Author Names

Castien, R., van der Windt, D., Grooten, A., Dekker, J.

Reviewer Name

Mallory Martlock, SPT

Reviewer Affiliation(s)

Duke Doctor of Physical Therapy Duke School of Medicine

 

Paper Abstract

Objective: To evaluate the effectiveness of manual therapy (MT) in participants with chronic tension-type headache (CTTH).  Subjects and Methods: We conducted a multicentre, pragmatic, randomised, clinical trial with partly blinded outcome assessment. Eighty-two participants with CTTH were randomly assigned to MT or to usual care by the general practitioner (GP). Primary outcome measures were frequency of headache and use of medication. Secondary outcome measures were severity of headache, disability and cervical function.  Results: After 8 weeks (n _ 80) and 26 weeks (n _ 75), a significantly larger reduction of headache frequency was found for the MT group (mean difference at 8 weeks, 6.4 days; 95% CI 8.3 to 4.5; effect size, 1.6). Disability and cervical function showed significant differences in favour of the MT group at 8 weeks but were not significantly different at 26 weeks.  Conclusions: Manual therapy is more effective than usual GP care in the short- and longer term in reducing symptoms of CTTH. Dutch Trial Registration no. TR 1074.

 

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
  1. Was the method of randomization adequate (i.e., use of randomly generated assignment)?
  • Yes
  1. Was the treatment allocation concealed (so that assignments could not be predicted)?
  • Yes
  1. Were study participants and providers blinded to treatment group assignment?
  • No
  1. Were the people assessing the outcomes blinded to the participants’ group assignments?
  • No
  1. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
  • Yes
  1. Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
  • Yes
  1. Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
  • Yes
  1. Was there high adherence to the intervention protocols for each treatment group?
  • Yes
  1. Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
  • No
  1. Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
  • Yes
  1. 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?
  • Yes
  1. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
  • Yes
  1. 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
  1. Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
  • No

 

Key Finding #1

Manual therapy treatment was effective for chronic tension-type headache in reducing frequency, intensity and impact of headache on daily life.

Key Finding #2

The use of medication did not show a significant difference in pain between the patients receiving manual therapy and the patients receiving usual care for headache.

 

Please provide your summary of the paper

This paper investigated the effects of manual therapy on patients with chronic tension type headache. The manual therapy treatment consisted of mobilization at the cervical and thoracic spine, exercises and postural correction for the treatment of cervicogenic headache. The control group received “usual care” which consisted of information, reassurance and advice and education on lifestyle changes. If necessary, the doctor also prescribed analgesics to the control group. Over the course of 26 weeks, the manual therapy group showed better outcomes compared to the control group. There was a significant difference in headache frequency and pain intensity in favor of the manual therapy group. The manual therapy group also reported a decreased impact of headache on disability and took less sick days from work compared to the control group. Finally, a larger percentage of the control group required additional care for their headache symptoms compared to the manual therapy group. The data shows that manual therapy is an effective intervention for chronic tension-type headache and should be a relevant referral from primary care physicians

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

The data found in this article was in favor of manual therapy as treatment for chronic tension-type headache. The type of manual therapy used in this study was relevant, but I think the more important part were the implications of referral from primary care physicians. Since the data was strongly in favor of manual therapy, this paper provides great support for physicians to refer patients to physical therapy instead of going through typical treatment, especially considering typical treatment consists of education, lifestyle changes and a prescription for pain medication.