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.

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