@Article{info:doi/10.2196/31482,
author="Pach, Daniel
and Bl{\"o}dt, Susanne
and Wang, Jiani
and Keller, Theresa
and Bergmann, Beatrice
and Rogge, Aliz{\'e} A
and Barth, J{\"u}rgen
and Icke, Katja
and Roll, Stephanie
and Witt, Claudia M",
title="App-Based Relaxation Exercises for Patients With Chronic Neck Pain: Pragmatic Randomized Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="7",
volume="10",
number="1",
pages="e31482",
keywords="neck pain; relaxation; RCT; mHealth; smartphone app; mobile phone",
abstract="Background: Chronic neck pain is a highly prevalent condition. Learning a relaxation technique is recommended by numerous guidelines for chronic neck pain. Smartphone apps can provide relaxation exercises; however, their effectiveness, especially in a self-care setting, is unclear. Objective: The aim of this pragmatic randomized trial is to evaluate whether app-based relaxation exercises, including audio-based autogenic training, mindfulness meditation, or guided imagery, are more effective in reducing chronic neck pain than usual care alone. Methods: Smartphone owners aged 18 to 65 years with chronic (>12 weeks) neck pain and the previous week's average neck pain intensity ≥4 on the Numeric Rating Scale (0=no pain to 10=worst possible pain) were randomized into either an intervention group to practice app-based relaxation exercises or a control group (usual care and app for data entry only). For both groups, the follow-up data were collected using app-based diaries and questionnaires. The primary outcome was the mean neck pain intensity during the first 3 months based on daily measurements. Secondary outcomes included neck pain based on weekly measurements, pain acceptance, neck pain--related stress, sick-leave days, pain medication intake, and adherence, which were all measured until the 6-month follow-up. For the primary analysis, analysis of covariance adjusted for baseline neck pain intensity was used. Results: We screened 748 participants and enrolled 220 participants (mean age 38.9, SD 11.3 years; mean baseline neck pain 5.7, SD 1.3 points). The mean neck pain intensity in both groups decreased over 3 months; however, no statistically significant difference between the groups was found (intervention: 4.1 points, 95{\%} CI 3.8-4.4; control: 3.8 points, 95{\%} CI 3.5-4.1; group difference: 0.3 points, 95{\%} CI −0.2 to 0.7; P=.23). In addition, no statistically significant between-group differences regarding neck pain intensity after 6 months, responder rate, pain acceptance, pain medication intake, or sick-leave days were observed. There were no serious adverse events that were considered related to the trial intervention. In week 12, only 40{\%} (44/110) of the participants in the intervention group continued to practice the exercises with the app. Conclusions: The study app did not effectively reduce chronic neck pain or keep the participants engaged in exercising in a self-care setting. Future studies on app-based relaxation interventions should take into account the most recent scientific findings for behavior change techniques. Trial Registration: ClinicalTrials.gov NCT02019134; https://clinicaltrials.gov/ct2/show/NCT02019134 International Registered Report Identifier (IRRID): RR2-10.1186/1745-6215-15-490 ",
issn="2291-5222",
doi="10.2196/31482",
url="https://mhealth.jmir.org/2022/1/e31482",
url="https://doi.org/10.2196/31482",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994708"
}