A feasibility study assessing manual therapies to different regions of the spine for patients with subacute or chronic neck pain

Abstract

Objective: The purpose of this project was to develop and test protocols for a randomized clinical trial of a combined therapeutic approach (thoracic spine and sacroiliac joint highvelocity, low-amplitude spinal manipulation [HVLA SM] + cervical spine postisometric relaxation) and cervical spine HVLA SM for patients with subacute or chronic neck pain. Methods: Patients were recruited in the Quad Cities in Iowa and Illinois. After a baseline assessment visit, eligible patients were randomly assigned to cervical spine HVLA SM or to the combined therapeutic approach for 4 treatment visits over 2 weeks. Outcome assessments included the Neck Disability Index, visual analog scale, and posttreatment response questionnaire. Patient outcomes were not aggregated or compared by treatment group. Results: It took approximately 8 months of planning, which included the development of forms and protocols, pretesting the forms, and training staff and clinicians in the standardized protocols. Twelve participants were screened, and 6 patients were enrolled and randomly allocated to care over a 6-week period. All patients completed 5 visits. Five of 6 patients had an improvement on the Neck Disability Index. On the visual analog scale, 2 patients improved at 2 weeks, whereas the other 4 got worse. Five patients completed the posttreatment response questionnaire; 2 of the 5 indicated they experienced discomfort or an unpleasant reaction from the study treatments. Conclusions: Designing a successful feasibility randomized clinical trial requires considerable planning, development and pretesting of the forms and protocols, and training clinicians and staff for standardized protocols. Patients were willing to be randomized, follow treatment protocols, complete baseline and outcome assessments, and return 83% of the follow-up questionnaires.

Standardization of Adverse Event Terminology and Reporting in Orthopaedic Physical Therapy: Application to the Cervical Spine

“…2. With the exception of the observational studies, there were 2 randomized controlled trials 28,46 that reported on harms within their abstract. Three papers (from 76 studies) noted harms in the introduction of their paper.…”

“…Three papers (from 76 studies) noted harms in the introduction of their paper. 28,32,46 3. Only 5 of 76 studies 16,28,31,32,46 explicitly reported in their methods their intention to collect adverse event data.…”

“…4. Only 2 of 76 studies 28,46 specified how they collected data on adverse events and none defined, specifically, which symptoms or events were considered to be adverse in nature. 5.…”

“…5. Two of the studies 28,46 defined specific time intervals at which harm data were collected. While some studies had multiple outcome intervals, timing of the adverse event data was not clearly specified.…”

Influence of Manipulation in the Peripheral Nervous System Tests: A Randomized Controlled Trial

“…6,7 Besides being effective in cervical pain complaints, vertebral repositioning is are also indicated in cases of radiculopathy. 1,[8][9][10][11][12][13] One of the manual therapy technique which promotes the mobilization of nerve roots and acts to test and treat the peripheral nervous system, is the neurodynamic mobilization. 14,15 The neural tissue has been pointed as a source radicular symptoms.…”