title: Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain: long-term results from a pragmatic randomized clinical trial.
abstract: OBJECTIVE
  The authors' goals were to compare the effectiveness of manual therapy (MT; mainly spinal mobilization), physical therapy (PT; mainly exercise therapy), and continued care by the general practitioner (GP; analgesics, counseling and education) over a period of 1 year.
  
  
  METHODS
  One hundred eighty-three patients suffering for at least 2 weeks from nonspecific neck pain were randomized to receive a 6-week treatment strategy of MT once a week, PT twice a week, or GP care once every 2 weeks. The primary outcome measures were perceived recovery, severity of physical dysfunctioning, pain intensity, and functional disability.
  
  
  RESULTS
  The differences between groups considered over 1 year were statistically significant (repeated measurements analyses P<0.001 to P=0.02) for all outcomes but borderline for the Neck Disability Index (P=0.06). Higher improvement scores were observed for MT for all outcomes, followed by PT and GP care. The success rate, based on perceived recovery after 13 weeks, was 72% for MT, which was significantly higher than the success rate for continued GP care (42%, P=0.001) but not significantly higher compared with PT treatment (59%, P=0.16). The difference between PT and GP approached statistical significance (P=0.06). After 1 year the success rates were 75%, 63%, and 56%, respectively, and no longer significantly different.
  
  
  CONCLUSIONS
  Short-term results (at 7 weeks) have shown that MT speeded recovery compared with GP care and, to a lesser extent, also compared with PT. In the long-term, GP treatment and PT caught up with MT, and differences between the three treatment groups decreased and lost statistical significance at the 13-week and 52-week follow-up.
authors.affiliation: Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jan L
authors.initials: JL
authors.lastname: Hoving
authors.forename: Henrica C W
authors.initials: HC
authors.lastname: de Vet
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Henk van
authors.initials: Hv
authors.lastname: Mameren
authors.forename: Walter L J M
authors.initials: WL
authors.lastname: Devillé
authors.forename: Daniëlle A W M
authors.initials: DA
authors.lastname: van der Windt
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
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: Ingeborg B C
authors.initials: IB
authors.lastname: Korthals-de Bos
authors.forename: Lex M
authors.initials: LM
authors.lastname: Bouter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods*; D019547:Neck Pain / Q000628:therapy*; D010147:Pain Measurement / Q000379:methods; D026741:Physical Therapy Modalities; D010821:Physicians, Family; D015990:Placebo Effect; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome