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| Immediate changes in neck pain intensity and widespread pressure pain sensitivity in patients with bilateral chronic mechanical neck pain: a randomized controlled trial of thoracic thrust manipulation versus non-thrust mobilization [with consumer summary] |
| Salom-Moreno J, Ortega-Santiago R, Cleland JA, Palacios-Cena M, Truyols-Dominguez S, Fernandez-de-las-Penas C |
| Journal of Manipulative and Physiological Therapeutics 2014 Jun;37(5):312-319 |
| 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* |
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OBJECTIVE: The purpose of this study was to compare the effects of thoracic thrust manipulation versus thoracic non-thrust mobilization in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity and neck pain intensity. METHODS: Fifty-two patients (58% were female) were randomly assigned to a thoracic spine thrust manipulation group or of thoracic non-thrust mobilization group. Pressure pain thresholds (PPTs) over C5-C6 zygapophyseal joint, second metacarpal, and tibialis anterior muscle and neck pain intensity (11-point numerical pain rate scale) were collected at baseline and 10 minutes after the intervention by an assessor blinded to group allocation. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of the treatment on each outcome. The primary analysis was the group x time interaction. RESULTS: No significant interactions were found with the mixed-model ANOVAs for any PPT (C5-C6 p > 0.252; second metacarpal p > 0.452; tibialis anterior p > 0.273): both groups exhibited similar increases in PPT (all, p < 0.01), but within-group and between-group effect sizes were small (standardized mean score difference (SMD) < 0.22). The ANOVA found that patients receiving thoracic spine thrust manipulation experienced a greater decrease in neck pain (between-group mean difference 1.4; 95% confidence interval 0.8 to 2.1) than did those receiving thoracic spine non-thrust mobilization (p < 0.001). Within-group effect sizes were large for both groups (SMD > 2.1), and between-group effect size was also large (SMD 1.3) in favor of the manipulative group. CONCLUSIONS: The results of this randomized clinical trial suggest that thoracic thrust manipulation and non-thrust mobilization induce similar changes in widespread PPT in individuals with mechanical neck pain; however, the changes were clinically small. We also found that thoracic thrust manipulation was more effective than thoracic non-thrust mobilization for decreasing intensity of neck pain for patients with bilateral chronic mechanical neck pain.
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