Use the Back button in your browser to see the other results of your search or to select another record.

Detailed Search Results

Dose optimization for spinal treatment effectiveness: a randomized controlled trial investigating the effects of high and low mobilization forces in patients with neck pain [with consumer summary]
Snodgrass SJ, Rivett DA, Sterling M, Vicenzino B
The Journal of Orthopaedic and Sports Physical Therapy 2014 Mar;44(3):141-152
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: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: To determine if force magnitude during posterior-to-anterior mobilization affects immediate and short-term outcomes in patients with chronic, nonspecific neck pain. BACKGROUND: The optimal dose of mobilization to effectively treat patients with neck pain is not known. METHODS: Patients with neck pain of at least 3 months in duration (n = 64) were randomized to receive a single treatment of posterior-to-anterior mobilization applied with 30 N or 90 N of mean peak force (3 sets of 30 seconds) or a placebo (detuned laser) on the spinous process at the painful spinal level. Pressure pain threshold, pain measured with a visual analog scale (range 0 to 100 mm), cervical range of motion, and spinal stiffness at the painful spinal level (measured with a custom device and normalized as a percentage of C7 stiffness) were assessed before, immediately after, and at a mean +/- SD follow-up of 4.0 +/- 1.8 days following treatment. Repeated-measures analysis of covariance and Bonferroni-adjusted post hoc tests determined group differences for each outcome measure after treatment and at follow-up. RESULTS: At follow-up, the 90-N group had less pain than the 30-N group (mean difference 11.3 mm; 95% confidence interval 0.1 to 22.6 mm; p = 0.048) and lower stiffness than the placebo group (mean difference 17.5%; 95% confidence interval 4.2% to 30.9%; p = 0.006). These differences were not present immediately after treatment. There were no significant between-group differences in pressure pain threshold or range of motion after treatment or at follow-up. CONCLUSION: A specific dose of mobilization, in terms of applied force, appears necessary for reducing stiffness and potentially pain in patients with chronic neck pain. Changes were not observed immediately after mobilization, suggesting that its effects are not directly mechanical. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (http://www.anzctr.org.au/) ACTRN12611000374965. LEVEL OF EVIDENCE: Therapy, level 1b-.

Full text (sometimes free) may be available at these link(s):      help