Author Names
Wong, J.; Shearer, H.; Mior, Silvano; Jacobs, C.; Pierre, C.; Randhawa, K.; Yu, H.; Southerst, D.; Varatharajan, s.; Sutton, D.;van der Velde, G.; Carroll, L.; Ameis, A.; Ammendolia, C.; Brison,R; Nordin, M.; Stupar, M.; Taylor-Vaisey, Anne.
Reviewer Name
Gabrielle Stanley, Duke SPT2
Reviewer Affiliation(s)
University of California, Davis B.S. Human Development 2019
Paper Abstract
In 2008, the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) found limited evidence on the effectiveness of manual therapies, passive physical modalities, or acupuncture for the management of whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD). This review aimed to update the findings of the Neck Pain Task Force, which examined the effectiveness of manual therapies, passive physical modalities, and acupuncture for the management of WAD or NAD. Sample The sample includes randomized controlled trials, cohort studies, and case-control studies comparing manual therapies, passive physical modalities, or acupuncture with other interventions, placebo or sham, or no intervention. Outcome Measures The outcome measures were self-rated or functional recovery, pain intensity, health-related quality of life, psychological outcomes, or adverse events. We systematically searched five databases from 2000 to 2014. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were stratified by the intervention’s stage of development (exploratory vs. evaluation) and synthesized following best evidence synthesis principles. Funding was provided by the Ministry of Finance.We screened 8,551 citations, and 38 studies were relevant and 22 had a low risk of bias. Evidence from seven exploratory studies suggests that (1) for recent but not persistent NAD grades I–II, thoracic manipulation offers short-term benefits; (2) for persistent NAD grades I–II, technical parameters of cervical mobilization (eg, direction or site of manual contact) do not impact outcomes, whereas one session of cervical manipulation is similar to Kinesio Taping; and (3) for NAD grades I–II, strain-counterstrain treatment is no better than placebo. Evidence from 15 evaluation studies suggests that (1) for recent NAD grades I–II, cervical and thoracic manipulation provides no additional benefit to high-dose supervised exercises, and Swedish or clinical massage adds benefit to self-care advice; (2) for persistent NAD grades I–II, home-based cupping massage has similar outcomes to home-based muscle relaxation, low-level laser therapy (LLLT) does not offer benefits, Western acupuncture provides similar outcomes to non-penetrating placebo electroacupuncture, and needle acupuncture provides similar outcomes to sham-penetrating acupuncture; (3) for WAD grades I–II, needle electroacupuncture offers similar outcomes as simulated electroacupuncture; and (4) for recent NAD grades III, a semi-rigid cervical collar with rest and graded strengthening exercises lead to similar outcomes, and LLLT does not offer benefits.
NIH Risk of Bias Tool
- 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?
- Cannot Determine, Not Reported, Not Applicable
- 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?
- Cannot Determine, Not Reported, Not Applicable
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Cannot Determine, Not Reported, Not Applicable
Key Finding #1
Mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain.
Key Finding #2
Electroacupuncture, strain-counterstrain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, and ultrasound) are not effective and should not be used to manage neck pain.
Please provide your summary of the paper
Of the 38 studies reviewed, evidence suggests that For recent, non chronic Neck Pain Associated Disorder (NAD) thoracic manipulation does offer increase in range of motion and decrease in pain, however these improvements only exist in the short term. For chronic NAD, specific parameters of cervical mobilization are not statistically significant, rather, general mobilization of the thoracic spine has proven beneficial. However, no more beneficial than Kinesio Taping. This study also claims that the following interventions have been unsuccessful in treating NAD: gentle/swedish massage, acupuncture, and rigid cervical collars.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
Overall, this study is incredibly helpful in guiding best practice recommendations for treating general neck pain. This study promotes the use of manual therapy in conjunction with exercise to improve range of motion, decrease pain, and reap the long and short term benefits respectively. One thing should be noted, however, upon addressing the results of this study. Only 38 studies of over 8,000 citations met the criteria of low-risk bias. This meta-analysis therefore was only a representation of a fraction of the articles that are out there. Not only that, but this most recent reputable source for how to address backspin was published over six years ago. While I applaud the findings of this research in pushing the field of physical therapy forward, I believe it is time for a more up to date, meta-analysis, and less bias ridden data, that can be used to give us better practice guidelines for NDA.
