| PMC full text: | Published online 2011 Nov 24. doi: 10.1155/2012/953139
|
Table 11
Summary of findings of combination of manipulation and mobilization for neck pain (only pain and functional outcomes).
| Duration and cause of pain | Outcomes | GRADE* | Findings |
|---|---|---|---|
| Manipulation + mobilization versus no treatment | |||
|
| |||
| Chronic nonspecific | Pain intensity (VAS score) |
Low
Design: RCT ROB: Medium Consistency: NA (one trial) Directness: yes | In one trial, spinal manipulation plus mobilization was significantly better in reducing pain intensity and the frequency of headache than no treatment (P < 0.001) [160]. |
|
| |||
| Acute/subacute, mixed, unknown (specific, nonspecific) | NA |
Insufficient
No trial | NA |
|
| |||
| Manipulation + mobilization versus placebo | |||
|
| |||
| Acute/subacute, chronic, or unknown (specific, nonspecific) | NA |
Insufficient
No trial | NA |
|
| |||
| Mixed specific, nonspecific | NA |
Insufficient
No trial | NA |
|
| |||
| Manipulation + mobilization versus usual care | |||
|
| |||
| Acute/subacute, chronic, or unknown (specific, nonspecific) | NA |
Insufficient
No trial | NA |
|
| |||
| Mixed specific/nonspecific | NA |
Insufficient
No trial | NA |
|
| |||
| Manipulation + mobilization versus physiotherapy | |||
|
| |||
| Acute/subacute, or unknown (specific, nonspecific) | NA |
Insufficient
No trial | NA |
|
| |||
| Chronic specific | NA |
Insufficient
No trial | NA |
|
| |||
| Chronic nonspecific | Pain intensity score (VAS) |
Low
Design: RCT ROB: Medium Consistency: NA (only 1 trial) Directness: yes | In one trial [155], the combination of spinal manipulation and mobilization was significantly better than physiotherapy (exercise, massage, heat, electrotherapy, ultrasound, shortwave diathermy) in reducing pain (mean score improvement: 4.5 versus 4.1, P < 0.05). The long-term results (12 months posttreatment) of the same trial [161] were reported for the combined sample of subjects with low-back and neck pain and therefore are not presented in this review. |
|
| |||
| Mixed specific, nonspecific | NA |
Insufficient
No trial | NA |
|
| |||
| Manipulation + mobilization versus exercise | |||
|
| |||
| Acute/subacute, mixed, or unknown (specific, nonspecific) | NA |
Insufficient
No trial | NA |
|
| |||
| Chronic specific | NA |
Insufficient
No trial | NA |
|
| |||
| Chronic nonspecific | Headache frequency (mean number per week) |
Low
Design: RCT ROB: Medium Consistency: NA (only 1 trial) Directness: yes | In one trial [160, 162], spinal manipulation plus mobilization did not significantly differ from exercise (low load endurance exercises aimed to train muscle control of the cervicoscapular region) in reducing headache frequency immediately (2.02 ± 0.24 versus 2.37 ± 0.21, P > 0.05) or at intermediate-term posttreatment followup (2.12 ± 0.23 versus 2.52 ± 0.24, P > 0.05). |
| Pain intensity score (VAS) |
Low
Design: RCT ROB: Medium Consistency: NA (only 1 trial) Directness: yes | In one trial [160, 162] spinal manipulation plus mobilization did not significantly differ from exercise (low load endurance exercises aimed to train muscle control of the cervicoscapular region) in reducing pain intensity immediately (3.37 ± 0.39 versus 3.26 ± 0.38, P > 0.05) or at intermediate-term posttreatment followup (2.69 ± 0.32 versus 2.83 ± 0.37, P > 0.05). | |
| Disability score (NPQ) |
Low
Design: RCT ROB: Medium Consistency: NA (only 1 trial) Directness: yes | In one trial [160, 162] spinal manipulation plus mobilization did not significantly differ from exercise (low load endurance exercises aimed to train muscle control of the cervicoscapular region) in reducing disability immediately (mean NPQ score change 12.13 ± 1.80 versus 11.03 ± 2.16, P > 0.05) or at intermediate-term posttreatment followup (mean NPQ score change 14.21 ± 1.82 versus 15.66 ± 2.01, P > 0.05). | |
|
| |||
| Manipulation + mobilization versus acupuncture | |||
|
| |||
| Acute/subacute, chronic, mixed, or unknown (specific, nonspecific) | NA |
Insufficient
No trial | NA |
|
| |||
| Manipulation + mobilization versus manipulation | |||
|
| |||
| Acute/subacute, chronic, mixed, or unknown (specific, nonspecific) | NA |
Insufficient
No trial | NA |
|
| |||
| Manipulation + mobilization versus mobilization | |||
|
| |||
| Acute/subacute, chronic, mixed, or unknown (specific, nonspecific) | NA |
Insufficient
No trial | NA |
|
| |||
| Manipulation + mobilization versus medication | |||
|
| |||
| Acute/subacute, chronic, mixed, or unknown (specific, nonspecific) | NA |
Insufficient
No trial | NA |
*Precision in formal grading was applied only to pooled results.
VAS: visual analog scale; RMDQ: Roland-Morris disability scale; NHP: Nottingham health profile; MPQ: McGill pain questionnaire; 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; SF-PQ: short form pain questionnaire; PRI: pain rating index; PPI: present pain intensity; NA: not applicable; NDI: neck disability index; IQR: interquartile range; PPT: pressure pain threshold; OR: odds ratio; 95% CI: ninety-five percent confidence interval.