BACKGROUND: Recurrent or persistent neck pain affects a vast number of people globally, leading to reduced quality of life and high societal costs. Clinically, it is a difficult condition to manage, and treatment effect sizes are often moderate at best. Activity and manual therapy are first-line treatment options in current guidelines. We aimed to investigate the combination of home stretching exercises and spinal manipulative therapy in a multicentre randomized controlled clinical trial, carried out in multidiscipline ary primary care clinics.
METHODS: The treatment modalities utilized were spinal manipulative therapy and home stretching exercises compared to home stretching exercises alone. Both groups received 4 treatments for 2 weeks. The primary outcome was pain, where the subjective pain experience was investigated by assessing pain intensity (NRS - 11) and the quality of pain (McGill Pain Questionnaire). Neck disability and health status were secondary outcomes, measured using the Neck Disability Indexthe EQ-5D, respectively. One hundred thirty-one adult subjects were randomized to one of the two treatment groups. All subjects had experienced persistent or recurrent neck pain the previous 6 months and were blinded to the other group intervention. The clinicians provided treatment for subjects in both group and could not be blinded. The researchers collecting data were blinded to treatment allocation, as was the statistician performing data analyses. An intention-to-treat analysis was used.
RESULTS: Sixty-six subjects were randomized to the intervention group, and sixty-five to the control group. For NRS - 11, a B-coefficient of - 0,01 was seen, indication a 0,01 improvement for the intervention group in relation to the control group at each time point with a p-value of 0,305. There were no statistically significant differences between groups for any of the outcome measures.
CONCLUSION: Based on the current findings, there is no additional treatment effect from adding spinal manipulative therapy to neck stretching exercises over 2 weeks for patients with persistent or recurrent neck pain.
TRIAL REGISTRATION: The trial was registered 03/07/2018 at ClinicalTrials.gov , registration number: NCT03576846.
|Rehab Clinician (OT/PT)|
This is a very interesting subject of study: neck pain can have a massive impact on well-being. Many drugs such as NSAIDs and opiates have many undesirable effects, which is why people are grateful for non-drug alternatives. In the present randomized trial, chirotherapy on the neck had no benefit over self-performed stretching exercises. This contrasts with the results of several other studies. It is noticeable in the baseline characteristics that most of the included patients had been suffering from neck pain for years (88 and 82%, respectively). In such a situation of chronicity, a benefit of chirotherapeutic manipulation would not be expected either. It would be exciting to know how a similar study would turn out in people with neck pain that has only existed for a short time.
As a MD who works in musculoskeletal and osteopathic medicine, I found this paper to be not relevant. A two week period of treatment is obviously too short to effectively treat chronic neck pain. In fact, when it comes to internal medicine, I cannot think of any chronic disease that can be managed in two weeks of conservative treatment. It is very sad to see the industry almost trying to prove that physical medicine and rehabilitation cannot be part of a healthcare system when so much is spent in monoclonal antibodies. Patients were supposed to spend up to 150 USD to get rid of neck pain? So someone with chronic low back pain, neck pain, shoulder pain, knee pain and hip pain should never spend less than on an Iphone to be completely pain free... honestly, a waste of time.
As a physical therapist and regular consumer of research, I find the results of this study are not surprising. It is nice to see a more pragmatic approach taken for manual therapy interventions, but it would be helpful to have more information regarding how dosing was commonly considered/used in this study, or at least a to see breakdown of proportion of thrust vs. non-thrust techniques to be able to better compare between other studies that have had more beneficial findings of manual therapy.
The main concern with this study is the very short duration of the intervention: only 4 treatments for 2 weeks. I would have expected a much longer duration in terms of weeks of durations considering the chronic population.