Table 14Key results – Manipulation therapy for treatment of neck pain & cervicogenic headaches

CAM therapyDuration of painCause of painOutcomeRisk-of-biasPrecision of the pooled estimateConsistencyDirectnessFindingGRADEψ
Man vs. No TxAcute/subacuteS------Insufficient
NS------Insufficient
ChronicS------Insufficient
NS------Insufficient
MixedS------Insufficient
NS------Insufficient
UnknownS------Insufficient
NSVAS: B324M-NADirect= S-NSLow
ROM: B324M-NAIndirect= S-NSLow
Man vs. PLAcute/subacuteS------Insufficient
NSVAS: B308,314H-YesDirect> SSLow
ChronicS------Insufficient
NSVAS: B, C326,330M-YesDirect> SSModerate
PPT: B, C326,330M-YesDirect> SSModerate
NDI: B, C326M-NADirect> SSLow
MixedS------Insufficient
NSPPT: B312H-NADirect> SSLow
VAS: B310M-NADirect> SSLow
ROM: B310M-NAIndirect> SSLow
UnknownS------Insufficient
NSVAS: B325H-NADirect> SSLow
Man** vs. PLAcute/subacuteS------Insufficient
NS------Insufficient
ChronicS------Insufficient
NS------Insufficient
MixedS------Insufficient
NSROM: B (ext, flx)84M-NAIndirect= S-NSLow
Physical functioning (10-point scale): B84M-NADirect> S-NSLow
UnknownS------Insufficient
NS------Insufficient
Man** vs. PTAcute/subacuteS------Insufficient
NS------Insufficient
ChronicS------Insufficient
NSVAS: B85M-NADirect> SSLow
MixedS------Insufficient
NSROM: B (ext, flx)84M-NAIndirect= S-NSLow
Physical functioning (10-point scale): B84M-NADirect> SSLow
UnknownS------Insufficient
NS------Insufficient
Man** vs. STAcute/subacuteS------Insufficient
NS------Insufficient
ChronicS------Insufficient
MixedS------Insufficient
NSROM: B (ext, flx)84M-NAIndirect= S-NSLow
Physical functioning (10-point scale): B84M-NADirect> SSLow
UnknownS------Insufficient
NS------Insufficient
Man** vs. ExAcute/subacuteS------Insufficient
NS------Insufficient
ChronicS------Insufficient
NSHeadache frequency (mean number per week): B, C83M-NADirect= S-NSLow
VAS: B, C83M-NADirect= S-NSLow
MixedS------Insufficient
NS------Insufficient
UnknownS------Insufficient
NS------Insufficient
Man vs. PTAcute/subacuteS------Insufficient
NS------Insufficient
ChronicS------Insufficient
NS------Insufficient
MixedS------Insufficient
NS------Insufficient
UnknownS------Insufficient
NS------Insufficient
Man vs. MedAcute/subacuteS------Insufficient
NS------Insufficient
ChronicS------Insufficient
NSVAS: C51,140,329H-NoDirect= >Low
NDI: C51,140H-YesDirect> SSLow
% pain-free pts: C51H-NAIndirect> SSLow
MixedS------Insufficient
NS------Insufficient
UnknownS------Insufficient
NS------Insufficient
Man vs. MobAcute/subacuteS------Insufficient
NSVAS: B308M-NADirect= S-NSLow
ChronicS------Insufficient
NS------Insufficient
MixedS------Insufficient
NSVAS: B309,310M-YesIndirect> SSLow
ROM (ext): B310M-NAIndirect> SSLow
VAS: D65M-NADirect= S-NSLow
NDI: D65M-NADirect= S-NSLow
UnknownS------Insufficient
NS------Insufficient
Man vs. ExAcute/subacuteS------Insufficient
NS------Insufficient
ChronicS------Insufficient
NS------Insufficient
MixedS------Insufficient
NS------Insufficient
UnknownS------Insufficient
NS------Insufficient
Headache
Man vs. NoTxAcute/subacuteS------Insufficient
NS------Insufficient
ChronicS------Insufficient
NS------Insufficient
MixedS------Insufficient
NS------Insufficient
UnknownS------Insufficient
NS------Insufficient
Man vs. PLAcute/subacuteS------Insufficient
NS------Insufficient
ChronicS------Insufficient
NSROM (ext, flx,rotation): B311L-NAIndirect> SSLow
MixedS------Insufficient
NS------Insufficient
UnknownS------Insufficient
NSVAS: B, D333M-NADirect= S-NSLow
Pain duration (# of hours daily): B, D333M-NADirect= S-NSLow
Use of analgesics (# of tablets daily): B, D333M-NAIndirect= S-NSLow
Man vs. Cold PacksAcute/subacuteS------Insufficient
NS------Insufficient
ChronicSVAS: B334M-NADirect> SSLow
VAS: C334M-NADirect= S-NSLow
ROM (ext, fix): B, C334M-NAIndirect= S-NSLow
NS------Insufficient
MixedS------Insufficient
NS------Insufficient
UnknownS-----Insufficient
NS-----Insufficient
Man vs. MobAcute/subacuteS------Insufficient
NS------Insufficient
ChronicS------Insufficient
NS------Insufficient
MixedS------Insufficient
NS------Insufficient
UnknownS------Insufficient
NS------Insufficient
Man vs. ExAcute/subacuteS------Insufficient
NS------Insufficient
ChronicS------Insufficient
NS------Insufficient
MixedS------Insufficient
NS------Insufficient
UnknownS------Insufficient
NS------Insufficient

S=specific; NS=nonspecific; SS=statistically significant; S-NS=statistically nonsignificant; Man=manipulation; Acu=acupuncture; Ma=massage; Mob=mobilization; PL=placebo; Tx=treatment. Med=medication(s); Int=intervention; PT=physiotherapy; ST=standard therapy; E-acu=electro-acupuncture; MR=muscle relaxation; TENS= transcutaneous electrical nerve stimulation; Ex=exercise; TrP=trigger point; VAS=visual analog scale; RMDQ=Roland Morris Disability scale; NHP=Nottingham Health Profile; PPT= pressure pain threshold; HFAQ=Hanover functional ability questionnaire; MPQ=McGill pain questionnaire; ext=extension; flx=flexion; rot=rotation; PDI=pain disability index; min=minute(s); hr(s)=hour(s); L=low; M=medium; H=high; pt(s)=patient(s); SF=short-form; NPQ=neck pain questionnaire; GWBS=global well-being scale; SLR=straight leg raising; GPE= Global perceived effect; NSAIDS=nonsteroidal antiinflammatory drugs; FTF=finger-to-floor; SF-PQ=short form pain questionnaire; PRI=pain rating index; PPI=present pain intensity; NA=not applicable

ψ Grade (High, moderate, low, and insufficient)

> Favors treatment A over treatment B

< Favors treatment B over treatment A

><, =>, <= Inconsistent beneficial effect

H = high

L = low

M = medium

- No evidence

** Manipulation in combination with mobilization

B = immediate post-treatment

C = short-term post-treatment

D = intermediate-term post-treatment

E = long-term post-treatment

= Similar beneficial effect

From: 3, Results

Cover of Complementary and Alternative Therapies for Back Pain II
Complementary and Alternative Therapies for Back Pain II.
Evidence Reports/Technology Assessments, No. 194.
Furlan AD, Yazdi F, Tsertsvadze A, et al.

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