Article type
Year
Abstract
Objective: The scientific literature on the conservative management of mechanical neck disorders is profiled using meta-analytic techniques. The efficacy of manual therapies (MT), physical medicine modalities (PMM), drug therapies (DT), and education (ED) was investigated.
Methods: Data Sources: Computerized and manual bibliographic conference proceedings database searches, written requests to content experts in musculoskeletal medicine, and manual searches of article references were strategies used to identify relevant published and unpublished research. Study Selection: Independent, blinded review of 201 relevant articles was performed using criteria for design, population, intervention and outcomes, and 23 RCTs were selected. Further blinded, independent evaluation for validity (methodologic quality) was then performed. Data Abstraction: Data on pain were extracted and transformed to a standardized 100 point scale. Effect sizes were calculated on raw data. For trials using non-parametric data, the inverse x2 method was used.
Results: Sixteen RCTs used PMM, 9 used MT, 5 DT, and 2 ED; many used combinations of therapies. Seventeen trials scored ? 3 out of 5 for validity. Four trials on MT (test of homogeneity: p=0.4) and 4 trials using PMM (2 using electromagnetic therapy (PEMT) and 2 using laser therapy (LT) were pooled. Between-trial differences precluded sensible pooling of the other trials. The mean change in pain in the 4 MT trials was -11.4 (95% CI : -19.8, -3.0), with a pooled effect size of -0.7 (95% CI: -1.0, -0.3), indicating significant reduction in pain. Decrease in pain was also found in 2 trials using PEMT (p=0.01). No significant pain decrease was found in 2 trials using LT (p=0.62).
Discussion: MT is an efficacious treatment for reduction of neck pain in these short term follow-up studies. Modest data also exists to support the use of PEMT. Evidence to support the use of DT and ED is limited. Further controlled trials are clearly needed in all treatment categories.
Methods: Data Sources: Computerized and manual bibliographic conference proceedings database searches, written requests to content experts in musculoskeletal medicine, and manual searches of article references were strategies used to identify relevant published and unpublished research. Study Selection: Independent, blinded review of 201 relevant articles was performed using criteria for design, population, intervention and outcomes, and 23 RCTs were selected. Further blinded, independent evaluation for validity (methodologic quality) was then performed. Data Abstraction: Data on pain were extracted and transformed to a standardized 100 point scale. Effect sizes were calculated on raw data. For trials using non-parametric data, the inverse x2 method was used.
Results: Sixteen RCTs used PMM, 9 used MT, 5 DT, and 2 ED; many used combinations of therapies. Seventeen trials scored ? 3 out of 5 for validity. Four trials on MT (test of homogeneity: p=0.4) and 4 trials using PMM (2 using electromagnetic therapy (PEMT) and 2 using laser therapy (LT) were pooled. Between-trial differences precluded sensible pooling of the other trials. The mean change in pain in the 4 MT trials was -11.4 (95% CI : -19.8, -3.0), with a pooled effect size of -0.7 (95% CI: -1.0, -0.3), indicating significant reduction in pain. Decrease in pain was also found in 2 trials using PEMT (p=0.01). No significant pain decrease was found in 2 trials using LT (p=0.62).
Discussion: MT is an efficacious treatment for reduction of neck pain in these short term follow-up studies. Modest data also exists to support the use of PEMT. Evidence to support the use of DT and ED is limited. Further controlled trials are clearly needed in all treatment categories.