Consensus-based dosage recommendations for sensorimotor training in the management of neck pain: a Delphi study

Key points

1. 01Recommended training cycle: 4-12 weeks, with experts noting lasting effects possible at 3-6 months
2. 02Frequency: 3-5 sessions per week up to 1-3 times daily (3-21 sessions per week), depending on patient tolerance
3. 03Session parameters: 10-20 minutes per session, 2-6 exercises, 2-5 sets per exercise, 7-15 repetitions or 20-60 seconds per exercise, 20-40 seconds rest between sets
4. 04Key targeted abilities include cervical spine proprioception, oculomotor function, movement control, postural control, and vestibular function
5. 05The factsheet includes criteria for adjusting dosage (pain VAS above 5/10, dizziness, compensation strategies) and progression indicators

How it was conducted

Design

Two-round Delphi consensus study

Participants

12 experts (physiotherapists, physicians, sports scientists) from Switzerland and Germany with more than 10 years of clinical or research experience in cervical spine or sensorimotor training

Consensus threshold

80% agreement required; final consensus achieved was 91.67-100% across all questions

Rounds

Round 1 (January-February 2022): 2 of 9 consensus questions reached threshold; Round 2 (March-April 2022): all remaining questions reached threshold

Questionnaire format

15 multiple-choice questions with optional free-text comments; administered via LimeSurvey

What they found

• Round 1 response rate: 92% (12 of 13 invited experts participated)
• Training cycle of 4-12 weeks: 91.67% consensus in Round 1
• Training duration of 10-20 minutes per session: 83.33% agreement in Round 1
• After Round 2, 100% consensus on: targeted abilities, training frequency (3-21 sessions per week), number of exercises (2-6 per session), sets per exercise (2-5), and repetitions (7-15)
• After Round 2, 91.67% consensus on: exercise duration (20-60 seconds per set) and rest period (20-40 seconds between sets)
• 75% of experts considered SMT appropriate for 50-100% of their neck pain patients; 66.66% applied SMT to 75-100% of those patients

Limitations

• Small expert panel of only 12 members limits generalizability of the consensus
• Strict inclusion criteria (German-speaking region, 10+ years experience) restrict geographic and cultural diversity
• Clinical knowledge was relied upon when developing adjustment and progression criteria where literature evidence was limited
• The dosage recommendations have not been validated in a clinical trial and await empirical confirmation in patient populations

Why it matters

For patients

Patients with neck pain can expect a structured sensorimotor training program of roughly 10-20 minutes, 3 or more times per week for 4-12 weeks, based on what experienced clinicians currently agree is appropriate.

For clinicians

The factsheet provides immediately usable dosage parameters (frequency, sets, reps, rest, progression and adjustment criteria) to standardise sensorimotor training prescription for neck pain until RCT validation is available.

For readers

This Delphi study fills a practical gap in the literature by converting scattered evidence and expert opinion into a single clinical reference, though the recommendations still need trial-based confirmation.