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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*

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.
Reprinted from the Journal of Manipulative and Physiological Therapeutics with copyright permission from the National University of Health Sciences.

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