Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain

Brønfort, Gert; Evans, Roni; Anderson, Alfred V.; Svendsen, Kenneth H.; Bracha, Yiscah; Grimm, Richard H.

doi:10.7326/0003-4819-156-1-201201030-00002

Cited by 169 publications

(115 citation statements)

References 55 publications

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“…16 Bronfort et al's 17 study included 272 participants, between the ages of 18 and 65 years, who had subacute, non-specific neck pain for 2-12 weeks. 17 Bronfort et al 17 also yielded a high quality score (16/19). They found that the intervention group, which included advice, basic anatomy, postural instructions, demonstrations of daily actions, and a HEP, had a larger effect on the Pain Scale when compared to medication or spinal manipulation (effect sizes of 0.11 and 0.16, respectively).…”

Section: 18mentioning

confidence: 99%

“…Bronfort et al 17 was the only study to not indicate adherence. Adherence to the prescribed HEP was measured in six of the seven studies using means such as training diaries 11,[19][20][21] and questionnaires.…”

Section: 1821mentioning

confidence: 99%

“…Within the seven included studies, one study used the HEP as a co-intervention to clinical treatment, 19 whereas six studies used a HEP only 11,[16][17][18]20,21 Adherence was defined in six of the studies and varied as to what constituted adherence (Table 6). Bronfort et al 17 was the only study to not indicate adherence.…”

Section: 1821mentioning

confidence: 99%

“…Outcome reporting on the pain construct (either frequency and/or intensity) occurred on different measures within the included studies: Visual Analog Scale (VAS), 11,16,19 Pain Scale (0-10), 17 Neck/ Shoulder Pain Index, 20 headache frequency, 20 and 16 Their study found that the HEP groups, which included 2-minutes and 12-minutes of resistance training, had a moderate effect on the VAS when compared to the control group, which received no intervention (Cohen's d50.67, 0.59, respectively). 16 When comparing the two HEP groups, no statistically significant difference on pain was reported on the VAS with an effect size of 0.00.…”

Section: 18mentioning

confidence: 99%

“…Acuity of neck pain was classified and defined in each study as either acute, 19 sub-acute, 17,19 and/or chronic symptom duration. 11,16,[18][19][20][21] Two of the included studies failed to perform a follow-up; 11,16 others studies performed follow-up at 4 weeks, 18 14 weeks, 17 6 months, 19,20 40 weeks, 17 and 12 months post discharge.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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The influence of home exercise programs for patients with non-specific or specific neck pain: a systematic review of the literature

Zronek

Sanker

Newcomb

et al. 2016

Journal of Manual & Manipulative Therapy

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Study design: Systematic review of randomized controlled trials (RCT). Objectives: To examine the effects of a therapeutic home exercise program (HEP) for patients with neck pain (associated with whiplash, non-specific, or specific neck pain, with or without radiculopathy, or cervicogenic headache) on pain, function, and disability. Our secondary aim was to describe the design, dosage, and adherence of the prescribed HEPs. Background: Neck pain is a leading cause of disability that affects 22-70% of the population. Different techniques have been found effective for the treatment of neck pain. However, there is conflicting evidence to support the role of a therapeutic HEP to reduce pain, disability, and improve function and quality of life (QOL). Methods: A systematic review in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement for reporting systematic reviews. The full-text review utilized the Maastricht-Amsterdam assessment tool to assess quality among RCTs. Results: A total of 1927 subjects included within seven full-text articles met our specific search strategy. It was found that HEPs with a focus on strength and endurance-training exercises, as well as selfmobilization, have a positive effect when used in combination with other conservative treatments or alone. Conclusions: Home exercise programs that utilize either self-mobilizations within an augmented HEP to address specific spinal levels, or strengthening, and/or endurance exercise are effective at reducing neck pain, function, and disability and improving QOL. The benefit of HEPs in combination with other conservative interventions yields some benefit with a range of effect sizes.

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Section: 18mentioning

confidence: 99%

Section: 1821mentioning

confidence: 99%

Section: 1821mentioning

confidence: 99%

Section: 18mentioning

confidence: 99%

Section: Study Selection and Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

The influence of home exercise programs for patients with non-specific or specific neck pain: a systematic review of the literature

Zronek

Sanker

Newcomb

et al. 2016

Journal of Manual & Manipulative Therapy

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Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment

Gross

Langevin

Burnie

et al. 2015

Cochrane Database of Systematic Reviews

162

136

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Although support can be found for use of thoracic manipulation versus control for neck pain, function and QoL, results for cervical manipulation and mobilisation versus control are few and diverse. Publication bias cannot be ruled out. Research designed to protect against various biases is needed. Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate-term follow-up. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long-term follow-up. Since the risk of rare but serious adverse events for manipulation exists, further high-quality research focusing on mobilisation and comparing mobilisation or manipulation versus other treatment options is needed to guide clinicians in their optimal treatment choices.

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Exercises for mechanical neck disorders

Kay¹,

Gross

Goldsmith

et al. 2012

Cochrane Database of Systematic Reviews

108

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Low to moderate quality evidence supports the use of specific cervical and scapular stretching and strengthening exercise for chronic neck pain immediately post treatment and intermediate term, and cervicogenic headaches in the long term. Low to moderate evidence suggests no benefit for some upper extremity stretching and strengthening exercises or a general exercise program. Future trials should consider using an exercise classification system to establish similarity between protocols and adequate sample sizes. Factorial trials would help determine the active treatment agent within a treatment regimen where a standardized representation of dosage is essential. Standardized reporting of adverse events is needed for balancing the likelihood of treatment benefits over potential harms.

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Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain

Abstract: National Center for Complementary and Alternative Medicine, National Institutes of Health.

Cited by 169 publications

References 55 publications

The influence of home exercise programs for patients with non-specific or specific neck pain: a systematic review of the literature

The influence of home exercise programs for patients with non-specific or specific neck pain: a systematic review of the literature

Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment

Exercises for mechanical neck disorders

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