Author Names
Cumplido-Trasmonte, C., Fernández-González, P., Alguacil-Diego, I. M., & Molina-Rueda, F.
Reviewer Name
Emilija Peleckas, SPT, B.S
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Introduction: Tension-type headache is the most common primary headache, with a high prevalence and a considerable socioeconomic impact. Manual physical therapy techniques are widely used in the clinical field to treat the symptoms associated with tension-type headache. This systematic review aims to determine the effectiveness of manual and non-invasive therapies in the treatment of patients with tension-type headache. Development: We conducted a systematic review of randomised controlled trials in the following databases: Brain, PubMed, Web of Science, PEDro, Scopus, CINAHL, and Science Direct. Ten randomised controlled trials were included for analysis. According to these studies, manual therapy improves symptoms, increasing patients’ well-being and improving the outcome measures analysed. Conclusions: Manual therapy has positive effects on pain intensity, pain frequency, disability, overall impact, quality of life, and craniocervical range of motion in adults with tension-type headache. None of the techniques was found to be superior to the others; combining different techniques seems to be the most effective approach. Keywords: Cefalea tensional; Fisioterapia; Manual therapy; Physiotherapy; Rehabilitación; Rehabilitation; Tension-type headache; Terapia manual; Tratamiento; Treatment.
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
- 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?
- Yes
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- No
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Cannot Determine, Not Reported, Not Applicable
Key Finding #1
Manual therapy techniques targeting the cervical region done independently showed improvement in neck mobility, pain ratings, and disability scores after 4-6 weeks of treatment.
Key Finding #2
Combined manual therapy, soft tissue techniques, and exercises showed the greatest improvement in outcomes of neck mobility, pain intensity and frequency, disability, and quality of life in patients with tension-type headaches compared to treatments done individually.
Please provide your summary of the paper
This study utilized a systematic review to explore the effect of various manual therapy techniques and other non-invasive therapies such as exercises, posture re-training and modalities in the treatment of patients with tension-type headaches. The studies consisted of groups receiving just manual therapy techniques, just alternate non-invasive therapies, combined treatments, and control groups. After 4-6 weeks of treatment sessions lasting between 10-30 minutes findings from multiple studies consisted of improved pain intensity and frequency (visual analogue scale and McGill Pain Questionnaire), increased craniocervical ROM, significant overall improvement in headache disability index, and improved quality of life measured by the short form-12. No one specific treatment group or technique yielded better outcomes comparatively, but an overall improvement in patient outcomes was found from performing manual therapy and/or other non-invasive therapies for this patient population.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This study analyzed 10 studies using variable manual techniques targeted at the cervical region with a selection of different non-invasive techniques. The findings were positive for effects of manual therapy combined with other non-invasive therapies however the quality of the studies reviewed were poor with sample populations being small or the same population being used in two of the studies. There was also limitation in the studies where only 3 studies were double blinded, one blinded only the participants, and other failed to mention any blinding. Therefore, there is a need for higher quality studies not limited by sample size/selection and blinding to better determine the effectiveness of the intervention. However, with the current information, clinicians should continue to participate in studies and clinically use a combination of manual and non-invasive therapies to see what works best for each patient for the most optimal outcomes.
