title: A Cochrane review of manipulation and mobilization for mechanical neck disorders.
abstract: OBJECTIVE
  Our systematic review of randomized trials assessed whether manipulation and mobilization relieve pain or improve function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders.
  
  
  BACKGROUND
  Neck disorders are common, disabling, and costly.
  
  
  METHODS
  Computerized bibliographic databases were searched up to March 2002. Two independent reviewers conducted study selection, data abstraction, and methodologic quality assessment. Relative risk and standardized mean differences were calculated. In the absence of heterogeneity, pooled effect measures were calculated using a random effects model.
  
  
  RESULTS
  Of the 33 selected trials, 42% were high quality trials. Single or multiple (3-11) sessions of manipulation or mobilization showed no benefit in pain relief when assessed against placebo, control groups, or other treatments for acute/subacute/chronic mechanical neck disorders with or without headache. There was strong evidence of benefit favoring multimodal care (mobilization and/or manipulation plus exercise) over a waiting list control for pain reduction [pooled standardized mean differences -0.85 (95% CI: -1.20 to -0.50)], improvement in function [pooled SMD -0.57 (95% CI: -0.94 to -0.21)] and global perceived effect [standardized mean differences -2.73 (95% CI: -3.30 to -2.16)] for subacute/chronic mechanical neck disorders with or without headache.
  
  
  CONCLUSIONS
  Mobilization and/or manipulation when used with exercise are beneficial for persistent mechanical neck disorders with or without headache. Done alone, manipulation and/or mobilization were not beneficial; when compared to one another, neither was superior. There was insufficient evidence available to draw conclusions for neck disorder with radicular findings. Factorial design would help determine the active agent(s) within a treatment mix.
authors.affiliation: McMaster University, Faculty of Health Sciences, School of Rehabilitation Sciences, Institute of Applied Health Sciences, Hamilton, Ontario, Canada. grossa@mcmaster.ca
authors.forename: Anita R
authors.initials: AR
authors.lastname: Gross
authors.forename: Jan L
authors.initials: JL
authors.lastname: Hoving
authors.forename: Ted A
authors.initials: TA
authors.lastname: Haines
authors.forename: Charles H
authors.initials: CH
authors.lastname: Goldsmith
authors.forename: T
authors.initials: T
authors.lastname: Kay
authors.forename: Peter
authors.initials: P
authors.lastname: Aker
authors.forename: Gert
authors.initials: G
authors.lastname: Bronfort
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D005260:Female; D006261:Headache / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic; D020393:Manipulation, Spinal; D008875:Middle Aged; D019547:Neck Pain / Q000150:complications / Q000628:therapy*; D010147:Pain Measurement; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D016896:Treatment Outcome