Langevin P1, Jacques M1, Bureau-Morin V1, Laliberté F1, Gross A2, Graham N2, Chaku N2, Goldsmith C3, Gelley G4, Burnie S4, Leblanc F4, Rice M2
1Université Laval, Réadaptation, Québec, Canada, 2McMaster University, Rehabilitation, Hamilton, Canada, 3University of British Columbia, Vancouver, Canada, 4Canadian Memorial Chiropractic College, Departement of Clinical Education, North York, Canada
Background: Manipulation and mobilisation are commonly used to treat neck pain. This is an update of a Cochrane review first published in 2003, and previously updated in 2010 and 2015.
Purpose: To assess the effects of manipulation or mobilisation alone compared with another active treatment on pain, function/disability, patient satisfaction, quality of life, global perceived effect, adverse events and cost of care in adults experiencing neck pain with or without radicular symptoms and cervicogenic headache (CGH) at immediate- to long-term follow-up.
Methods: Review authors searched computerised databases to Marsh 2018 to identify additional Randomised controlled trials (RCTs) that meet inclusion criteria. We also searched ClinicalTrials.gov, checked references, searched citations and contacted study authors to find relevant studies. At least two review authors independently selected studies, abstracted data, assessed risk of bias and applied Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods (very low, low, moderate, high quality). We calculated standardised mean differences (SMDs) and risk ratios (RRs).
Results: We included 57 trials (4035 participants; 50 trials of manipulation/mobilisation only versus another treatment, 7 trials of manipulation/mobilisation only versus an inactive control and another active treatment). Thirty studies (30/57, 53%) had low risk of bias.
Cervical manipulation versus another active treatment: For acute to chronic neck pain, multiple sessions of cervical manipulation produced small pain improvement over medication at immediate- (SMDpooled -0.32 (-0.59 to -0.05)) and long-term follow-up (2 trials, 231 participants, moderate quality) and a small improvement of function at immediate- (SMDpooled: -0.37 (-0.64 to -0.09)) and intermediate-term follow-up. Furthermore, there is moderate quality evidence that medication produce significantly more benign and transient adverse events (AE) than manipulation (RR 0.07 (0.03 to 0.18)).
Multiple sessions of cervical manipulation produced similar changes in pain, function, quality of life (QoL), global perceived effect (GPE) and patient satisfaction at immediate-, short- and intermediate-term compared with multiple sessions of cervical mobilisation (2 trials, 446 participants, moderate quality). There is low quality evidence that manipulation produce no more adverse events (mild to moderate) than mobilisation (RR 1.31 (0.84 to 2.03)).
For chronic CGH, multiple sessions of cervical manipulation produced moderate improvement of pain over massage at short- and intermediate-term follow-up (low quality).
Thoracic manipulation versus another active treatment: For acute to chronic neck pain, thoracic manipulation was better than thoracic mobilisation to moderately improve pain at immediate-term follow-up (3 trials, 138 participants, low quality, SMD -0.52 95%CI -0.93 to -0.11).
Mobilisation versus another active treatment: There was various findings regarding mobilisations but quality of evidence was low to very low, which greatly limits their interpretation for clinical practice.
Conclusion(s): Cervical manipulation alone improves neck pain when contrasted against medication but is equally effective than mobilisation. Thoracic manipulation is more effective than mobilisation at immediate-term follow-up to improve neck pain. Authors of clinical trials should pay greater attention to methodological quality and process and do further research about optimal parameters of the most effective treatment.
Implications: Manipulation and mobilisation should be considered in a multimodal approach as a treatment to improve neck pain.
Keywords: Manipulation, Mobilisation, Neck Pain
Funding acknowledgements: No funding
Purpose: To assess the effects of manipulation or mobilisation alone compared with another active treatment on pain, function/disability, patient satisfaction, quality of life, global perceived effect, adverse events and cost of care in adults experiencing neck pain with or without radicular symptoms and cervicogenic headache (CGH) at immediate- to long-term follow-up.
Methods: Review authors searched computerised databases to Marsh 2018 to identify additional Randomised controlled trials (RCTs) that meet inclusion criteria. We also searched ClinicalTrials.gov, checked references, searched citations and contacted study authors to find relevant studies. At least two review authors independently selected studies, abstracted data, assessed risk of bias and applied Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods (very low, low, moderate, high quality). We calculated standardised mean differences (SMDs) and risk ratios (RRs).
Results: We included 57 trials (4035 participants; 50 trials of manipulation/mobilisation only versus another treatment, 7 trials of manipulation/mobilisation only versus an inactive control and another active treatment). Thirty studies (30/57, 53%) had low risk of bias.
Cervical manipulation versus another active treatment: For acute to chronic neck pain, multiple sessions of cervical manipulation produced small pain improvement over medication at immediate- (SMDpooled -0.32 (-0.59 to -0.05)) and long-term follow-up (2 trials, 231 participants, moderate quality) and a small improvement of function at immediate- (SMDpooled: -0.37 (-0.64 to -0.09)) and intermediate-term follow-up. Furthermore, there is moderate quality evidence that medication produce significantly more benign and transient adverse events (AE) than manipulation (RR 0.07 (0.03 to 0.18)).
Multiple sessions of cervical manipulation produced similar changes in pain, function, quality of life (QoL), global perceived effect (GPE) and patient satisfaction at immediate-, short- and intermediate-term compared with multiple sessions of cervical mobilisation (2 trials, 446 participants, moderate quality). There is low quality evidence that manipulation produce no more adverse events (mild to moderate) than mobilisation (RR 1.31 (0.84 to 2.03)).
For chronic CGH, multiple sessions of cervical manipulation produced moderate improvement of pain over massage at short- and intermediate-term follow-up (low quality).
Thoracic manipulation versus another active treatment: For acute to chronic neck pain, thoracic manipulation was better than thoracic mobilisation to moderately improve pain at immediate-term follow-up (3 trials, 138 participants, low quality, SMD -0.52 95%CI -0.93 to -0.11).
Mobilisation versus another active treatment: There was various findings regarding mobilisations but quality of evidence was low to very low, which greatly limits their interpretation for clinical practice.
Conclusion(s): Cervical manipulation alone improves neck pain when contrasted against medication but is equally effective than mobilisation. Thoracic manipulation is more effective than mobilisation at immediate-term follow-up to improve neck pain. Authors of clinical trials should pay greater attention to methodological quality and process and do further research about optimal parameters of the most effective treatment.
Implications: Manipulation and mobilisation should be considered in a multimodal approach as a treatment to improve neck pain.
Keywords: Manipulation, Mobilisation, Neck Pain
Funding acknowledgements: No funding
Topic: Musculoskeletal: spine; Pain & pain management
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: It is a Systematic Review
All authors, affiliations and abstracts have been published as submitted.
