Author Names
Mesa-Jiménez JA, Lozano-López C, Angulo-Díaz-Parreño S, Rodríguez-Fernández ÁL, De-la-Hoz-Aizpurua JL, Fernández-de-las-Peñas C.
Reviewer Name
Makayla Spade SPT
Reviewer Affiliation(s)
Duke school of Medicine Doctorate of Physical Therapy 2024
Paper Abstract
Background Manual therapies are generally requested by patients with tension type headache. Objective To compare the efficacy of multimodal manual therapy vs. pharmacological care for the management of tension type headache pain by conducting a meta-analysis of randomized controlled trials. Methods PubMed, MEDLINE, EMBASE, AMED, CINAHL, EBSCO, Cochrane Database of Systematic Reviews, Cochrane Collaboration Trials Register, PEDro and SCOPUS were searched from their inception until June 2014. All randomized controlled trials comparing any manual therapy vs. medication care for treating tension type headache adults were included. Data were extracted and methodological quality assessed independently by two reviewers. We pooled headache frequency as the main outcome and also intensity and duration. The weighted mean difference between manual therapy and pharmacological care was used to determine effect sizes. Results Five randomized controlled trials met our inclusion criteria and were included in the meta-analysis. Pooled analyses found that manual therapies were more effective than pharmacological care in reducing frequency (weighted mean difference –0.8036, 95% confidence interval –1.66 to –0.44; three trials), intensity (weighted mean difference –0.5974, 95% confidence interval –0.8875 to –0.3073; five trials) and duration (weighted mean difference –0.5558, 95% confidence interval –0.9124 to –0.1992; three trials) of the headache immediately after treatment. No differences were found at longer follow-up for headache intensity (weighted mean difference –0.3498, 95% confidence interval –1.106 to 0.407; three trials). Conclusion Manual therapies were associated with moderate effectiveness at short term, but similar effectiveness at longer follow-up for reducing headache frequency, intensity and duration in tension type headache than pharmacological medical drug care. However, due to the heterogeneity of the interventions, these results should be considered with caution at this stage.
Key Finding #1
At short term, manual therapies had moderate effectiveness, but at longer follow-up, they were similar to pharmacological medical drug therapies at reducing headache frequency, intensity and duration.
Key Finding #2
A pair of authors independently extracted data from each study. Based on the CONSORT statement (16), a standardized data extraction form was used to collect information on the population, interventions, study methods, results, and outcomes. Each study was evaluated on the following criteria: inclusion and exclusion criteria; randomization; sample size; dropouts; blinding of patients or assessors; outcome measures; interventions; results; follow-up periods. Each item of the data extraction form had to be agreed upon by both authors.
Key Finding #3
Pain frequency was expressed as days per month with pain, intensity was abstracted using the scale used by each study, and duration was expressed as hours per day with pain.
Please provide your summary of the paper
Chronic headaches were the subject of four studies, while frequent episodic TTH was the subject of one study. It took 4 to 6 weeks for treatment to take place with 5–12 manual therapy sessions. Various treatment approaches were used in manual therapy, including spinal manipulation, low-load stabilization exercises, release of soft tissue pressure, and corrective posture awareness. Pharmacological drug intervention followed accepted guidelines and was administered for the same time period than manual therapy. Most studies linked protective situation and severe remedy including non-steroidal antagonistic-instigative drugs. All studies contained required follow ups after the interventions, however 3 studies were reported 18 to 24 weeks after the interventions given. Manual analysis was more effective than pharmacological first-contact medical care in lowering migraine repetitiveness urgently subsequently invasion and care in dropping problem force rapidly later. However, even though manual remedy was effective for short term relief accompanying pharmacological first-contact medical care the distinctness was not statistically important. Manual analysis was still more persuasive than pharmacological first-contact medical care in lowering the hours per epoch accompanying migraine soon, that was statistically important (P < 0.001) and given the test of variety.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
Manual therapy was found to be more effective and subjectively reported more relieving immediate compared to Pharmacological drug. However, manual therapy is a short term relief so that patients are needing pharmacological drug for long term relief. Manual therapy was still suggested than pharmacological first-contact medical care in lowering the hours per day accompanying migraine soon after, showing that it is statistically important (P < 0.001) and passing exam of divergency.
