Detailed Search Results
| Author/Association: | Hoving JL, Koes BW, de Vet HCW, van der Windt DAWM, Assendelft WJJ, van Mameren H, Deville WLJM, Pool JJM, Scholten RJPM, Bouter LM |
| Title: | Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain [with consumer summary] |
| Source: | Annals of Internal Medicine 2002 May 21;136(10):713-722 |
| Method: | clinical trial |
| Method Score: | 8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
| Consumer Summary: | WHAT IS THE PROBLEM AND WHAT IS KNOWN ABOUT IT SO FAR: Neck pain is common and can interfere with daily activities. Neck pain usually goes away without treatment, but patients often seek treatment to speed recovery. Treatments include pain medications, rest, manual therapy, and physical therapy. In manual therapy, a trained therapist moves a patient's neck in specific ways to help improve neck mobility. In physical therapy, a trained therapist assists patients with exercises to improve neck mobility. The main difference between manual therapy and physical therapy is that the therapist moves the patient in manual therapy, while physical therapy requires the patient to do exercises. The best treatment for neck pain is not known. WHY DID THE RESEARCHERS DO THIS PARTICULAR STUDY: To compare the effectiveness of three treatments for neck pain: routine care by a doctor (rest and medication), manual therapy, or physical therapy. WHO WAS STUDIED: 183 adults who had had nonspecific neck pain for at least 2 weeks. Nonspecific means that the neck pain was due to strain of muscles and joints rather than to some serious problem such as a broken bone. Forty-two primary care doctors in the Netherlands referred patients to the study. HOW WAS THE STUDY DONE: The researchers used a computerized coin flip to assign patients to treatment with manual therapy, physical therapy, or continued care by their doctor. One of 6 manual therapists performed the manual therapy for 45 minutes, once per week, for up to 6 weeks. One of 5 physical therapists performed the physical therapy for 30 minutes, twice per week, for up to 6 weeks. The doctors used medications to treat pain and inflammation and gave advice about rest, hot compresses, and home exercises. All patients were allowed to use home exercises, nonprescription medicines, or medicines their doctors had prescribed before referring them to the study. Seven weeks after beginning treatment, patients rated their neck pain on a scale from "much worse" to "completely recovered." The researchers compared the number of patients in each group who reported feeling "much improved" or "completely recovered." WHAT DID THE RESEARCHERS FIND: In the manual therapy group, 68.3% of patients felt "much improved" or "completely recovered" compared with 50.8% of patients in the physical therapy group and 35.9% of doctor-treated patients. The differences between manual therapy and either physical therapy or treatment by a doctor were large enough to prove that there were true differences between the groups. The results suggested that physical therapy might also be better than treatment by a doctor, but the study was too small to prove this. WHAT WERE THE LIMITATIONS OF THE STUDY: The results could be different with different therapists or doctors. WHAT ARE THE IMPLICATIONS OF THE STUDY: Doctors should consider referring patients with neck pain to manual therapy. |
| Abstract: | BACKGROUND: Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. OBJECTIVE: To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner. DESIGN: Randomised, controlled trial. SETTING: Outpatients care setting in the Netherlands. PATIENTS: 183 patients, 18 to 70 years of age, who had non-specific neck pain for at least 2 weeks. INTERVENTION: 6 weeks of manual therapy (specific mobilisation techniques) once per week, or continued care by a general practitioner (analgesics, counselling, and education). MEASUREMENTS: Treatment was considered successful if the patient reported being "completely recovered" or "much improved" on an ordinal six-point scale. Physical dysfunction, pain intensity, and disability were also measured. RESULTS: At 7 weeks, the success rates were 68.3% for manual therapy, 50.8% for physical therapy, and 35.9% for continued care. Statistically significant differences in pain intensity with manual therapy compared with continued care or physical therapy ranged from 0.9 to 1.5 on a scale of 0 to 10. Disability scores also favoured manual therapy, but the differences among groups were small. Manual therapy scored consistently better than the other two interventions on most outcome measures. Physical therapy scored better than continued care on some outcome measures, but the differences were not satisfactorily significant. CONCLUSION: In daily practice, manual therapy is a favourable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner. Full text (sometimes free) may be available at these link(s):  help |
