Question

Complete the literature review of the topic: In adults with chronic neck pain, what is the minimum dose of manipulation necessary to produce a clinically important improvement in neck pain compared to supervised exercise? 2-4 pages long

Answer 1

About 275 patients were studied out in the outpatient settings through randomized controlled trials. The aim of the study is to evaluate the effectiveness of high dose supervised exercise with or without manipulation therapy and home exercise for chronic neck pain. The participants were randomly allocated to the below interventions

• High dose supervised exercise with manipulation therapy(ET+SMT).
• Supervised exercise alone(ET).
• Home exercises(HEA).

The primary outcome of patient's pain scale is marked at 4, 16, 26, and 52 weeks. The disability of patient, health status, medication use, and satisfaction are considered as secondary outcomes. The findings show that the supervised strengthening exercises with or without manipulation therapy have better outcomes compared to home exercises.

Another literature reported that there is a significant improvement in the chronic neck pain following chiropractic manipulation therapy. The clinical trials are done in patients with chronic neck pain for at least 8 weeks. The study report says, improvement in the pain level following spinal manipulation. The study also found the benefits of mobilization therapy in the improvement of patient's pain level.

Another systemic review of RCT study was conducted to determine the effectiveness of manual therapy in reducing the pain of mechanical neck disorders. Five clinical trials were conducted over 995 participants. The patients are more satisfied with the manual therapy, and significant improvements were found in patients combined with manual therapy and exercise. Thus the study results show that the manual therapy with exercises shows improvement in the patient with the mechanical disorder.

Another systematic review study was conducted among seniors to find the effectiveness of manipulation and supervised exercises in chronic neck pain. The Old age person 65years or above with neck pain of 12weeks or more than longer with pain rating scale of greater than 3 were included in the study. Patient outcomes related to pain was collected at 4, 12,26, and 52weeks. The secondary measures included disability, health status, patient satisfaction, and medication use. The results show that the patient with manipulation therapy along with home exercises have greater improvement than home exercises alone. Supervised exercises make additional benefits to the patient.

Physiotherapists use manipulation therapy and mobilization technique for reducing neck pain. Many systemic reviews were found that manipulation therapy is effective in patients with neck pain. But the clinical practice guideline shows that the manipulation therapy is a risk of having irreversible injury 1 in 20000 patients. The researcher concluded that the risk is minimum so the use of mobilization mostly instead of manipulation.

The Cochrane systemic review excluded that the manipulation is the high velocity and low amplitude, and the exercise is the low velocity and large amplitude and these are within the patient range of motion and control.

Reference:

1. Spinal Manipulative Therapy and Exercise for Seniors with Chronic Neck Pain - American spine society, The Spine Journal, November 2013.

2. Dr.Shad Foster -Spinal Manipulation Beneficial for Neck Pain, The foster chiropractic Blog, February 2013.

3. Holly Jonely, David A. Scalzatti, Oxford academic Physical Therapy, Volume 94, Issue 2, 1 February 2014, Pages 179–184,