Author Names
Maicki, T., Bilski, J., Szczygieł, E., and Trąbkaa, R.
Reviewer Name
Beautiful Reed, SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
PURPOSE: The aim of this study was to evaluate the effectiveness of PNF and manual therapy methods in the treatment of patients with cervical spine osteoarthritis, especially their efficacy in reducing pain and improving functionality in everyday life. Long-term results were also compared in order to determine which method of treatment is more effective.
SUBJECTS AND METHODS: Eighty randomly selected females aged 45–65 were included in the study. They were randomly divided into two groups of 40 persons. One group received PNF treatment and the other received manual therapy (MAN.T). To evaluate functional capabilities, the Functional Rating Index was used. To evaluate changes in pain, a shortened version of the McGill Questionnaire was used.
RESULT: The PNF group achieved a greater reduction in pain than the MAN.T group. The PNF group showed a greater improvement in performing daily activities such as sleeping, personal care, traveling, work, recreation, lifting, walking and standing as well as decreased intensity and frequency of pain compared to the MAN.T group.
CONCLUSION: The PNF method proved to be more effective in both short (after two weeks) and long (after three months) term.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- Yes
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Yes
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Cannot Determine, Not Reported, or Not Applicable
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
PNF and manual therapy had a statistically significant impact on reducing pain and improving the performance of daily activities of females with cervical spine pain
Key Finding #2
Individuals in the PNF group showed twice as much pain reduction on the McGill Questionnaire than the manual therapy group.
Key Finding #3
PNF was shown to have better short term and long term affects (according to the McGill Questionnaire and the Functional Rating Index) than manual therapy.
Please provide your summary of the paper
This is a randomized-controlled trial that tests the differences in improved outcomes between Proprioceptive Neuromuscular Facilitation (PNF) and Manual Therapy on patients with cervical spine osteoarthritis. The study states that the patients in both the PNF and manual therapy groups had statistically significant reductions in their pain and improvements in their activities of daily living. When comparing the two groups however, PNF resulted in twice as much of a reduction in pain than manual therapy. This data was taken after two weeks of treatment as well as three months post the treatment bout – both of which showed PNF had better effects on patient outcomes than manual therapy. A limitation of this study was that only females were tested.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This article helps demonstrate that manual therapy can have statistically significant reductions on pain and improvements in ADL’s for patients with cervical spine osteoarthritis. It also showcases however that PNF may be more impactful to patients with the same diagnosis. Based soley on this paper alone, it can be safe to assume that both manual therapy and PNF individually can have great positive impacts on patients throughout their treatment bout and even following. This article begs the questions of whether a combination of these techniques may result in even greater statistically significant patient outcomes than just the lone test groups. This article also approaches the concept of using deep neck muscle strengthening in this population, claiming that both PNF and manual therapy target the deep neck flexors, but in different ways. Deep neck flexor strengthening has been seen in some articles to decrease pain and disability in patients with chronic neck pain. This article discusses that perhaps the reason that more improvements were seen in the PNF group may be because PNF targets muscles in a three-dimensional fashion (i.e., diagonal and spiral patterns) while manual therapy addresses this same strengthening via one-dimension (i.e.,posterior to anterior mobilizations). Overall, this article helps cement the concept of using manual therapy or PNF as valid pain reducers in therapy.
