¹Physical Therapy Department, East Jeddah Hospital ,Jeddah, Saudi Arabia.

²Physical Therapy Department, College of Applied Medical Sciences, Umm  Al-Qura University, Makkah, Saudi Arabia.

³Physical Therapy Department, Comprehensive Rehabilitation Center, Jeddah, Saudi Arabia.

⁴Physical Medicine and Rehabilitation Department, Dr Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.

⁵Physical Therapy Specialist. Makkah.

Corresponding Author  email: Aam_fallatah@hotmail.com

Article Publishing History

INTRODUCTION

Musculoskeletal disorders are considered as life threatening and more over having the potential to restrict daily activities, cause absence from work, and result in a change or discontinuation in employment .Neck pain is one of major problems  that are affecting people in  several parts of their life and a lot of studies  have  recommended that  the neck pain is  most popular in the  middle age with  marked variations in its  prevalence. The pain begins from cervical region and can rise to be of  more complex nature; and  may impact seriously the  psycho-social lifestyles of patients, causeing  economic problems on health organizations. Mechanical neck pain is most common kind of neck pain disorder ^.The prevalence of neck pain is one the major challenging issues, because it directly affects the quality of life. There are more factors related to neck pain, including muscle strains, nerve compression, stiffness leading to traumatic  injuries ( Bulk et al 2018,Suvarnnato.2019 Dias et al 2021).

The neck pain usually  does not subside within days but  can persist for months  and be a signal of an underlying medical cause that needs to be  urgently treated. Patient-centered design that addresses patients’ preferences and needs is considered important aim for improving health care systems. In  the current study,  we have found that the field of pain rehabilitation including  patients’ preferences regarding tele rehabilitation remains  unexplored and little is known about the optimal combination between human and electronic contact from the patients’ perspective. The assessment of patients’ preferences important regarding telemedicine because it is the step toward the design of effective patient-centered care, (Bulk et al.2018 Fiani et al 2020). The importance of tele-rehabilitation  is focused  to circumvent physical barriers ,transportation concerns and financial limitations, concurrently, improving the quality of  the health care environment, and giving more attention to reduce the number of  such cases. Studies  have shown that tele rehabilitation should be   developed and implemented with  well planned strategies particularly pointed towards  ensuring an adequate level of rehabilitation, (Dias.2021).

MATERIAL AND METHODS

A quasi-experimental study approach was used including 4 patients with neck pain at western region orthopedic clinics in Saudi Arabia during the period of 2021 January to May. The subjects were assigned in to one group pre-test-post-test design and the study intends to assess the effect of Tele rehabilitation exercise program on pain and functional ability of patients with neck pain. The sample size was calculated with using an online sample size calculator (American Association for Public Opinion Research.2015). A purposive sampling technique used to collect the data including patient’s demographic data such as age, gender, educational level and moreover the data were collected by the researchers personally for a period of three months to recruit as many eligible patients as possible.

The patients who met the inclusion criteria were approached with explaining the study purpose and assurance to protect their information and received signature on a consent form. The numerical pain scale score and neck index used in the assessment sheet of patient to assess the neck pain and the  quality of patient life via Tele rehabilitation or zoom videos conferences to conduct the tele-sessions with using personal computers. The exclusion criteria for sample selection included history of cervical and thoracic spine fracture and dislocation, surgery of the cervical and thoracic spine, spinal infections and the intake of analgesic medication to reduced pain. (Morphine, Paracatamol). Pre-test and post-test analysis were conducted personally by the researchers and placed into large envelopes for confidentiality. Each session took around 30 minutes for completion.

The data were collected through the use of ZOOM video conference (Zoom Video Communications. 2019) to evaluate by assessment sheet treat the patients, neck disability index to measure the functional ability for Neck. Numerical Pain Scale to measure pain intensity (Schofield.2018) and more over Personal computer used to keep all data. The Tele-rehabilitation exercises program session was 2 per week. The participants were instructed to repeat the same exercises program daily at home. The exercises program started with active range of motion exercises, flexed and extended their neck slowly without holding at the end ranges.

Participants rotated their neck slowly to right and left without holding at the end ranges, bending   their neck in bilateral side without holding at the end ranges. The repetition was 10 times in 3 sets, in each direction, with adequate  rest between of about  30 seconds  in each set, followed by stretching exercises, which  they  performed  by  stretching  toward lateral flexion and general  through stretching exercises for extensor neck muscles. The exercises were performed for 30 seconds /10 times  with a 30 second rest between each set, thus finishing 10 isometric strengthening exercises: The strengthening exercises were performed as isometric neck strength exercises with holding  for 10 seconds /10times in each direction sets, (Ylinen.2007).

RESULTS AND DISCUSSION

The statistical values provided an explanation of the relationship between demographic characteristics of the patient and factors that influence neck pain as well as the quality of tele rehabilitation. All statistical analysis  were conducted using IBM SPSS Statistics version 21.Data, which  was presented as descriptive analysis, frequencies, percentages and mean ±standard deviation. The results of the study are presented in this section .showing the  descriptive analysis of socio demographic details where a paired t-test was used to analyze the difference between the mean of groups. It is expected that the results of this study will add to the existing database of body knowledge regarding tele-rehabilitation in KSA.

Figure 1: Distribution of patients based on age group

Figure 2: Distribution of patients based on profession.

Figure 3: Distribution of patients numerical pain score based on pre and post-test

Figure 4: Distribution of patients neck disability index score based on pre and posttest

Table 1.The T value calculated for both pain scale score as well as neck index where the critical valueless than p-value which identifies no significant both variables.

Variable	Mean pre test	Mean posttest	P-value	T-value	Inference
Numerical Pain score	4.5	3	0.48345	2.044	Not Significant
Neck disability index	6.75	5	0.2158	1.225	Not Significant

The pre-numerical pain scale score (N=4) was associated with M=4.5(SD=2.03) by comparison of post-test (N=4) was associated with M=3(SD=2.03).to the t-test hypothesis that the pain score. The pre- neck disability index score (N=4) was associated with M=6.75(SD=4) by comparison of post-test (N=4) was associated with M=5(SD=4).

Tele rehabilitation has become  more expanded and moreover the people are trying to understand the benefits of the same rapidly. The fast development of telecommunication technologies require continuous study in order to establish the efficacy of technologies. Data of the present work show that the neck exercises are one of important treatment modalities in treat neck pain and play  prime role in reducing pain and improving the functional ability in neck patients. It strengthens the weak muscles and improves neck posture as well. Suvarnnato, et al  (2019) have also shown that  excurses are highly beneficial and have effect on  specific deep cervical muscles decreasing the   functional disability  and  pain intensity  in a randomized controlled trial.

The overall aim of the  present study was to measure the effectiveness of tele rehabilitation exercise program on pain and functional ability in patient neck pain. The socio demographic data revealed that all patients responded were males and the age between 25 to35 years. Also the current study showed there was an improvement in the statistical difference at p<0.1 between pre and post- test in both numerical pain score and neck disability index. From the Findings of the study includes, 4 patients were participated and three among the patients showed improvement were as one among them pain score and neck index became 0 after post- test and one patient increased pain and neck index score after the session.

The result of the present study showed more significance among the score of both pre and post -test in numerical pain score as well as neck disability index .The use of tele-rehabilitation was associated with minimizing the time, expense and inconvenience of receiving rehabilitative care These results indicate the tele rehabilitation  can be a promising potential alternative standard of care although some factors like unavailability of internet and materials always negatively affect the therapy. The exercises program is important to treat patients with neck pain and furthermore the treatment sessions should focus on specific cervical muscles.

The study was limited to the patients who  came to participate in this study additionally the small sample size was  another challenge because of COVID 19 crisis and more over the study could only choose the patients with neck pain, although we did not observe for other diagnosis. Furthermore the study  was conducted among male patients only and during  the sample collection the patients were willing to participate only for  the part of study  due to covid-19 pandemic, the number of patients of this study was quite  low.

CONCLUSION

In this part the conclusion of the present study in addition their recommendation for further study of practice, education, and research implication was discussed. The result of the present study showed more significance among the score of both pre and post -test in numerical pain score as well as neck disability index .The use of tele-rehabilitation was associated with minimizing the time, expense and inconvenience of receiving rehabilitative care These results indicate the tele rehabilitation  can be a promising potential alternative standard of care although some factors like unavailability of internet and materials always negatively affect the therapy. The exercises program is important to treat patients with neck pain and furthermore the treatment sessions should focus on specific cervical muscles.

ACKNOWLEDGEMENTS

We would like to thank the experts involved in the facilitation of data collection for this research project from Western region orthopedic clinics in Saudi Arabia. Without the patient’s passionate participation and input, it could not have been successfully conducted.

Ethical Statement: Registration No. in National committee of Bio Ethics: HAPO-02-K-012 Date: 22/2/2021 University: Umm Al-Qura University, Saudi Arabia.

Conflict of Interest: Authors declares no conflicts of interests to disclose.

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