Table 2.16Neck Pain - Manipulation & Mobilization - Unknown - Non-Specific Pain

Author ID CountryStudy CharacteristicsPopulation CharacteristicsPain CharacteristicsIntervention DetailOutcome results: Pain, DisabilityOutcome results: Other outcomes; Harms
Cleland, J (2004)262 Abstract

Country: US

Quality score: 2/13

Initial of reviewer: SG
Trial Design
RCT

Tx duration: One session
Fu duration (last assessment): NR

N screened: 68
N randomized: 68
N completed tx: NR
N attended last fu: NR

Inclusion: 18-60 yrs of age with complain of mechanical NP

Exclusion: NR
Mean age (SD/range): NR

% of male: NR

Racial composition: NR

Work status: NR

Other socio-demographics: NR

Co morbidities: NR

Prior episode of pain if acute: NR

Prior CAM intervention: NR

Prior surgery related to current complaint: NR
Region of pain:
NP
Cause of Pain:
N-S

Duration of Pain, mean (SD/range): Unknown, NR

Severity of pain (Grading): NR

Current tx/ co-intervention common in all groups: NR
Groups
IG (n = 34) – Thoracic spine manipulation: treating clinician performed a segmental evaluation of thoracic spine and then performed a thoracic spine manipulation to identified segmental restriction; one tx
Drop outs: NR

CG (n = 34) – Placebo: NR; one tx
Drop outs: NR
Outcomes (describe instrument used):
Pain: VAS (0 – 100)

Results:

Immediate post tx:
Pain-mean change (reduction in pain): IG = -15.5 (95% CI: 11.8, 19.2), CG = -4.2 (95% CI: 1.9, 6.6), p < 0.001

Short term: NR

Intermediate: NR

Long term: NR
Outcomes (describe instrument used):
QoL/ well being: NR

Other:

Results- mean:
Baseline: NA

Immediate post tx: NA

Short term: NR

Intermediate: NR

Long term: NR

Harms: NR
Krauss, J (2008)264

Country: US

Quality score: 9/13

Initial of reviewer: SG
Trial Design-RCT-

Tx duration: One session
Fu duration (last assessment): post tx

N screened: 32
N randomized: 32
N completed tx: 32
N attended last fu: 32

Inclusion: 19 to 50 yrs with complaints of non-traumatic posterior mid-cervical pain of insidious onset in region of fourth to seventh cervical vertebral levels and aggravated with active cervical rot

Exclusion: symptoms originating from thoracic spine, systemic disease or autoimmune disease affecting musculoskeletal system, positive radicular signs, myelopathy or previous surgery to cervical spine
Mean age (SD/range): IG = 35 (10.51) vs. CG = 34.2 (9.56) yrs

% of male: IG = 14%; CG = 30%

Racial composition: NR

Work status: NR

Other socio-demographics: NR

Co morbidities: NR

Prior episode of pain if acute: NR

Prior CAM intervention: NR

Prior surgery related to current complaint: NR
Region of pain:
NP
Cause of Pain:
N-S

Duration of Pain, mean (SD/range): Unknown, NR

Severity of pain (Grading): NR

Current tx/ co-intervention common in all groups: NR
IG (n = 22) – Translatoric SM: using short straight-lined high and low velocity movements directed parallel to or at a right angle to spinal joint surfaces; Sally a bilateral translatoric facet joint traction manipulation to hypomobile UT intervertebral segments, a short passive linear movement perforemed in a dorsal direction perpendicular to plane of facet joints and parallel to plane or UT intervertebral disc joints at each level; one tx
Drop outs: A = 0, B = 0

CG (n = 10) – No tx: no intervention to minimize N-S effects of sham tx but remained seated on tx table for approx. the same amount of time it would take for TSM to be performed; As IG
Drop outs: A = 0, B = 0
Outcomes:
Pain: Faces pain scale to assess pain at end range of active cervical rot: right direction; left direction

Results:
Baseline:
Pain: IG = 2.8 (2.7), CG = 2.8 (1.8); IG = 3.7 (2.7), CG = 2.5 (2.8)
Immediate post tx change from baseline: right rot, 1.5 (2.88) vs. -1.0 (0.23) left rot: 0.69 (1.03) vs. 0.67 (1.2)

Short term: NR

Intermediate: NR

Long term: NR
Outcomes:
QoL/ well being: NR

Results- mean:
Baseline: NA

Immediate post tx:

Short term: NR

Intermediate: NR

Long term: NR

Harms: NR

Summary: sign. Between group differences in riht rot only
Metcalfe, S (2006)266

Country: Canada

Quality score: 4/13

Initial of reviewer: SG
Trial Design- RCT

Tx duration: One session
Fu duration (last assessment): NR

N screened: NR
N randomized: 67
N completed tx: 67
N attended last fu: 67

Inclusion: with NP or headaches

Exclusion: non-cervicogenic NP or headaches, over 65 yrs had previous neck surgery, unable to achieve adequate ROM for strength test position (80° rot) or displayed radicular signs such as loss of reflexes, decreased sensation or fatigable weakness, if strength testing limited by pain or the result of strength testing was 66 pounds
Mean age (SD/range): 37 (11) yrs (total)

% of male: 23.9% (total)

Racial composition: NR

Work status: NR

Other socio-demographics: NR

Co morbidities: NR

Prior episode of pain if acute: NR

Prior CAM intervention: NR

Prior surgery related to current complaint: NR
Region of pain:
NP
Cause of Pain:
N-S

Duration of Pain, mean (SD/range): Unknown

Severity of pain (Grading): NR

Current tx/ co-intervention common in all groups: NR
Groups
IG (n = 41) – Manipulation: low amplitude, high-velocity thrusts with a primary movement of side bending to dysfunctional segments in upper (c0-c2) and lower (c2-c7) cervical spine; lower cervical dysfunctional segments received linear thrust along tri-planar motion in direction of restricted movement; 1 tx
Drop outs: A = 0, B = 0

CG (n = 26) – Manipulation: manipulation to dysfunctional segments of lower cervical spine only; 1 tx
Drop outs: A = 0, B = 0
Outcomes (describe instrument used):
Pain: NA

Disability: NA

Results:
Baseline:
Pain: NA
Disability: NA

Immediate post tx:
Pain: NA
Disability: NA

Short term: NR

Intermediate: NR

Long term: NR
Outcomes (describe instrument used):
QoL/ well being: NR

Mean strength (pounds):
Immediate post tx:
predicted weak: 19.6 (6.5) vs. 15.5 (6.4)
predicted strong: 18.8 (5.4) vs. 15.8 (6.3)

Short term: NR

Intermediate: NR

Long term: NR

Harms: NR
Parkin-Smith, G (1998)265

Country: South Africa

Quality score: 6/13

Initial of reviewer: SG
Trial Design-RCT

Tx duration: 3 wks
Fu duration (last assessment): Immed. Post-tx

N screened: 30
N randomized: 30
N completed tx: 30
N attended last fu: 30

Inclusion: Mechanical NP without neurological or vascular deficit, unilateral or bilateral, possible discomfort with joint challenge/pressure, restriction of movement of at least one motion segment identified by motion palpation, between 16-60 yrs old, exhibit a negative Wallenberg's test

Exclusion: Radiculopathy, contraindications to SM, history of cardiovascular disease, hypertension or dizziness, received manual therapy for at least 2 wks prior to study
Mean age (SD/range): IG = 33.8 vs. CG = 37 yrs

% of male: IG = 54%, CG = 71%

Racial composition: NR

Work status: NR

Other socio-demographics: NR

Co morbidities: NR

Prior episode of pain if acute: NR

Prior CAM intervention: NR

Prior surgery related to current complaint: NR
Region of pain:
NP
Cause of Pain:
N-S

Duration of Pain, mean (SD/range): Unknown, NR

Severity of pain (Grading): NR

Current tx/ co-intervention common in all groups: no Med was allowed during the study
Groups
IG (n = 13) – Cervical SM: most fixated segment(s) were manipulated (no more than 2). Chiropractic adjustments were applied; S manipulative techniques were selected and given in the form of cervical breaks, combination movements, crossed bilateral ransvers pisiform, and anterior thoracic techniques. If required, pts received brief (no more than 20-30 min) of non-therapeutic pre-manipulative soft-tissue massage of cervical spine for muscle spasm; 2 tx/wk for 3 wks
Drop outs: NR

CG (n = 17) – Cervical and upper thoracic SM: most fixated cervical and thoracic segments were manipulated, not extending below T7; As IG
Drop outs: NR
Outcomes:
Pain: NPRS-101 (0-100)

Disability: CMCC NDI (0-100)

Results:
Baseline:
Pain: IG = 33.89 (12.47), CG = 33 (13.99)
Disability: IG = 18.24 (9.66), CG = 17.64 (8.17)

Immediate post tx:
Pain: IG = 17.17 (18.41), CG = 13.18 (10.56)
Disability: IG = 6.89 (8.17), CG = 4.71 (5.74)

Short term: NR

Intermediate: NR

Long term: NA
Outcomes (describe instrument used):
QoL/ well being: NR ROM, mean change from baseline:

Immediate post tx: Flexion: 3.71 (3.9) vs. 1.4 (1.8)
Extension: 2.7 (3.9) vs. 1.7 (2.8)
Right lateral flx: 2.0 (3.2) vs. 2.6 (2.6)
Right rot: 2.6 (3.2) vs. 3.5 (3.3) Left rot: 1.8 (3.6) vs. 3.6 (5.2)

Short term: NR

Intermediate: NR

Long term: NR

Harms: NR

Summary: two tx were not different
Van Schalkwyk, R (2000)263

Country: South Africa

Quality score: 1/13

Initial of reviewer: SG
Trial Design-RCT

Tx duration: 4 wks
Fu duration (last assessment): 3 mos

N screened: NR
N randomized: 30
N completed tx: 30
N attended last fu: 30

Inclusion: over 15 yrs of age with mechanical NP with lateral flx fixations in cervical spine, literate

Exclusion: pathologic condition or disease; contraindications to manipulation, no form of analgesic or anti-inflammatory before or during tx
Mean age (SD/range): IG = 31.7 vs. CG = 27.7 yrs

% of male: IG = 80%, CG = 53.3%

Racial composition: NR

Work status: NR

Other socio-demographics: NR

Co morbidities: NR

Prior episode of pain if acute: NR

Prior CAM intervention: NR

Prior surgery related to current complaint: NR
Region of pain:
NP
Cause of Pain:
N-S

Duration of Pain, mean (SD/range): Unknown, NR

Severity of pain (Grading): NR

Current tx/ co-intervention common in all groups: NR
Groups
IG (n = 15)– Manipulation on ipsilateral side: supine cervical rotary break manipulation with contact taken on ipsilateral side of lateral flx fixation; 10 tx over 4 wks
Drop outs: NR

CG (n = 15) – Manipulation on contralateral side: supine lateral break manipulation on contralateral side of lateral flx fixation; As IG
Drop outs: NR
Outcomes:
Pain: NPRS-level of pain intensity; SF-McGill-quality of pain
Disability: CMCC (CANadian Memorial Chiropractic Colledge) NDI

Results-

Immediate post tx:
Pain: IG = 9.4 (5.47), CG = 17.54 (12.47);IG = 4.27 (8.17), CG = 7.48 (13.47)
Disability: IG = 6 (5.74), CG = 6.13 (18.41)

Short term: Pain: IG = 11.83 (11.8), CG = 18.52 (14); IG = 6.18 (5.8), CG = 9.08 (10.7)
Disability: IG = 6 (6.8), CG = 6.13 (8)
Intermediate: NR

Long term: NR
Outcomes:
QoL/ well being: NA
Cervical ROM

Immediate post tx,
Flexion: 60.8 (12.9) vs. 60.9 (11.67)
Extension: 53.4 (13.6) vs. 54.8 (12.2)

Short term: NR

Intermediate: NR

Long term: NR

Harms: NR

Summary: both txs were effective but there was no sign. Difference between the grps

From: Appendix C, Evidence Tables

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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