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A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain.

Martel J, Dugas C, Dubois JD, Descarreaux M - BMC Musculoskelet Disord (2011)

Bottom Line: The objective of the study is to investigate the efficacy of preventive spinal manipulative therapy (SMT) compared to a no treatment group in NCNP patients.Further research is needed to delineate the specific and non-specific effects of treatment modalities to prevent unnecessary disability and to minimise morbidity related to NCNP.Additional investigation is also required to identify the best strategies for secondary and tertiary prevention of NCNP.

View Article: PubMed Central - HTML - PubMed

Affiliation: Département de Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières G9A 5H7, Canada.

ABSTRACT

Background: Evidence indicates that supervised home exercises, combined or not with manual therapy, can be beneficial for patients with non-specific chronic neck pain (NCNP). The objective of the study is to investigate the efficacy of preventive spinal manipulative therapy (SMT) compared to a no treatment group in NCNP patients. Another objective is to assess the efficacy of SMT with and without a home exercise program.

Methods: Ninety-eight patients underwent a short symptomatic phase of treatment before being randomly allocated to either an attention-group (n = 29), a SMT group (n = 36) or a SMT + exercise group (n = 33). The preventive phase of treatment, which lasted for 10 months, consisted of meeting with a chiropractor every two months to evaluate and discuss symptoms (attention-control group), 1 monthly SMT session (SMT group) or 1 monthly SMT session combined with a home exercise program (SMT + exercise group). The primary and secondary outcome measures were represented by scores on a 10-cm visual analog scale (VAS), active cervical ranges of motion (cROM), the neck disability index (NDI) and the Bournemouth questionnaire (BQ). Exploratory outcome measures were scored on the Fear-avoidance Behaviour Questionnaire (FABQ) and the SF-12 Questionnaire.

Results: Our results show that, in the preventive phase of the trial, all 3 groups showed primary and secondary outcomes scores similar to those obtain following the non-randomised, symptomatic phase. No group difference was observed for the primary, secondary and exploratory variables. Significant improvements in FABQ scores were noted in all groups during the preventive phase of the trial. However, no significant change in health related quality of life (HRQL) was associated with the preventive phase.

Conclusions: This study hypothesised that participants in the combined intervention group would have less pain and disability and better function than participants from the 2 other groups during the preventive phase of the trial. This hypothesis was not supported by the study results. Lack of a treatment specific effect is discussed in relation to the placebo and patient provider interactions in manual therapies. Further research is needed to delineate the specific and non-specific effects of treatment modalities to prevent unnecessary disability and to minimise morbidity related to NCNP. Additional investigation is also required to identify the best strategies for secondary and tertiary prevention of NCNP.

Trial registration: ClinicalTrials.gov: NCT00566930.

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Mean (SD) VAS, NDI and Bournemouth scores during the preventive phase of the trial.
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Figure 2: Mean (SD) VAS, NDI and Bournemouth scores during the preventive phase of the trial.

Mentions: Although improvement was significant on the NDI, BQ and lateral flexion ROM in all groups, ANCOVA (adjusted for gender and pain improvement in the symptomatic phase) did not yield significant between group differences for the primary and secondary outcome measures. Table 3 reports mean (SD) values and 95% confidence intervals for the primary and secondary outcomes, namely, VAS, NDI, BQ and active cROMs, in the baseline, initiation of RCT, mid-trial and end of trial. Improvement in pain and disability status (NDI and BQ scores) over time is illustrated in Figure 2. Even though no significant group differences could be found, a trend was observed toward a progressive decrease in disability level for both variables. Overall a majority of the participants in the attention-control group (16 patients; 55%), the SMT group (20 patients; 56%) and the SMT + exercise group (24 patients; 73%) stayed below a level of clinically acceptable pain (2 point difference from the symptomatic phase baseline VAS score) during the preventive phase of the trial during the preventive phase of the trial.


A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain.

Martel J, Dugas C, Dubois JD, Descarreaux M - BMC Musculoskelet Disord (2011)

Mean (SD) VAS, NDI and Bournemouth scores during the preventive phase of the trial.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3045999&req=5

Figure 2: Mean (SD) VAS, NDI and Bournemouth scores during the preventive phase of the trial.
Mentions: Although improvement was significant on the NDI, BQ and lateral flexion ROM in all groups, ANCOVA (adjusted for gender and pain improvement in the symptomatic phase) did not yield significant between group differences for the primary and secondary outcome measures. Table 3 reports mean (SD) values and 95% confidence intervals for the primary and secondary outcomes, namely, VAS, NDI, BQ and active cROMs, in the baseline, initiation of RCT, mid-trial and end of trial. Improvement in pain and disability status (NDI and BQ scores) over time is illustrated in Figure 2. Even though no significant group differences could be found, a trend was observed toward a progressive decrease in disability level for both variables. Overall a majority of the participants in the attention-control group (16 patients; 55%), the SMT group (20 patients; 56%) and the SMT + exercise group (24 patients; 73%) stayed below a level of clinically acceptable pain (2 point difference from the symptomatic phase baseline VAS score) during the preventive phase of the trial during the preventive phase of the trial.

Bottom Line: The objective of the study is to investigate the efficacy of preventive spinal manipulative therapy (SMT) compared to a no treatment group in NCNP patients.Further research is needed to delineate the specific and non-specific effects of treatment modalities to prevent unnecessary disability and to minimise morbidity related to NCNP.Additional investigation is also required to identify the best strategies for secondary and tertiary prevention of NCNP.

View Article: PubMed Central - HTML - PubMed

Affiliation: Département de Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières G9A 5H7, Canada.

ABSTRACT

Background: Evidence indicates that supervised home exercises, combined or not with manual therapy, can be beneficial for patients with non-specific chronic neck pain (NCNP). The objective of the study is to investigate the efficacy of preventive spinal manipulative therapy (SMT) compared to a no treatment group in NCNP patients. Another objective is to assess the efficacy of SMT with and without a home exercise program.

Methods: Ninety-eight patients underwent a short symptomatic phase of treatment before being randomly allocated to either an attention-group (n = 29), a SMT group (n = 36) or a SMT + exercise group (n = 33). The preventive phase of treatment, which lasted for 10 months, consisted of meeting with a chiropractor every two months to evaluate and discuss symptoms (attention-control group), 1 monthly SMT session (SMT group) or 1 monthly SMT session combined with a home exercise program (SMT + exercise group). The primary and secondary outcome measures were represented by scores on a 10-cm visual analog scale (VAS), active cervical ranges of motion (cROM), the neck disability index (NDI) and the Bournemouth questionnaire (BQ). Exploratory outcome measures were scored on the Fear-avoidance Behaviour Questionnaire (FABQ) and the SF-12 Questionnaire.

Results: Our results show that, in the preventive phase of the trial, all 3 groups showed primary and secondary outcomes scores similar to those obtain following the non-randomised, symptomatic phase. No group difference was observed for the primary, secondary and exploratory variables. Significant improvements in FABQ scores were noted in all groups during the preventive phase of the trial. However, no significant change in health related quality of life (HRQL) was associated with the preventive phase.

Conclusions: This study hypothesised that participants in the combined intervention group would have less pain and disability and better function than participants from the 2 other groups during the preventive phase of the trial. This hypothesis was not supported by the study results. Lack of a treatment specific effect is discussed in relation to the placebo and patient provider interactions in manual therapies. Further research is needed to delineate the specific and non-specific effects of treatment modalities to prevent unnecessary disability and to minimise morbidity related to NCNP. Additional investigation is also required to identify the best strategies for secondary and tertiary prevention of NCNP.

Trial registration: ClinicalTrials.gov: NCT00566930.

Show MeSH
Related in: MedlinePlus