A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain

doi:10.1155/2012/953139

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Evid Based Complement Alternat Med. 2012; 2012: 953139.

Published online 2011 Nov 24. doi: 10.1155/2012/953139

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Table 7

Summary of findings of mobilization for neck pain (only pain and functional outcomes).

Duration and cause of pain	Outcomes	GRADE*	Findings
Mobilization versus no treatment

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 [135], mobilization was significantly better than “no treatment” group immediately after treatment (P = 0.04); the mean VAS score decrease in mobilization group was from 0.68 ± 0.42 to 0.33 ± 0.02 mm. Corresponding numerical data for “no treatment” group was not reported.

Mixed specific	NA	Insufficient No trial	NA

Mixed nonspecific	Pain intensity score (VAS)	Low Design: RCT ROB: High Consistency: NA (only 1 trial) Directness: yes	In one study [136], the use of bone-setting resulted in a significantly greater mean VAS reduction compared to “no treatment” immediately (18.5, 95% CI: 12.0, 25.1 versus 4.0, 95% CI: −3.1, 11.1; P = 0.002), short- (21.2, 95% CI: 12.7, 29.7 versus 6.2, 95% CI: −1.4, 13.8; P = 0.01), and intermediate-term (22.9, 95% CI: 13.1, 32.7 versus 5.4, 95% CI: −1.9, 12.8; P = 0.005) after treatment; the between-group difference was not significant (14.2, 95% CI: 5.3, 23.1 versus 5.5, 95% CI: −4.9, 15.5; P = 0.2) at long-term followup (1 year posttreatment). Similarly, the proportion of improved subjects (> 50% on VAS) in bone setting group was significantly greater compared to “no treatment” group immediately (P = 0.04) and intermediate-term (P = 0.002) after treatment. This difference was not statistically significant after one year (P = 0.2).

Mobilization versus placebo

Acute/subacute specific	NA	Insufficient No trial	NA

Acute/subacute nonspecific	Pain intensity score (VAS)	Low Design: RCT ROB: Medium Consistency: NA (only 1 trial) Directness: yes	In one trial [114], mobilization was significantly (numerical data not reported; P < 0.01) better than placebo (hand placement without any pressure or tension).

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 [135], mobilization was not significantly (P = 0.09) different from placebo (hand placement without movement of vertebral segment). The mean VAS score decrease in mobilization group was from 0.68 ± 0.42 to 0.33 ± 0.02 mm. Corresponding numerical data for placebo group was not reported.

Mixed or unknown (specific, nonspecific)	NA	Insufficient No trial	NA

Mobilization versus pain medication

Acute/subacute, chronic, mixed, or unknown (specific, nonspecific)	NA	Insufficient No trial	NA

Mobilization versus Massage

Acute/subacute, mixed, 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 [137], bone setting was significantly better than massage at intermediate-term after treatment (mean VAS score: 17.9 ± 18.0 versus 25.4 ± 22.0, P < 0.05).
Chronic nonspecific	Disability score (NDI)	Low Design: RCT ROB: Medium Consistency: NA (only 1 trial) Directness: yes	In one trial [137], bone setting was significantly better than massage at intermediate-term after treatment (mean NDI score: 11.7 ± 9.0 versus 15.3 ± 10.0, P < 0.05).

Mobilization versus manipulation (see Table 5 for manipulation for neck pain)

Mobilization versus usual care

Acute/subacute, chronic or unknown (specific, nonspecific)	NA	Insufficient No trial	NA

Mixed specific	NA	Insufficient No trial	NA

Mixed nonspecific	Pain intensity score (VAS)	Low Design: RCT ROB: High Consistency: NA (only 1 trial) Directness: yes	In one trial [138], spinal mobilization was not significantly different from usual care (counseling and advice on staying active, role of psychosocial factors, self-care such as heat application, home exercises, and ergonomic advice) at intermediate-term posttreatment followup (between-group difference in mean VAS score reduction: 0.5, 95% CI: −0.4, 1.3).
Mixed nonspecific	Disability score (NDI)	Low Design: RCT ROB: High Consistency: NA (only 1 trial) Directness: yes	In one trial [138] spinal mobilization was not significantly different from usual care (counseling and advice on staying active, role of psychosocial factors, self-care such as heat application, home exercises, and ergonomic advice) at intermediate-term posttreatment followup (between-group difference in mean NDI score reduction: −0.02, 95% CI: −2.3, 2.3).

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, [137] bone setting was significantly better than physiotherapy (massage, therapeutic stretching, and exercise therapy) at intermediate-term after treatment (mean VAS score: 17.9 ± 18.0 versus 29.6 ± 23.0, P < 0.05).
Chronic nonspecific	Disability score (NDI)	Low Design: RCT ROB: Medium Consistency: NA (only 1 trial) Directness: yes	In one trial, [137] bone setting was significantly better than physiotherapy (massage, therapeutic stretching, and exercise therapy) at intermediate-term after treatment (mean NDI score: 11.7 ± 9.0 versus 18.4 ± 10.0, P < 0.05).

Mixed specific	NA	Insufficient No trial	NA

Mixed nonspecific	Pain intensity score (VAS)	Low Design: RCT ROB: High Consistency: NA (only 1 trial) Directness: yes	In one trial [138] spinal mobilization was significantly better than physiotherapy (including specific exercises) at intermediate-term posttreatment followup (between-group difference in mean VAS score reduction: 1.0, 95% CI: 0.1, 1.9).
Mixed nonspecific	Disability score (NDI)	Low Design: RCT ROB: High Consistency: NA (only 1 trial) Directness: yes	In one trial [138] spinal mobilization was not significantly different physiotherapy at intermediate-term posttreatment followup (between-group difference in mean NDI score reduction: 1.1, 95% CI: −1.3, 3.4).

Mobilization versus exercise

Acute/subacute, chronic, mixed, or unknown (specific, nonspecific)	NA	Insufficient No trial	NA

Mobilization versus acupuncture

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; 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.