an answer to the following questions on their first visit of Week 1 (1='not at all'; and 5='somewhat'; to 9='very much'): "How much do you expect that treatment will alleviate your symptoms during the study period?"

Time frame: Week 1 post-baseline (screening)

Drug Consumption (drug type)

The drug type of prescription intake for medicine or rescue medicine (acetaminophen) will be recorded.

Time frame: Week 1, 2, 3, 4, 5, 6, Month 3, 6, 9, 12 post-baseline (screening)

Drug Consumption (drug dose)

The drug dose of prescription intake for medicine or rescue medicine (acetaminophen) will be recorded.

Time frame: Week 1, 2, 3, 4, 5, 6, Month 3, 6, 9, 12 post-baseline (screening)

Other treatments (treatment type)

The type of other treatments received (e.g. physical therapy, injections) will be recorded.

Time frame: Week 1, 2, 3, 4, 5, 6, Month 3, 6, 9, 12 post-baseline (screening)

Other treatments (treatment frequency)

The frequency of other treatments received (e.g. physical therapy, injections) will be recorded.

Time frame: Week 1, 2, 3, 4, 5, 6, Month 3, 6, 9, 12 post-baseline (screening)

Adverse events

Physicians will monitor and record any unexpected or unintended patient reaction to Chuna or usual care at each visit. Adverse events (AEs) associated with Chuna will include, but not be limited to, AEs anticipated from previous reports of manual therapy, and will stay open to all possibilities taking into consideration other potential, unknown AEs.

Time frame: Week 1, 2, 3, 4, 5, 6, Month 3, 6, 9, 12 post-baseline (screening) (every visit)