Effectiveness of a multimodal physiotherapy program in fighter pilots with flight-related neck pain: A randomized controlled trial.

Abstract

Flight-related neck pain constitutes a clinical entity related to the performance, occupational health, and flight safety of fighter pilots. To investigate whether a multimodal physiotherapy program combining supervised motor control exercises with laser-guided feedback and interferential current therapy with electromassage improves cervical pain and function outcomes in fighter pilots with flight-related neck pain compared to their usual operational routines. Thirty-one pilots participated in the study, divided into two groups: intervention group (n = 14), who received eight sessions of a multimodal physiotherapy program (twice a week for 4 weeks), and a control group (n = 17), who did not receive any intervention and maintained their usual operational routines. Primary outcome measures were perceived pain intensity (Numeric Pain Rating Scale) and Joint Position Sense Error. The secondary outcome measures were neck disability (Neck Disability Index), cervical range of motion, and pressure pain threshold. Measurements were taken at baseline and immediately after treatment. An intention-to-treat analysis was carried out. To quantify the effect size of the interventions, the relative risk, the absolute and relative risk reduction, and the number needed to treat were calculated. Statistically significant changes were observed between groups in favor of the intervention group in both primary outcomes measures: Numeric Pain Rating Scale (mean difference: 2.5 [1.5-3.5]; p < .001; d = 0.7); Joint Position Sense Error (mean difference: 2 [1.5-2.5]; p < .001; d = 0.8), and secondary outcomes measures (p < .05), with large effect sizes (d ≥ 0.8) in cervical range of motion and pressure pain threshold and moderate (d ≥ 0.6) in Neck Disability Index. In the analysis for treatment benefit, the number needed to treat was 2 (95% confidence interval, 2-3, p < .001) for neck pain and proprioceptive acuity. A multimodal physiotherapy program based on supervised exercises with laser-guided feedback and interferential current therapy improves the symptoms and cervical function of fighter pilots with flight-related neck pain.