title: Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial.
abstract: 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.
authors.affiliation: Department of Clinical Epidemiology, Cabrini Hospital, Victoria, Australia. Jan.Hoving@med.monash.edu.au
authors.forename: Jan Lucas
authors.initials: JL
authors.lastname: Hoving
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Henrica C W
authors.initials: HC
authors.lastname: de Vet
authors.forename: Danielle A W M
authors.initials: DA
authors.lastname: van der Windt
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
authors.forename: Henk
authors.initials: H
authors.lastname: van Mameren
authors.forename: Walter L J M
authors.initials: WL
authors.lastname: Devillé
authors.forename: Jan J M
authors.initials: JJ
authors.lastname: Pool
authors.forename: Rob J P M
authors.initials: RJ
authors.lastname: Scholten
authors.forename: Lex M
authors.initials: LM
authors.lastname: Bouter
mesh_terms: 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
chemical_list: D000700:Analgesics