Article type
Year
Abstract
Introduction:
Objectives: To determine if manual therapy (MT) reduces pain or improves other clinically important outcomes in adults with neck disorders.
Methods: Sequenced computerized searches up to December 1997and personal files were used to identify published research. Teams of two reviewers independently applied selection criteria (randomized/ controlled trials; neck disorder +- radicular signs/symptoms or with headache; MTs; pain/clinically relevant measure). Two/three reviewers independently evaluated quality and extracted data. Relative risk, median effect sizes or standard mean difference were calculated and pooled if appropriate.
Results: 21 trials met selection. Quality was varied. 'More is better'. Mobilisations or manipulation and to a lesser extent massage based multimodal interventions consistently showed similar effects to the placebo, wait period or a control. One session of MT is of no benefit. Evidence favours the use of multimodal MT based strategies with exercise when compared to a control. 'MT plus exercise are superior to modalities and rest.' Single or multimodal manipulation or mobilisation in combination with exercise, thermal agents, education and rare collar use were superior to certain passive physical medicine methods specifically massage/laser, ice, collar/rest, TNS/PEMT/US, electrical stimulation. 'Manipulation and mobilisation appear similar.' In fact, adding mobilisation to manipulation did not add to the effect. 'Is high tech best?' While high tech exercises were superior to manipulation alone in the long term, manipulation in combination with low tech exercise had similar effects to the former. Further, manipulation plus exercise, thermal modalities and education showed similar effects to both high tech or other exercise/education combinations and rare collar use. Analgesics, antiinflammatories and education combinations compared with manipulation and mobilisation or massage, exercise and PMM had similar effects. Drug therapies were often used as controls. It is unclear what interactive effect drug therapies had.
Discussion: There is little information available from trials to make definitive statements for anyone of the neck disorder subgroups or one specific therapy combination. A general trend favours multimodal treatments over a control, specific modalities and rest. Manipulation and mobilisation may have a similar effect. No evidence of benefit exists for manipulation or mobilisation alone or over one session. More robust design/methodology are needed. The use of valid/reliable measures and adequate power is a priority.
Objectives: To determine if manual therapy (MT) reduces pain or improves other clinically important outcomes in adults with neck disorders.
Methods: Sequenced computerized searches up to December 1997and personal files were used to identify published research. Teams of two reviewers independently applied selection criteria (randomized/ controlled trials; neck disorder +- radicular signs/symptoms or with headache; MTs; pain/clinically relevant measure). Two/three reviewers independently evaluated quality and extracted data. Relative risk, median effect sizes or standard mean difference were calculated and pooled if appropriate.
Results: 21 trials met selection. Quality was varied. 'More is better'. Mobilisations or manipulation and to a lesser extent massage based multimodal interventions consistently showed similar effects to the placebo, wait period or a control. One session of MT is of no benefit. Evidence favours the use of multimodal MT based strategies with exercise when compared to a control. 'MT plus exercise are superior to modalities and rest.' Single or multimodal manipulation or mobilisation in combination with exercise, thermal agents, education and rare collar use were superior to certain passive physical medicine methods specifically massage/laser, ice, collar/rest, TNS/PEMT/US, electrical stimulation. 'Manipulation and mobilisation appear similar.' In fact, adding mobilisation to manipulation did not add to the effect. 'Is high tech best?' While high tech exercises were superior to manipulation alone in the long term, manipulation in combination with low tech exercise had similar effects to the former. Further, manipulation plus exercise, thermal modalities and education showed similar effects to both high tech or other exercise/education combinations and rare collar use. Analgesics, antiinflammatories and education combinations compared with manipulation and mobilisation or massage, exercise and PMM had similar effects. Drug therapies were often used as controls. It is unclear what interactive effect drug therapies had.
Discussion: There is little information available from trials to make definitive statements for anyone of the neck disorder subgroups or one specific therapy combination. A general trend favours multimodal treatments over a control, specific modalities and rest. Manipulation and mobilisation may have a similar effect. No evidence of benefit exists for manipulation or mobilisation alone or over one session. More robust design/methodology are needed. The use of valid/reliable measures and adequate power is a priority.