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Cottone KA, Schumacher MR, Young JL, Rhon DI. The majority of clinical trials assessing mobilization and manipulation for neck pain lack a pragmatic approach: a systematic review of 174 trials. J Man Manip Ther 2024; 32:478-494. [PMID: 38525785 PMCID: PMC11421161 DOI: 10.1080/10669817.2024.2327127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/01/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Disorders of the cervical spine are some of the costliest musculoskeletal conditions to manage globally. Joint mobilization and manipulation have been shown to be an effective treatment for neck pain. However, the generalizability and clinical translation depends on the nature of the trial designs that inform its use. The extent to which randomized control trials (RCTs) assessing manual therapy treatments for cervical spine disorders fall on the efficacy (explanatory) -effectiveness (pragmatic) spectrum often informs how the findings are translated into clinical practice. OBJECTIVE The aim of this systematic review was to determine where RCTs of manual therapy for neck disorders fall on the efficacy-effectiveness spectrum. METHODS A search of three electronic databases including PubMed, CINAHL, and CENTRAL were completed for trials published from inception to May 2023. RCTs in which joint mobilization or manipulation were used to treat cervical spine disorders were assessed on the effectiveness-efficacy spectrum using the Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool and risk of bias using the Revised Cochrane Risk of Bias tool. RESULTS A total of 174 trials met eligibility. RITES domain two trial setting (71.3% vs 16.1%), domain three flexibility of intervention(s) (62.1% vs 23%), and domain four clinical relevance of experimental and comparison intervention(s) (51.7% vs 29.3%) all favored efficacy over effectiveness. Domain one participant characteristic(s) had a slightly greater emphasis on effectiveness compared to efficacy (36.8% vs 44.8%). Most studies (96%) had at least some risk of bias. CONCLUSION Over half of the RCTs assessing the treatment effect of joint mobilization and manipulation for neck pain favor efficacy (explanatory) over effectiveness (pragmatic) designs. Future RCTs on this topic should consider a greater emphasis on pragmatic trial design components in order to better reflect real-world translation to clinical practice.
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Affiliation(s)
- Kyle A Cottone
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Department of Physical Therapy and Health Science, Bradley University, Peoria, IL, USA
| | - Matthew R Schumacher
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Doctor of Physical Therapy Program, University of Mary, Bismarck, ND, USA
| | - Jodi L Young
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy, Bellin College, Green Bay, WI, USA
- Department of Rehabilitation Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
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Skordis C, Liaskou C, Papagiakoumou E, Sotiropoulos S, Plavoukou T, Karakasidou P, Georgoudis G. Intra-rater and Inter-rater Reliability of the Commander Pressure Algometer in Greek Patients With Chronic Neck Pain. Cureus 2024; 16:e66350. [PMID: 39247009 PMCID: PMC11379426 DOI: 10.7759/cureus.66350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 09/10/2024] Open
Abstract
Introduction Non-specific chronic neck pain (NSCNP) is a musculoskeletal disorder that affects 45%-54% of the general population. There is a strong correlation between patient-reported pain and mechanical pain pressure threshold (PPT) measured with an algometer. Purpose This study aims to investigate the intra- and inter-rater reliability of the Commander algometer in Greek NSCNP patients, in an urban primary care setting. Methods Thirty-three patients (22 women and 11 men) suffering from NSCNP (>3 months), the majority (42.4%) between the ages of 50 years and 59 years and overweight, were measured bilaterally both at the neck (mastoid, trapezius head-insertion and mid-portion, C5-C6 facet, insertion of levator scapula) and at the control areas (mid-deltoid and tibialis anterior) using the Commander algometer. Measurements were taken twice over a span of six days, by two raters, in a primary care setting. Intraclass correlation coefficient (ICC) statistics were used as measures of reliability (p = 0.05). Results Intra-rater reliability was "moderate to good" for both raters. ICC values for PPT at the seven bilaterally measured sites varied between 0.67 and 0.86 for the first rater (p ≤ 0.001) and 0.64 and 0.82 for the second rater (p ≤ 0.003). The inter-rater reliability was "moderate to excellent" (ICC = 0.68-0.92) in the first measurement (T1) and "moderate to good" (ICC = 0.68 to 0.89) in the second measurement (T2). Conclusion This study supports the intra- and inter-rater reliability of the Commander algometer in detecting reliably the mechanical PPT, in Greek NSCNP patients, as measured according to the procedures and methodology followed throughout this study.
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Affiliation(s)
| | - Christina Liaskou
- Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
| | | | | | - Theodora Plavoukou
- Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
| | - Palina Karakasidou
- Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
| | - George Georgoudis
- Physiotherapy Department, University of West Attica (UNIWA), Athens, GRC
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García-González J, Romero-del Rey R, Martínez-Martín V, Requena-Mullor M, Alarcón-Rodríguez R. Comparison of Short-Term Effects of Different Spinal Manipulations in Patients with Chronic Non-Specific Neck Pain: A Randomized Controlled Trial. Healthcare (Basel) 2024; 12:1348. [PMID: 38998882 PMCID: PMC11241534 DOI: 10.3390/healthcare12131348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Spinal manipulations for chronic non-specific neck pain (CNNP) include cervical, cervicothoracic junction, and thoracic spine (CCT) manipulations as well as upper cervical spine (UCS) manipulations. This study aimed to compare the short-term effects of UCS manipulation versus a combination of CCT spine manipulations on pain intensity, disability, and cervical range of motion (CROM) in CNNP patients. In a private physiotherapy clinic, 186 participants with CNNP were randomly assigned to either the UCS (n = 93) or CCT (n = 93) manipulation groups. Neck pain, disability, and CROM were measured before and one week after the intervention. No significant differences were found between the groups regarding pain intensity and CROM. However, there was a statistically significant difference in neck disability, with the CCT group showing a slightly greater decrease (CCT: 16.9 ± 3.8 vs. UCS: 19.5 ± 6.8; p = 0.01). The findings suggest that a combination of manipulations in the CCT spine results in a slightly more pronounced decrease in self-perceived disability compared to UCS manipulation in patients with CNNP after one week. However, no statistically significant differences were observed between the groups in terms of pain intensity or CROM.
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Affiliation(s)
| | - Raúl Romero-del Rey
- Department of Nursing, Physiotherapy, and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain; (J.G.-G.); (M.R.-M.); (R.A.-R.)
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Osama M. Effects of muscle specific as compared to movement specific muscle energy technique in mechanical neck pain: A randomized controlled trial. J Back Musculoskelet Rehabil 2024; 37:37-46. [PMID: 37599516 DOI: 10.3233/bmr-210293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND Muscle energy technique (MET) is found to be effective for the management of neck pain and in addition to the muscle specific approach, clinicians may also adopt movement specific approach for METs. However, the literature is deficient in terms of comparison of muscle specific and movement specific METs in the management of mechanical neck pain. OBJECTIVE To compare the effects of muscle specific and movement specific METs in the management of mechanical neck pain. METHODS A single blind parallel design randomized controlled trial was conducted on 66 participants with mechanical neck pain ranging from 40-80 mm on visual analogue scale (VAS), aged between 19-44 years with pain and limitation on cervical motion. Once included, the participants were randomly allocated to two groups, namely the muscle specific MET group and the movement specific MET group. Outcome measures included VAS, Neck Disability Index (NDI) and cervical range of motion (ROM). RESULTS No significant differences (p> 0.05) were observed, neither immediately nor after 5 days, between muscle specific and movement specific MET in terms of VAS, NDI and ROM. However, a significant difference (p< 0.05) was observed in both groups in terms of pre- and post-analysis for all outcome variables. CONCLUSIONS Both muscle specific and movement specific METs are effective in the management of mechanical neck pain, with no significant differences between the two treatment techniques.
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Affiliation(s)
- Muhammad Osama
- Foundation University College of Physical Therapy (FUCP), Foundation University Islamabad, Islamabad, Pakistan
- Brainstorm Research (brainstormresearch.org), Islamabad, Pakistan
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Kustra-Mulder A, Löwe B, Weigel A. Healthcare-related factors influencing symptom persistence, deterioration, or improvement in patients with persistent somatic symptoms: A scoping review of European studies. J Psychosom Res 2023; 174:111485. [PMID: 37716128 DOI: 10.1016/j.jpsychores.2023.111485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE This scoping review explored healthcare-related factors associated with symptom persistence, deterioration, or improvement in patients with persistent somatic symptoms (PSS) across Europe. METHODS Articles were systematically searched in PubMed, Web of Science, Cochrane Library, and PsycINFO by combining terms of PSS and healthcare-related factors. Studies published in English, German, Polish, or Dutch between 2000 and 2022 were included. Healthcare-related factors associated with PSS symptom course were investigated, and study quality assessed (Center for Evidence-Based Medicine Checklist, Newcastle-Ottawa Scale). RESULTS Of 8386 identified studies, 56 were included in the analysis. A significant knowledge gap was evident, as most studies lacked comprehensive healthcare descriptions with particularly unclear definitions of "treatments as usual" in RCTs. The only extractable healthcare factor according to Andersen's Behavioral Model was the treatment setting. Rates of PSS improvement split by care-levels were 38% in primary, 44% in secondary, 25% in mixed, and 71% in specialized care. Persistence rates were 57%, 50%, 75%, and 29% respectively. Deterioration was observed in 5% of primary and 6% of secondary care studies. Studies were skewed toward the United Kingdom, Germany, and the Netherlands. CONCLUSIONS This scoping review shed light on the association between care levels and symptom outcomes in PSS patients. However, limited information in the current studies constrained our exploration of associations with other factors and symptom outcomes. Important aspects, like care availability, referral processes, and insurance coverage, are yet to be elucidated. Addressing these gaps is pivotal for developing targeted treatments across Europe, ultimately enhancing PSS patients' outcomes.
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Affiliation(s)
- Aleksandra Kustra-Mulder
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
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Minnucci S, Innocenti T, Salvioli S, Giagio S, Yousif MS, Riganelli F, Carletti C, Feller D, Brindisino F, Faletra A, Chiarotto A, Mourad F. Benefits and Harms of Spinal Manipulative Therapy for Treating Recent and Persistent Nonspecific Neck Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2023; 53:510-528. [PMID: 37561605 DOI: 10.2519/jospt.2023.11708] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE: We aimed to estimate the benefits and harms of cervical spinal manipulative therapy (SMT) for treating neck pain. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: We searched the MEDLINE, Cochrane CENTRAL, Embase, CINAHL, PEDro, Chiropractic Literature Index bibliographic databases, and grey literature sources, up to June 6, 2022. STUDY SELECTION CRITERIA: RCTs evaluating SMT compared to guideline-recommended and nonrecommended interventions, sham SMT, and no intervention for adults with neck pain were eligible for our systematic review. Prespecified outcomes included pain, range of motion, disability, health-related quality of life. DATA SYNTHESIS: Random-effects meta-analysis for clinically homogenous RCTs at short-term and long-term outcomes. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 Tool. We used the Grading of Recommendations, Assessment, Development, and Evaluations approach to judge the certainty of evidence. RESULTS: We included 28 RCTs. There was very low to low certainty evidence that SMT was more effective than recommended interventions for improving pain at short term (standardized mean difference [SMD], 0.66; 95% confidence interval [CI]: 0.35, 0.97) and long term (SMD, 0.73; 95% CI: 0.31, 1.16), and for reducing disability at short-term (SMD, 0.95; 95% CI: 0.48, 1.42) and long term (SMD, 0.65; 95% CI: 0.23, 1.06). Transient side effects only were found (eg, muscle soreness). CONCLUSION: There was very low certainty evidence supporting cervical SMT as an intervention to reduce pain and improve disability in people with neck pain. J Orthop Sports Phys Ther 2023;53(9):510-528. Epub: 10 August 2023. doi:10.2519/jospt.2023.11708.
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Arias-Álvarez G, Bustos MM, Hidalgo-García C, Córdova-León K, Pérez-Bellmunt A, López-de-Celis C, Rodríguez-Sanz J. Are there differences between a real C0-C1 mobilization and a sham technique in function and pressure pain threshold in patients with chronic neck pain and upper cervical restriction? A randomised controlled clinical trial. J Back Musculoskelet Rehabil 2023; 36:61-70. [PMID: 35871321 DOI: 10.3233/bmr-220008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic neck pain is one of the main reasons for visiting a healthcare professional. In recent years, it has been shown that upper cervical restriction may be a factor involved in neck pain. OBJECTIVE To compare the immediate effects of a real cervical mobilization technique versus a sham cervical mobilization technique in patients with chronic neck pain and upper cervical restriction. METHODS This was a randomised, controlled, double-blind clinical trial. Twenty-eight patients with chronic neck pain were recruited and divided into two groups (14 = real cervical mobilization; 14 = sham mobilization). Both groups received a single 5-minute treatment session. Upper cervical range motion, flexion-rotation test, deep cervical activation and pressure pain threshold were measured. RESULTS In the between-groups comparison, statistically significant differences were found in favour of the real cervical mobilization group in upper cervical extension (p= 0.003), more restricted side of flexion-rotation test (p< 0.001) and less restricted side of flexion-rotation test (p= 0.007) and in the pressure pain threshold of the right trapezius (p= 0.040) and right splenius (p= 0.049). No differences in deep muscle activation were obtained. CONCLUSION The real cervical mobilization group generates improvements in upper cervical spine movement and pressure pain threshold of right trapezius and right splenius compared to the sham group in patients with chronic neck pain and upper cervical restriction.
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Affiliation(s)
- Gonzalo Arias-Álvarez
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile.,Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile
| | - Mario Muñoz Bustos
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Concepción, Concepción, Chile.,Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile
| | | | - Karen Córdova-León
- Facultad de Ciencias de la Salud, Escuela de Kinesiología, Universidad de las Américas, Providencia, Chile
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.,ACTIUM Functional Anatomy Group, Barcelona, Spain
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.,ACTIUM Functional Anatomy Group, Barcelona, Spain
| | - Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.,ACTIUM Functional Anatomy Group, Barcelona, Spain
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Rodríguez-Sanz J, Malo-Urriés M, Lucha-López MO, López-de-Celis C, Pérez-Bellmunt A, Corral-de-Toro J, Hidalgo-García C. Comparison of an exercise program with and without manual therapy for patients with chronic neck pain and upper cervical rotation restriction. Randomized controlled trial. PeerJ 2021; 9:e12546. [PMID: 34900443 PMCID: PMC8627131 DOI: 10.7717/peerj.12546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background Cervical exercise has been shown to be an effective treatment for neck pain, but there is still a need for more clinical trials evaluating the effectiveness of adding manual therapy to the exercise approach. There is a lack of evidence on the effect of these techniques in patients with neck pain and upper cervical rotation restriction. Purpose To compare the effectiveness of adding manual therapy to a cervical exercise protocol for the treatment of patients with chronic neck pain and upper cervical rotation restriction. Methods Single-blind randomized clinical trial. Fifty-eight subjects: 29 for the Manual Therapy+Exercise (MT+Exercise) Group and 29 for the Exercise group. Neck disability index, pain intensity (0–10), pressure pain threshold (kPa), flexion-rotation test (°), and cervical range of motion (°) were measured at the beginning and at the end of the intervention, and at 3-and 6-month follow-ups. The MT+Exercise Group received one 20-min session of manual therapy and exercise once a week for 4 weeks and home exercise. The Exercise Group received one 20-min session of exercise once a week for 4 weeks and home exercise. Results The MT+Exercise Group showed significant better values post-intervention in all variables: neck disability index: 0% patient with moderate, severe, or complete disability compared to 31% in the Exercise Group (p = 0.000) at 6-months; flexion-rotation test (p = 0.000) and pain intensity (p = 0.000) from the first follow-up to the end of the study; cervical flexion (p = 0.002), extension (p = 0.002), right lateral-flexion (p = 0.000), left lateral-flexion (p = 0.001), right rotation (p = 0.000) and left rotation (p = 0.005) at 6-months of the study, except for flexion, with significative changes from 3-months of follow up; pressure pain threshold from the first follow-up to the end of the study (p values range: 0.003–0.000). Conclusion Four 20-min sessions of manual therapy and exercise, along with a home-exercise program, was found to be more effective than an exercise protocol and a home-exercise program in improving the neck disability index, flexion-rotation test, pain intensity, and pressure pain threshold, in the short, medium, and medium-long term in patients with chronic neck pain and upper rotation restriction. Cervical range of motion improved with the addition of manual therapy in the medium and medium-long term. The high dropout rate may have compromised the external validity of the study.
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Affiliation(s)
- Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences. ACTIUM Anatomy Group. Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Miguel Malo-Urriés
- Department of Physiatry and Nursing. Physiotherapy Research Unit. Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - María Orosia Lucha-López
- Department of Physiatry and Nursing. Physiotherapy Research Unit. Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences. ACTIUM Anatomy Group. Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences. ACTIUM Anatomy Group. Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Jaime Corral-de-Toro
- Department of Physiatry and Nursing. Physiotherapy Research Unit. Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - César Hidalgo-García
- Department of Physiatry and Nursing. Physiotherapy Research Unit. Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain
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