Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial.
BACKGROUND
Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared.


OBJECTIVE
To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner.


METHODS
Randomized, controlled trial.


METHODS
Outpatient care setting in the Netherlands.


METHODS
183 patients, 18 to 70 years of age, who had had nonspecific neck pain for at least 2 weeks.


METHODS
6 weeks of manual therapy (specific mobilization techniques) once per week, physical therapy (exercise therapy) twice per week, or continued care by a general practitioner (analgesics, counseling, and education).


METHODS
Treatment was considered successful if the patient reported being "completely recovered" or "much improved" on an ordinal six-point scale. Physical dysfunction, pain intensity, and disability were also measured.


RESULTS
At 7 weeks, the success rates were 68.3% for manual therapy, 50.8% for physical therapy, and 35.9% for continued care. Statistically significant differences in pain intensity with manual therapy compared with continued care or physical therapy ranged from 0.9 to 1.5 on a scale of 0 to 10. Disability scores also favored manual therapy, but the differences among groups were small. Manual therapy scored consistently better than the other two interventions on most outcome measures. Physical therapy scored better than continued care on some outcome measures, but the differences were not statistically significant.


CONCLUSIONS
In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.
Hoving
Jan Lucas
JL
Department of Clinical Epidemiology, Cabrini Hospital, Victoria, Australia. Jan.Hoving@med.monash.edu.au
Koes
Bart W
BW
de Vet
Henrica C W
HC
van der Windt
Danielle A W M
DA
Assendelft
Willem J J
WJ
van Mameren
Henk
H
Devillé
Walter L J M
WL
Pool
Jan J M
JJ
Scholten
Rob J P M
RJ
Bouter
Lex M
LM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003376:Counseling; D005081:Exercise Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic / Q000009:adverse effects; D008875:Middle Aged; D019547:Neck Pain / Q000628:therapy*; D010353:Patient Education as Topic; D010821:Physicians, Family / Q000592:standards*; D016896:Treatment Outcome
D000700:Analgesics