A Systematic Review and Meta-Analysis of Efficacy, Cost-Effectiveness, and Safety of Selected Complementary and Alternative Medicine for Neck and Low-Back Pain
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 () [160].
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, ). 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 ( versus , ) or at intermediate-term posttreatment followup ( versus , ).
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 ( versus , ) or at intermediate-term posttreatment followup ( versus , ).
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 versus , ) or at intermediate-term posttreatment followup (mean NPQ score change versus , ).
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.