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| Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain [with consumer summary] |
| Evans R, Bronfort G, Nelson B, Goldsmith CH |
| Spine 2002 Nov 1;27(21):2383-2389 |
| clinical trial |
| 7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; 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* |
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STUDY DESIGN: Randomised clinical trial. OBJECTIVES: To compare the effects of spinal manipulation combined with low-tech rehabilitative exercise, MedX rehabilitative exercise, or spinal manipulation alone in patient self-reported outcomes over a two-year follow-up period. SUMMARY OF BACKGROUND DATA: There have been few randomised clinical trials of spinal manipulation and rehabilitative exercise for patients with neck pain, and most have only reported short-term outcomes. METHODS: One hundred ninety-one patients with chronic neck pain were randomised to 11 weeks of one of the three treatments. Patient self-report questionnaires measuring pain, disability, general health status, improvement, satisfaction, and OTC medication use were collected after 5 and 11 weeks of treatment and 3,6,12, and 24 months after treatment. Data were analysed taking into account all time points using repeated measures analyses. RESULTS: Ninety-three percent (178) of randomised patients completed the 11-week intervention phase, and 76% (145) provided data at all evaluation time points over the two-year follow-up period. A difference in patient-rated pain with no group-time interaction was observed in favour of the two exercise groups (F[2141] = 3.2; p = 0.04). There was also a group difference in satisfaction with care (F[2143] = 7.7; p = 0.001), with spinal manipulation combined with low-tech rehabilitative exercise (p = 0.02) and spinal manipulation alone (p < 0.001). No significant group differences were found for neck disability, general health status, improvement, and OTC medication use, although the trend over time was in favour of the two exercise groups. CONCLUSION: The results of this study demonstrate an advantage of spinal manipulation combined with low-tech rehabilitative exercise and MedX rehabilitative exercise versus spinal manipulation alone over two years and are similar in magnitude to those observed after one-year follow-up. These results suggest treatments including supervised rehabilitative exercise should be considered for chronic neck pain sufferers. Further studies are needed to examine the cost effectiveness of these therapies and how spinal manipulation compares to no treatment or minimal intervention.
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