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. 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 2 weeks. They will mark the exercise diary provided to them when they do
their exercises. They will have remote check-ups via video call every two weeks (on the
15th and 30th days) 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 exercise at home three times a day for
2 weeks. They will mark the exercise diary provided to them when they do their exercises.
They will have clinical check-ups every two weeks (on the 15th and 30th days) 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 total money spent on follow-up visits (transportation expenses, healthcare
expenses) and time (time spent on the road, hospital waiting time) for Group B.
VAS and NDI will be measured initially for both groups through face-to-face assessments.
In 15th day, VAS and NDI 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), and total money and time
spent on transportation will be calculated for Group B. In day 30, 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 demonstrates an equivalent or superior
efficacy to the conventional method, If the telemedicine method shows an effectiveness
equal to or superior to the conventional method and this method is 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.