Postoperative care and rehabilitation
pain
Participants in both groups received the same initial postoperative care at the surgical clinic during the first six weeks, which consisted of information, advice and mobility exercises for the shoulders. After six weeks, participants were instructed to perform mobility exercises for the neck. Neither group used a cervical collar. Participants in the SPT group visited the physiotherapist (referral from the project team) once weekly beginning with postoperative week six, and then twice weekly from postoperative weeks 12 to 24. Participants also performed exercises at home. SPT focused on facilitation and endurance of neck muscles, strengthening of scapular muscles, postural control and increasing overall level of physical activity. The exercises were individually adjusted and progressed for each patient by the treating physiotherapist and registered in an exercise diary. A cognitive behavioural approach consisting of different lessons aimed at improving pain management, coping strategies, ergonomics and self-efficacy was included in the rehabilitation programme. Participants in the SA group received the usual postoperative care after surgery for CR in Sweden. They were advised to seek pragmatic postoperative physiotherapy independently (61%) beginning in postoperative week six if they felt this was necessary, without the need for a referral.