Author Names

Arsh A, Darain H, Iqbal M, Rahman M, Ullah I, Khalid S

Reviewer Name

Aria Mathew, SPT

Reviewer Affiliation(s)

Duke University Doctor of Physical Therapy Division

 

Paper Abstract

Objective: To compare the effectiveness of manual therapy to the cervical spine with and without manual therapy to the upper thoracic spine in the management of non-specific neck pain.  Methods: The randomized controlled trial was conducted at 3 different hospitals in Peshawar, Pakistan, from October 2016 to January 2017, and comprised patients suffering from non-specific neck pain aged 25-60 years. The control group received cervical manual therapy alone while the experimental group received cervical along with thoracic manual therapy for 2 weeks. Data was analyzed using SPSS 20.  Results: Of the 37 subjects, 20(54%) were cases and 17(46%) were controls. The overall mean age was 35.9±9.6 years. There was no significant difference between the groups at baseline in terms of the levels of pain (p=0.125) and disability (p=0.392). The experiential group showed greater reduction in pain (p=0.02) and disability (p=0.03) compared to the control group.  Conclusion: Cervical along with thoracic manual therapy reduced neck pain and associated neck disability more effectively than cervical manual therapy alone.  Keywords: Cervical, Manual therapy, Neck pain, Thoracic (JPMA 70: 399; 2020)

 

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)?
  • Cannot Determine, Not Reported, or Not Applicable
  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?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Was there high adherence to the intervention protocols for each treatment group?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
  • Yes
  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?
  • No
  1. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
  • No
  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

 

Key Finding #1

Cervical along with thoracic manual therapy reduced neck pain and associated neck disability more effectively than cervical manual therapy alone

Key Finding #2

Thoracic manual therapy lowers mechanical stresses of cervical spine and improves normal distribution of joint forces, resulting into the restoration of normal biomechanics of cervical spine

 

Please provide your summary of the paper

After reviewing the results included in the randomized controlled trial, there does seem to be increased benefits to providing both cervical and thoracic manual therapy in comparison to just cervical manual therapy when treating patients with cervical neck pain. This could be due to the close anatomical relationship between the cervical and thoracic spine and the overlapping neural connections. This study measured effects after two weeks, so long term effectiveness is unclear.

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

Because of its acute effectiveness in reducing neck pain, cervical manual therapy in conjunction with thoracic manual therapy should be used to treat patients with neck pain.