| Background:There is a growing body of evidence regarding the effectiveness of manipulation of the cervical spine as compared to other treatment methods for neck pain. Published reviews of this body of literature have failed to achieve a clear consensus regarding the efficacy of manipulation for neck pain. Criteria for assessing studies of manipulation have been proposed but evaluation of the validity of the construct of studies on manipulation is lacking. Objective and Purpose:To evaluate the literature on manipulation for neck pain for its quality and to review the literature for insight as to any recommendations that can be made regarding the most efficacious way clinicians can approach manipulative care for neck pain. Methods:An expert group with clinical and research experience in the application of manipulation was assembled. The group first created a list of potential variables that might affect the outcome of patients who were treated with manipulation for neck pain. A tool to assess the quality of randomized controlled trials (RCTs) was chosen to evaluate the literature. The chiropractic and medical literature was searched using Pub MED, Mantis and Index to the Chiropractic Literature from 1966 to March 2005 to identify RCTs of manipulation for neck pain. Additional non-computerized searching of the literature was conducted. The papers were then randomly divided between the group to critically assess them for their quality and for insight into the differing methodological approaches within the studies. Data were compiled and separated into broad categories that related to “patient profiles,” “methods,” and “interventions” and these data were compared to the reported outcomes in those studies. The data were then evaluated to ascertain if management strategies could be recommended to improve clinical outcomes for patients with neck pain receiving manipulative care. Results:The initial search uncovered 23 papers that were divided between the reviewers. A wide range of methodological differences in the design of the studies evaluated was noted as well as significant ranges in their quality. Recommendations regarding study designs for RCTs looking at manipulation for neck pain were formulated. Clinical considerations for providers of manipulation services to patients with neck pain that may positively impact patient outcomes were also formulated. Discussion: While the literature on the subject of manipulation for neck pain continues to evolve, practitioners who are providing these services are looking for ways to improve their effectiveness. Clinical trials that compare completely different treatment approaches may be appropriate to evaluate efficacy of the treatment being tested. However, studies comparing groups of patients treated with manipulation that have well documented subtle nuances between management strategies and/or patient profiles may lend better insight into exactly when and to whom a manipulative procedure is best applied. This abstract is reproduced with the permission of the publisher. |
