Manipulation or mobilisation for neck pain: a Cochrane Review.
Manipulation and mobilisation are often used, either alone or combined with other treatment approaches, to treat neck pain. This review assesses if manipulation or mobilisation improves pain, function/disability, patient satisfaction, quality of life (QoL), and global perceived effect (GPE) in adults experiencing neck pain with or without cervicogenic headache or radicular findings. A computerised search was performed in July 2009. Randomised trials investigating manipulation or mobilisation for neck pain were included. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (pRR) and standardised mean differences (pSMD) were calculated. 33% of 27 trials had a low risk of bias. Moderate quality evidence showed cervical manipulation and mobilisation produced similar effects on pain, function and patient satisfaction at intermediate-term follow-up. Low quality evidence suggested cervical manipulation may provide greater short-term pain relief than a control (pSMD -0.90 (95%CI: -1.78 to -0.02)). Low quality evidence also supported thoracic manipulation for pain reduction (NNT 7; 46.6% treatment advantage) and increased function (NNT 5; 40.6% treatment advantage) in acute pain and immediate pain reduction in chronic neck pain (NNT 5; 29% treatment advantage). Optimal technique and dose need to be determined.
School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario L8S 1C7, Canada. grossa@mcmaster.ca
Anita
A
Gross
Jordan
J
Miller
Jonathan
J
D'Sylva
Stephen J
SJ
Burnie
Charles H
CH
Goldsmith
Nadine
N
Graham
Ted
T
Haines
Gert
G
Brønfort
Jan L
JL
Hoving
D000328:Adult; D019317:Evidence-Based Medicine; D006261:Headache / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D026201:Musculoskeletal Manipulations / Q000379:methods*; D019547:Neck Pain / Q000503:physiopathology / Q000534:rehabilitation*; D010043:Outcome and Process Assessment, Health Care; D010147:Pain Measurement; D017060:Patient Satisfaction; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function