Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain

A Randomized, Controlled Trial

21 May 2002 | Volume 136 Issue 10 | Pages 713-722

Background: Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared.

Objective: To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner.

Design: Randomized, controlled trial.

Setting: Outpatient care setting in the Netherlands.

Patients: 183 patients, 18 to 70 years of age, who had had nonspecific neck pain for at least 2 weeks.

Intervention: 6 weeks of manual therapy (specific mobilization techniques) once per week, physical therapy (exercise therapy) twice per week, or continued care by a general practitioner (analgesics, counseling, and education).

Measurements: Treatment was considered successful if the patient reported being "completely recovered" or "much improved" on an ordinal six-point scale. Physical dysfunction, pain intensity, and disability were also measured.

Results: At 7 weeks, the success rates were 68.3% for manual therapy, 50.8% for physical therapy, and 35.9% for continued care. Statistically significant differences in pain intensity with manual therapy compared with continued care or physical therapy ranged from 0.9 to 1.5 on a scale of 0 to 10. Disability scores also favored manual therapy, but the differences among groups were small. Manual therapy scored consistently better than the other two interventions on most outcome measures. Physical therapy scored better than continued care on some outcome measures, but the differences were not statistically significant.

Conclusion: In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.

Editors' Notes Context Neck pain is common among primary care patients. Evidence on the effectiveness of therapies for neck pain is limited. A previous randomized, controlled trial suggested benefits from manual therapy and physical therapy. Contribution This randomized, controlled trial of manual therapy, physical therapy, and continued care by a doctor confirms the superiority of manual therapy and physical therapy over continued care. At 7 weeks, 68.3% of patients in the manual therapy group reported resolved or much improved pain, compared with 50.8% of patients in the physical therapy group and 35.9% of patients in the continued care group. Clinical Implications Primary care physicians should consider manual therapy when treating patients with neck pain. –The Editors

 

Author and Article Information

From Institute for Research in Extramural Medicine, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands; Cabrini Medical Centre, Malvern, and Monash University, Melbourne, Victoria, Australia; Erasmus University Rotterdam, Rotterdam, the Netherlands; University of Maastricht, Maastricht, the Netherlands; and Dutch College of General Practitioners and Nivel Netherlands Institute for Health Services Research, Utrecht, the Netherlands.

Acknowledgments: The authors thank Anita Gross for critical review of the manuscript; Eva Stokx, Luite van Assen, Vera Veldman, and Ingeborg Korthals-de Bos for data collection and data entry; Frans Krapels for advice on usual care; and Brigitte Kapteijn and Raymond Swinkels for advice on physical and manual therapy. They also thank the participating physical therapists, manual therapists, general practitioners, and patients.

Grant Support: By Netherlands Organization for Scientific Research (904-66-068) and the Fund for Investigative Medicine of the Health Insurance Council (OG95-008).

Requests for Single Reprints: Jan Lucas Hoving, PhD, Department of Clinical Epidemiology, Cabrini Hospital, and Monash University Department of Epidemiology and Preventive Medicine, Cabrini Medical Centre, Suite 41, 183 Wattletree Road, Malvern, 3144 Victoria, Australia; e-mail, Jan.Hoving{at}med.monash.edu.au.

Current Author Addresses: Dr. Hoving: Department of Clinical Epidemiology, Cabrini Hospital, and Monash University Department of Epidemiology and Preventive Medicine, Cabrini Medical Centre, Suite 41, 183 Wattletree Road, Malvern, 3144 Victoria, Australia.

Dr. Koes: Department of General Practice, Faculty of Medicine, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands.

Drs. de Vet, van der Windt, and Bouter and Mr. Pool: Institute for Research in Extramural Medicine, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.

Dr. Assendelft: Dutch College of General Practitioners, Department of Guidelines and Research Policy, PO Box 3231, 3502 GE Utrecht, the Netherlands.

Dr. van Mameren: Department of Anatomy/Embryology, Faculty of Medicine, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands.

Dr. Devillé: Nivel Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.

Dr. Scholten: Dutch Cochrane Centre, Academic Medical Center, University of Amsterdam, J2-229, PO Box 22700, 1100 DE Amsterdam, the Netherlands.

Author Contributions: Conception and design: J.L. Hoving, B.W. Koes, D.A.W.M. van der Windt, W.J.J. Assendelft, H. van Mameren, J.J.M. Pool, R.J.P.M. Scholten, L.M. Bouter.

Analysis and interpretation of the data: J.L. Hoving, B.W. Koes, H.C.W. de Vet, D.A.W.M. van der Windt, W.L.J.M. Devillé, J.J.M. Pool, R.J.P.M. Scholten, L.M. Bouter.

Drafting of the article: J.L. Hoving, B.W. Koes, H.C.W. de Vet, D.A.W.M. van der Windt, W.J.J. Assendelft, H. van Mameren, R.J.P.M. Scholten, L.M. Bouter.

Critical revision of the article for important intellectual content: J.L. Hoving, B.W. Koes, H.C.W. de Vet, D.A.W.M. van der Windt, W.J.J. Assendelft, H. van Mameren, W.L.J.M. Devillé, R.J.P.M. Scholten, L.M. Bouter.

Final approval of the article: J.L. Hoving, B.W. Koes, H.C.W. de Vet, D.A.W.M. van der Windt, W.J.J. Assendelft, H. van Mameren, W.L.J.M. Devillé, J.J.M. Pool, R.J.P.M. Scholten, L.M. Bouter.

Provision of study materials or patients: J.L. Hoving, J.J.M. Pool.

Statistical expertise: J.L. Hoving, W.L.J.M. Devillé, R.J.P.M. Scholten.

Obtaining of funding: B.W. Koes, W.J.J. Assendelft, L.M. Bouter.

Administrative, technical, or logistic support: J.L. Hoving, H.C.W. de Vet, J.J.M. Pool.

Collection and assembly of data: J.L. Hoving, J.J.M. Pool.