Author Names
Chaibi, A., Stevem, K., Russell, M.
Reviewer Name
Miles Moore SPT CSCS
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
(1) Background: Acute neck pain is common and usually managed by medication and/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs); (2) Method: To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain. Data extraction was done in duplicate and formulated in tables. Quality and evidence were assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria, respectively; (3) Results: Six studies were included. The overall pooled effect size for neck pain was very large −1.37 (95% CI, −2.41, −0.34), favouring treatments with SMT compared with controls. A single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment, ((−2.8 (46%) (95% CI, −2.1, −3.4) vs. −1.7 (30%) (95% CI, −1.1, −2.3), respectively; p = 0.02)). Minor transient AEs reported included increased pain and headache, while no serious AEs were reported; (4) Conclusions: SMT alone or in combination with other modalities was effective for patients with acute neck pain. However, limited quantity and quality, pragmatic design, and high heterogeneity limit our findings.
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
- Is the review based on a focused question that is adequately formulated and described?
- Yes
- Were eligibility criteria for included and excluded studies predefined and specified?
- Yes
- Did the literature search strategy use a comprehensive, systematic approach?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Yes
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- Yes
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Yes
Key Finding #1
The main conclusion is that spinal manipulation alone or in combination with another modality is likely to be effective in the treatment of acute neck pain.
Key Finding #2
Randomized Clinical Trials report few, mild and transient adverse effects of Spinal Manipulations.
Key Finding #3
The literature surrounding spinal manipulations for acute neck pain contains large levels of heterogeneity with RCTs, small sample sizes, lack of blinding, and unaccounted for placebo effects.
Please provide your summary of the paper
Acute neck pain is an experience that warrants comprehensive assessment and adequate intervention when treating. At times, clinicians can display hesitancy when reasoning through whether to deploy spinal manipulation or other treatment intervention for this pathology. This systematic review and meta-analysis revealed spinal manipulation alone or as an adjunct with other interventions can likely be effective in treating patients with acute neck pain. Importantly, the authors note that the included randomized clinical trials reported few, mild and transient adverse effects when patients received spinal manipulations. However, robustness is lacking in the literature on acute neck pain and spinal manipulations as a treatment method. The literature surrounding spinal manipulations for acute neck pain contains large levels of heterogeneity with RCTs, small sample sizes, lack of blinding, and unaccounted-for placebo effects calling into question the true efficacy of spinal manipulations as a treatment intervention.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
Spinal manipulative therapy can be an effective treatment for acute neck pain. However, due to the heterogeneity, small sample sizes, and like of blinding within the RCTs supporting the efficacy of this treatment it is difficult to infer direct correlation and causation. Additionally, since the mechanism this treatment follows is still largely debated it is difficult for me to deploy this intervention confidently within my clinical reasoning framework. Though these results do add to the growing body of literature around manual therapy and neck pain and will equip clinicians with ways to better serve patients in the future.
