Pragmatically Applied Cervical and Thoracic Nonthrust Manipulation Versus Thrust Manipulation for Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial

Abstract

Study Design Randomized clinical trial. Background The comparative effectiveness between nonthrust manipulation (NTM) and thrust manipulation (TM) for mechanical neck pain has been investigated, with inconsistent results. Objective To compare the clinical effectiveness of concordant cervical and thoracic NTM and TM for patients with mechanical neck pain. Methods The Neck Disability Index (NDI) was the primary outcome. Secondary outcomes included the Patient-Specific Functional Scale (PSFS), numeric pain-rating scale (NPRS), deep cervical flexion endurance (DCF), global rating of change (GROC), number of visits, and duration of care. The covariate was clinical equipoise for intervention. Outcomes were collected at baseline, visit 2, and discharge. Patients were randomly assigned to receive either NTM or TM directed at the cervical and thoracic spines. Techniques and dosages were selected pragmatically and applied to the most symptomatic level. Two-way mixed-model analyses of covariance were used to assess clinical outcomes at 3 time points. Analyses of covariance were used to assess between-group differences for the GROC, number of visits, and duration of care at discharge. Results One hundred three patients were included in the analyses (NTM, n = 55 and TM, n = 48). The between-group analyses revealed no differences in outcomes on the NDI (P = .67), PSFS (P = .26), NPRS (P = .25), DCF (P = .98), GROC (P = .77), number of visits (P = .21), and duration of care (P = .61) for patients with mechanical neck pain who received either NTM or TM. Conclusion NTM and TM produce equivalent outcomes for patients with mechanical neck pain. The trial was registered with ClinicalTrials.gov (NCT02619500). Level of Evidence Therapy, level 1b. J Orthop Sports Phys Ther 2018;48(3):137-145. Epub 6 Feb 2018. doi:10.2519/jospt.2018.7738.

Pragmatic application of manipulation versus mobilization to the upper segments of the cervical spine plus exercise for treatment of cervicogenic headache: a randomized clinical trial

“…Another difference is clearly the fact this trial used a pragmatic approach where clinicians identified the technique to use and the segment to treat whereas Dunning et al [11] prescribed the same technique, and the location or which cervical segment to target. The current study findings are like those of Griswold et al [12] who examined a pragmatic approach to manipulation versus mobilization for the management of individuals with neck pain. The researchers found that when clinicians had the ability to assess and treat according to their findings there was no difference in terms of pain and disability.…”

“…Their results found that individuals receiving manipulation experienced significantly greater and more clinically meaningful improvement in pain and disability at 3-month followup than those receiving mobilization. However, the study design used by Dunning and colleagues [11] was prescriptive in nature (clinicians were told exactly what levels to treat and what techniques to use) which fails to account for therapists decision making and the patient's clinical presentation [12]. In comparison, pragmatic trials allow clinicians the ability to select techniques they feel most appropriate for the individual patient given their clinical presentation.…”

Visceral Origin: An Underestimated Source of Neck Pain. A Systematic Scoping Review

“…Yet, none of the latter studies mentioned visceral or organic disorders as possible specific causes for the NP. Some other visceral sources of NP were enumerated in other clinical trials: (a) hepatitis [37]; (b) systemic disorders, including metabolic disease [30,35,36,41,46,57,58]; (c) abuse of alcohol and drugs [37,54]; (d) rheumatic disease [31][32][33]35,37,46,49,[51][52][53]55,56,58]; (e) cancer [30,31,35,37,42,[51][52][53][55][56][57]; (f) HIV [37]; and (g) infection [30,33,34,40,45,47,57]. Pregnancy was also included as exclusion criteria in almost half of the trials [30,32,34,37,38,…”

The effect of Spinal Manipulative Therapy on Heart Rate Variability and pain in patients with chronic neck pain: A Randomized Controlled trial

“…SMT in this study is defined both as a High-Velocity-Low -Amplitude (HVLA) thrust applied to the target joint, and also spinal mobilization (MOB) where the application of manual force to the spinal joints is within the passive range of joint motion and does not involve a thrust (39). The type of techniques applied will be decided upon and described by the participating clinicians (chiropractors), and both HVLA and MOB will be considered manual treatments as they have been found to have similar effects on several pain parameters in a recent multicentre study (40). This also provides the possibility for the chiropractor to adapt the force applied to the individual patient, which is normally done in the clinical encounter.…”