Management of neck pain with manual therapy VS GP
Date First Published:
May 4, 2009
Last Updated:
June 8, 2009
Report by:
Dr Christopher McCarthy, Orthopaedic Practitioner (Imperial College Healthcare)
Search checked by:
Chris McCarthy, Imperial College Healthcare
Three-Part Question:
In [neck pain] is [manual therapy better than GP care] at [reducing pain and restoring function]?
Clinical Scenario:
A 45 year old man presents with pain in the neck, wanting to know if he should be referred for Manual therapy (delivered by physiotherapists).
Search Strategy:
Medline 1966-09 using the PubMed Clinical queries database was searched using the following terms (Broad Therapy Filter = ((clinical[Abstract] AND trial[Abstract]) OR clinical trials[neck pain, manual therapy, manipulative therapy] OR clinical trial[Journal] OR random*[Abstract] OR random allocation[Neck pain,] OR therapeutic use[manual therapy, manipulative therapy]). In addition the BestBETS database was searched using similar terms. Finally the PEDrO (Physiotherapy best evidence) database was searched, as above, with only papers already rated as 7/10 on the quality score being selected for inclusion.
Outcome:
Altogether 352 abstracts were identified from the combined searches, after duplicates had been removed. Abstracts were screened in teams of two. Full papers were obtained for those papers that answered, or potentially answered the three part search question. This resulted in 12 papers being obtained. These papers were rated for quality and risk of bias using a standard proforma (See appendix 1) with papers scoring over 5/10 being summarised in Table 1. This process resulted in four papers being rated as good quality and directly answering the three part question
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial Hoving JL, Koes BW, de Vet HC, van der Windt DA, Assendelft WJ, van Mameren H, Devillé WL, Pool JJ, Scholten RJ, Bouter LM. 2002 Netherlands | 183 Primary Care patients with at least 2weeks of neck pain | 3 groups GP care (medication) Manual therapy Physiotherapy exercises Pragmatic RCT 1b |
Pain: 11 point NRSt | Manual therapy group had greater reduction than the other two groups by 1.5 point greater than GP care | Short term follow up at 7 weeks (immediately after treatment. Dutch Healthcare system setting. |
| Function: Neck Disability Index | Manual therapy group had greater reduction than the other two groups by 1.9 point greater than GP care | ||||
| Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain: long-term results from a pragmatic randomized clinical trial Hoving JL, de Vet HC, Koes BW, Mameren H, Devillé WL, van der Windt DA, Assendelft WJ, Pool JJ, Scholten RJ, Korthals-de Bos IB, Bouter LM. 2006 Netherlands | 183 Primary Care patients with at least 2weeks of neck pain |
3 groups GP care (medication) Manual therapy Physiotherapy exercises |
Pain: 11 point NRS | Manual therapy group had greater reduction than the other two groups by 0.9 point greater than GP care | Follow up at 13 and 52 weeks |
| Function: Neck Disability Index | Manual therapy group had greater reduction than the other two groups by 1.9 point greater than GP care | ||||
| Societal Costs | Patients receiving Manual therapy cost society less in the year following treatment (932 euro less than GP care alone) | ||||
| Cost effectiveness of physiotherapy, manual therapy and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial Hoving J.L, Van Tulder, M.W., Rutten-van-Molken, P.M.H. et al 2003 Netherlands | 183 Primary Care patients with at least 2weeks of neck pain | Pragmatic RCT with Health Economy Analysis 3 groups GP care (medication) Manual therapy Physiotherapy exercises |
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| Effectiveness of manual therapy or pulsed shortwave diathermy in addition to advice and exercise for neck disorders: a pragmatic randomized controlled trial in physical therapy clinics. Dziedzic K, Hill J, Lewis M, Sim J, Daniels J, Hay EM. 2005 UK | 350 Primary care patients | Pragmatic RCT with Health Economy Analysis 3 groups Advice and exercise (A+E) A+E and manual therapy A+E and Pulsed Short-wave diathermy |
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| An economic evaluation of three physiotherapy treatments for non-specific neck disorders alongside a randomized trial. Lewis M, James M, Stokes E, Hill J, Sim J, Hay E, Dziedzic K.( 2007 UK | 350 Primary care patients | Pragmatic RCT with Health Economy Analysis 3 groups Advice and exercise (A+E) A+E and manual therapy A+E and Pulsed Short-wave diathermy |
Author Commentary:
Manual therapy, provided by physiotherapists, offers beneficial improvement in neck pain in the short term however by 6 to 12 months there is no additional benefit of manual therapy over GP care. There is a suggestion that advice and exercise, provided by a physiotherapist, may be equally beneficial as manual therapy, in both the short and long term. However manual therapy is more cost effect for society than GP care alone or advice and exercise
Bottom Line:
Manual therapy is more clinically effective than GP care in the short-term more cost effective than GP care or just advice and exercise in the long term.
References:
- Hoving JL, Koes BW, de Vet HC, van der Windt DA, Assendelft WJ, van Mameren H, Devillé WL, Pool JJ, Scholten RJ, Bouter LM. . Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial
- Hoving JL, de Vet HC, Koes BW, Mameren H, Devillé WL, van der Windt DA, Assendelft WJ, Pool JJ, Scholten RJ, Korthals-de Bos IB, Bouter LM.. Manual therapy, physical therapy, or continued care by the general practitioner for patients with neck pain: long-term results from a pragmatic randomized clinical trial
- Hoving J.L, Van Tulder, M.W., Rutten-van-Molken, P.M.H. et al. Cost effectiveness of physiotherapy, manual therapy and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial
- Dziedzic K, Hill J, Lewis M, Sim J, Daniels J, Hay EM. . Effectiveness of manual therapy or pulsed shortwave diathermy in addition to advice and exercise for neck disorders: a pragmatic randomized controlled trial in physical therapy clinics.
- Lewis M, James M, Stokes E, Hill J, Sim J, Hay E, Dziedzic K.(. An economic evaluation of three physiotherapy treatments for non-specific neck disorders alongside a randomized trial.