Can the sleep quality of patients with chronic neck pain be improved by muscle energy techniques combined with Swedish massage?

Author Names

Hadamus, A

Reviewer Name

Laurel Hale, SPT ’24

Reviewer Affiliation(s)

Duke University, Doctor of Physical Therapy

 

Paper Abstract

Background and purpose: Muscle energy techniques (METs) are used to reduce tension in neck muscles and therefore, can be used together with Swedish massage to enhance its effect. The aim of this study was to assess if using METs combined with massage could improve sleep quality.  Materials and methods: In this prospective, randomised controlled trial forty patients with chronic cervical spine pain were divided into two equal groups. Both groups attended 10 sessions of Swedish massage, and the study group additionally attended MET-sessions. Sleep disturbances were assessed with the Pittsburgh Sleep Quality Index (PSQI).  Results: A significant improvement in terms of sleep disturbances was seen in both groups. The MET group demonstrated improvement in all PSQI components. In the control group, the improvement included only 4 components of the index.  Conclusion: Massage therapy combined with relaxing METs may be more effective than massage therapy alone in this group of patients.  Keywords: massage therapy; muscle energy technique; sleep disorder; neck pain

 

NIH Risk of Bias Tool

Quality Assessment of Controlled Intervention Studies

1. Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT

• Yes

2. Was the method of randomization adequate (i.e., use of randomly generated assignment)?

• Yes

3. Was the treatment allocation concealed (so that assignments could not be predicted)?

• Yes

4. Were study participants and providers blinded to treatment group assignment?

• Yes

5. Were the people assessing the outcomes blinded to the participants’ group assignments?

• No

6. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?

• Yes

7. Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?

• Yes

8. Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?

• Yes

9. Was there high adherence to the intervention protocols for each treatment group?

• Yes

10. Were other interventions avoided or similar in the groups (e.g., similar background treatments)?

• No

11. Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?

• Yes

12. 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?

• No

13. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?

• Cannot Determine, Not Reported, or Not Applicable

14. 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

Both groups experienced significant improvements by reducing sleep disturbances as seen in pre and post treatment scores on Pittsburg Sleep Quality Index Score (PSQI).

Key Finding #2

After the treatment, the experimental group (MET group) achieved better results in all 7 sleep components of PSQI while the control group only showed improvement in 4 components. Massage therapy combined with relaxing muscle energy techniques is more effective at reducing neck pain causing sleep disturbances than massage alone.

 

Please provide your summary of the paper

The findings of this study showed that massage in conjunction with muscle energy techniques is an effective tool to reduce neck pain causing sleep disturbances.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

I feel that given the high prevalence of chronic neck pain, that this study could be repeated with a larger sample size to get more data on effective treatment options for patients struggling with sleep who are experiencing chronic neck pain. I also think that in future studies introducing a second experimental group that has massage, muscle energy techniques, and exercise could be valuable to see if adding in a treatment component that could be continued at home after the trial ends could help in long term reduction of sleep disturbances in those experiencing chronic neck pain.