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Effectiveness of a "spring pillow" versus education in chronic nonspecific neck pain: a randomized, controlled trial
Vanti C, Banchelli F, Marino C, Puccetti A, Guccione AA, Pillastrini P
Physical Therapy 2019 Sep;99(9):1177-1188
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Different types of pillows have been proposed for neck pain, but no previous randomized controlled trial (RCT) has investigated the effectiveness of a "spring pillow" for adults with chronic nonspecific neck pain (CNP). OBJECTIVE: We evaluated the effectiveness of using a pillow made from viscoelastic polyurethane and 60 independent springs compared to an educational intervention in patients with CNP. DESIGN: This was an RCT with crossover study design. SETTING: The setting was Occupational Medicine Unit, University Hospital, Bologna (Italy). PARTICIPANTS: We recruited 70 adults with CNP, of whom 64 patients completed the trial. INTERVENTION: Subjects were randomly assigned to 2 groups. 1 group used the spring pillow for 4 weeks, while the other group followed educational advice for 4 weeks while continuing to use their own pillows. After 4 weeks of treatment and 4 weeks of washout, groups were crossed over. Pain perceived in the neck, thoracic, and shoulder areas, and headache were the primary outcome measures. In addition, disability, sleep quality, subjective improvement, and pillow comfort were assessed. Measures were captured at pretreatment (T0), after 4 weeks (T1), after the 4-week washout period (T2), and 4 weeks after crossover (T3). The mean differences (MD) in outcomes between groups were assessed. RESULTS: Treatment with the spring pillow appeared to reduce neck pain (MD -8.7; 95% CI -14.7 to -2.6), thoracic pain (MD -8.4; 95% CI -15.2 to -1.5), and headache (MD -16.0; 95% CI -23.2 to -8.7). Reductions in shoulder pain were not statistically significant between groups (MD -6.9; 95% CI -14.1 to 0.3). Neither the crossover sequence nor the period (first versus second intervention administration) significantly affected the results. LIMITATIONS: Education may not have been the best comparator for the spring pillow; drugs consumption, actual pillow use, and the implementation of the educational suggestions as prescribed were not controlled. CONCLUSIONS: Use of the spring pillow in this study was more effective than an educational intervention for improving cervical, thoracic, and head pain. Whether a spring pillow is more effective than other ergonomic pillows remains to be tested.

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