Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial

被引:118
作者
Dunning, James R. [1 ,2 ]
Cleland, Joshua A. [3 ]
Waldrop, Mark A. [4 ]
Arnot, Cathy [5 ]
Young, Ian [6 ]
Turner, Michael [7 ]
Sigurdsson, Gisli [8 ]
机构
[1] Alabama Phys Therapy & Acupuncture, Montgomery, AL USA
[2] Nova SE Univ, Ft Lauderdale, FL 33314 USA
[3] Franklin Pierce Univ, Concord, NH USA
[4] Newberry Phys Therapy & Sports Med, Newberry, SC USA
[5] Univ S Carolina, Columbia, SC 29208 USA
[6] Sport & Spine Phys Therapy, Savannah, GA USA
[7] OrthoSport Phys Therapy, Honolulu, HI USA
[8] Physiotherapy Clin Orkuveitan, Reykjavick, Iceland
关键词
high-velocity low-amplitude thrust; mobilization; neck pain; spinal manipulation; FLEXION-ROTATION TEST; CERVICOTHORACIC MOTION SEGMENT; LOW-BACK-PAIN; SPINAL MANIPULATION; CERVICOGENIC HEADACHE; DISABILITY INDEX; PREDICTION RULE; SHOULDER PAIN; HIGH-VELOCITY; CRANIOCERVICAL FLEXION;
D O I
10.2519/jospt.2012.3894
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
100224 [整形外科学];
摘要
STUDY DESIGN: Randomized clinical trial. OBJECTIVE: To compare the short-term effects of upper cervical and upper thoracic high-velocity low-amplitude (HVLA) thrust manipulation to nonthrust mobilization in patients with neck pain. BACKGROUND: Although upper cervical and upper thoracic HVLA thrust manipulation and nonthrust mobilization are common interventions for the management of neck pain, no studies have directly compared the effects of both upper cervical and upper thoracic HVLA thrust manipulation to nonthrust mobilization in patients with neck pain. METHODS: Patients completed the Neck Disability Index, the numeric pain rating scale, the flexion-rotation test for measurement of C1-2 passive rotation range of motion, and the craniocervical flexion test for measurement of deep cervical flexor motor performance. Following the baseline evaluation, patients were randomized to receive either HVLA thrust manipulation or nonthrust mobilization to the upper cervical (C1-2) and upper thoracic (T1-2) spines. Patients were reexamined 48-hours after the initial examination and again completed the outcome measures. The effects of treatment on disability, pain, C1-2 passive rotation range of motion, and motor performance of the deep cervical flexors were examined with a 2-by-2 mixed-model analysis of variance (ANOVA). RESULTS: One hundred seven patients satisfied the eligibility criteria, agreed to participate, and were randomized into the HVLA thrust manipulation (n = 56) and nonthrust mobilization (n = 51) groups. The 2-by-2 ANOVA demonstrated that patients with mechanical neck pain who received the combination of upper cervical and upper thoracic HVLA thrust manipulation experienced significantly (P<.001) greater reductions in disability (50.5%) and pain (58.5%) than those of the nonthrust mobilization group (12.8% and 12.6%, respectively) following treatment. In addition, the HVLA thrust manipulation group had significantly (P<.001) greater improvement in both passive C1-2 rotation range of motion and motor performance of the deep cervical flexor muscles as compared to the group that received nonthrust mobilization. The number needed to treat to avoid an unsuccessful outcome was 1.8 and 2.3 at 48-hour follow-up, using the global rating of change and Neck Disability Index cut scores, respectively. CONCLUSION: The combination of upper cervical and upper thoracic HVLA thrust manipulation is appreciably more effective in the short term than nonthrust mobilization in patients with mechanical neck pain. LEVEL OF EVIDENCE: Therapy, level 1b. J Orthop Sports Phys Ther 2012;42(1):5-18, Epub 30 September 2011. doi:10.2519/jospt.2012.3894
引用
收藏
页码:5 / 18
页数:14
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