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Unformatted text preview: SPINE Volume 33, Number 22, pp 2371–2378 ©2008, Lippincott Williams & Wilkins The Effectiveness of Manual Physical Therapy and Exercise for Mechanical Neck Pain A Randomized Clinical Trial Michael J. Walker, PT, DSc, OCS, CSCS, FAAOMPT,* Robert E. Boyles, PT, DSc, OCS, FAAOMPT,† Brian A. Young, PT, DSc, OCS, FAAOMPT,‡ Joseph B. Strunce, PT, DSc, OCS, FAAOMPT, § Matthew B. Garber, PT, DSc, OCS, FAAOMPT,¶ Julie M. Whitman, PT, DSc, OCS, FAAOMPT, Gail Deyle, PT, DSc, DPT, OCS, FAAOMPT,** and Robert S. Wainner, PT, PhD, OCS, ECS, FAAOMPT†† Study Design. Randomized clinical trial. Objective. To assess the effectiveness of manual phys- ical therapy and exercise (MTE) for mechanical neck pain with or without unilateral upper extremity (UE) symp- toms, as compared to a minimal intervention (MIN) ap- proach. Summary of Background Data. Mounting evidence supports the use of manual therapy and exercise for me- chanical neck pain, but no studies have directly assessed its effectiveness for UE symptoms. Methods. A total of 94 patients referred to 3 physical therapy clinics with a primary complaint of mechanical neck pain, with or without unilateral UE symptoms, were randomized to receive MTE or a MIN approach of advice, motion exercise, and subtherapeutic ultrasound. Primary outcomes were the neck disability index, cervical and UE pain visual analog scales (VAS), and patient-perceived global rating of change assessed at 3-, 6-, and 52-weeks. Secondary measures included treatment success rates and post-treatment healthcare utilization. Results. The MTE group demonstrated significantly larger reductions in short- and long-term neck disability index scores (mean 1-year difference 5.1, 95% confi- dence intervals (CI) 8.1 to 2.1; P 0.001) and short- term cervical VAS scores (mean 6-week difference 14.2, 95% CI 22.7 to 5.6; P 0.001) as compared to the MIN group. The MTE group also demonstrated significant within group reductions in short- and long-term UE VAS scores at all time periods (mean 1-year difference 16.3, 95% CI 23.1 to 9.5; P 0.000). At 1-year, patient per- ceived treatment success was reported by 62% (29 of 47) of the MTE group and 32% (15 of 47) of the MIN group ( P 0.004). Conclusion. An impairment-based MTE program re- sulted in clinically and statistically significant short- and long-term improvements in pain, disability, and patient- perceived recovery in patients with mechanical neck pain when compared to a program comprising advice, a mo- bility exercise, and subtherapeutic ultrasound. Key words: mechanical neck pain, cervical pain, radic- ular pain, radiculitis, manual therapy, manipulation, mo- bilization, exercise. Spine 2008;33:2371–2378 Neck pain is a common musculoskeletal disorder, with a reported life-time prevalence of 22% 1 to 67% 2 and a point-prevalence of 13% to 22%....
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This note was uploaded on 01/03/2012 for the course CLIN 51502 taught by Professor Long during the Fall '11 term at Palmer Chiropractic.
- Fall '11