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Some evidence manual therapy is effective for neck pain, review

PainSci » bibliography » D’Sylva et al 2010
Tags: neck, treatment, head/neck, spine

One article on PainSci cites D’Sylva 2010: The Complete Guide to Neck Pain & Cricks

PainSci commentary on D’Sylva 2010: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This new study of studies (meta-analysis) of manual therapy for neck pain was published in Manual Therapy without much in the way of clear conclusions — the data is complex and limited. After eliminating about 75% of studies from consideration due to likely bias (somewhat interesting in itself), the authors concluded that there was some “low to moderate quality evidence” that manual therapy is an effective treatment for neck pain compared to advice and exercise alone. That’s a bit underwhelming on one hand … but, on the other, it’s certainly better than nothing, for a condition that is notoriously difficult to treat.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Manual therapy interventions are often used with or without physical medicine modalities to treat neck pain. This review assessed the effect of 1) manipulation and mobilisation, 2) manipulation, mobilisation and soft tissue work, and 3) manual therapy with physical medicine modalities on pain, function, patient satisfaction, quality of life (QoL), and global perceived effect (GPE) in adults with neck pain. A computerised search for randomised trials was performed up to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (RR) and standardised mean differences (SMD) were calculated when possible. We included 19 trials, 37% of which had a low risk of bias. Moderate quality evidence (1 trial, 221 participants) suggested mobilisation, manipulation and soft tissue techniques decrease pain and improved satisfaction when compared to short wave diathermy, and that this treatment combination paired with advice and exercise produces greater improvements in GPE and satisfaction than advice and exercise alone for acute neck pain. Low quality evidence suggests a clinically important benefit favouring mobilisation and manipulation in pain relief [1 meta-analysis, 112 participants: SMD -0.34(95% CI: -0.71, 0.03), improved function and GPE (1 trial, 94 participants) for participants with chronic cervicogenic headache when compared to a control at intermediate and long term follow-up; but no difference when used with various physical medicine modalities.

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